Subepithelial Connective Tissue Graft With or Without Enamel Matrix Derivative for the Treatment of Miller Class I and II Gingival Recessions: A Controlled Randomized Clinical Trial

J Periodontal Res. 2013 Oct;48(5):563-72. doi: 10.1111/jre.12039. Epub 2013 Jan 14.


Background: The aim of this study was to evaluate whether the combination of enamel matrix derivative (EMD) with subepithelial connective tissue graft (SCTG) plus coronally advanced flap (CAF) would improve the treatment outcomes of Miller class I and II gingival recessions when compared with the same technique (SCTG plus CAF) alone.

Methods: The study was designed as a randomized, parallel, controlled, double-blinded clinical trial. Forty-two patients were randomly assigned in the test group (SCTG plus EMD) and in the control group (SCTG). Patients had at least one gingival recession ≥ 2 mm. The clinical parameters were evaluated at baseline and at 14 d, 1, 3, 6 and 12 mo follow-up time points.

Results: Forty-two patients, 21 in the test group (SCTG plus EMD) and 21 in the control group (SCTG), aged 21-48 years (mean age 31 ± 8.56) were initially included in the study. Both treatments, STCG plus EMD and SCTG, resulted in a significant final mean root coverage (2.91 ± 0.95mm and 2.91 ± 1.29 mm, respectively) (p < 0.001) and in a high mean percentage of root coverage (82.25 ± 22.20% and 89.75 ± 17.33%, respectively) (p < 0.001), 1 year after surgery. The differences in mean root coverage recorded for the two techniques after 1 year, were not statistically significant (p = 0.19). Complete root coverage was achieved in 56.5% of patients treated with SCTG plus EMD and in 70.6% of patients treated with SCTG (p = 0.275), 1 year after treatment.

Conclusions: The present study failed to demonstrate any additional clinical benefits when EMD was added to SCTG plus CAF.

Keywords: connective tissue; periodontal surgery; regeneration.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Connective Tissue / transplantation
  • Dental Enamel Proteins / therapeutic use*
  • Double-Blind Method
  • Esthetics, Dental
  • Follow-Up Studies
  • Gingiva / pathology
  • Gingiva / transplantation*
  • Gingival Recession / classification
  • Gingival Recession / surgery*
  • Humans
  • Keratins
  • Middle Aged
  • Periodontal Pocket / pathology
  • Periodontal Pocket / surgery
  • Photography, Dental / methods
  • Root Planing / methods
  • Surgical Flaps / surgery
  • Tooth Root / pathology
  • Tooth Root / surgery
  • Treatment Outcome
  • Young Adult


  • Dental Enamel Proteins
  • enamel matrix proteins
  • Keratins