4.3.23 Rafael_Perio surgery 3: Allografts, Cells, GTR, Biologics

Question 1

Approximately how much root coverage can be expected from GTR?

Answer 1

75% (GTR average root coverage)

Dr Wang says: CTG coverage is usually “much better”. (Zucchelli ‘98, Trombelli in ‘98)

Many historical membranes used ePTFE (GoreTex - has significant porosity, was able to stretch and was easy to stabilize) - this is no longer used. Today, dPTFE (dense PTFE) is used, it does not stretch, and requires fixation. Movement causes more granulation tissue and makes it easy to expose

Question 2

When to use Mucograft vs. Fibrogide?

Answer 2

The outcome of root coverage vs. soft tissue thickness are different depending on material or techniques. coverage depends on 1) GT and 2) adjacent bone (or tissue) levels

CAF: If there is thickness, then you can get root coverage. And if it is RT1 (or Miller I or II), then just a CAF can be used successfully, without any materials.

Mucograft:
* 1st generation: 75% coverage in short term, 65% in long term
* 2nd generation: Company is trying to improve it
Fibrogide:
*

Sanz: Examined coverage in implants - but that is a different concept because peri-implant tissue is essentially scar tissue
Urban: Need a strip graft as a source of cells to gain KTW.

Jon Chao (?) - pinhole technique, can add any materials and still have a great result. PRF, collagen, collatape, etc (depending on company sponsorship)

Question 3

What tissue thickness is required for non-CTG grafts?

Answer 3

> 1.1 mm (per Dr. Wang)
Anything less than that, should instead use a CTG (if possible)

Question 4

How well does ADM + CAF perform, compared to CTG + CAF?

Answer 4

Harris ‘00
NSSD in mean root coverage and KG increase.
CTG = 96.2% (2mm KG increase)
ADM = 95.8% (1.2mm KG
increase)

Woodyard ‘04 - ADM does not increase the KT.
Mean root coverage:
* ADM = 96%
* CAF alone = 67%
Complete root coverage:
* ADM = 91.6%
* CAF alone = 33.3%

Question 5

What is the minimal % root coverage of CTG + CAF? (from a research standard perspective)

Answer 5

75- 80% (per Dr. Wang)

Question 6

What is passive vs. active tissue engineering?

Answer 6

Passive: Alloderm, matrix (only a scaffold)
Active: Contains cells

Question 7

By how much does adding EMD to CAF improve root coverage? How about adding EMD + CAF + CTG?

Answer 7

McGuire & Nunn ‘03
Split-mouth RCT
1y FU
CAF + CTG
CAF + EMD
Mean root coverage:
CAF + CTG = 93.8%
CAF + EMD = 95.1%
= Similar outcomes in results.

Rasperini ‘11
Multicenter RCT
CAF + CTG + EMD
CAF + CTG
Mean root coverage:
CAF + CTG + EMD = 90%
CAF + CTG = 80%
Complete root coverage:
CAF + CTG + EMD = 62%
CAF + CTG = 47%

Question 8

How much root coverage is expected with CAF only? What about CAF + biologics?

Answer 8

CAF only: 65-70% (per Dr. Wang)
CAF + biologics: Increases coverage by about 15% (~80-90%)

McGuire ‘09
Split-mouth RCT – 6 months
Recessions ≥ 3mm
CAF + rhPDGF-BB + beta-TCP
CAF + CTG
Mean root coverage:
CAF + rhPDGF-BB + beta-TCP = 89%
CAF + CTG = 98%
Complete root coverage:
CAF + rhPDGF-BB + beta-TCP = 70%
CAF + CTG = 90%

Question 9

Why add PDGF to a Bio-Oss block?

Answer 9

Simion
You need to add biologics to the Bio-Oss block in order for it to work. Without, it will “fail miserably” (says Dr. Wang)

Question 10

Do PRF membranes improve root coverage?

Answer 10

Moraschini ‘16
PRF membranes had No improvements in root coverage, KT width, or CAL.

Question 11

When does Dr. Wang use PRF?

Answer 11

When using Alloderm.

Dr. Wang suggests: Use biologics when using allografts (Alloderm, collagen matrices, scaffolds)