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   Table of Contents    
Year : 2017  |  Volume : 21  |  Issue : 6  |  Page : 439-448  

Acellular dermal matrix and subepithelial connective tissue grafts for root coverage: A systematic review

Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada

Date of Submission15-Sep-2017
Date of Acceptance09-Nov-2017
Date of Web Publication16-Feb-2018

Correspondence Address:
Debora Candace Matthews
Faculty of Dentistry, Dental Clinical Sciences, Dalhousie University, 5981 University Avenue, Halifax, NS B3H 4R2
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jisp.jisp_222_17

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Background: The aim of this systematic review was to evaluate whether patients with gingival recession would benefit from an acellular dermal matrix graft (ADMG) in ways that are comparable to the gold standard of the subepithelial connective tissue graft (SCTG). Materials and Methods: A systematic review and meta-analysis comparing ADMG to SCTG for the treatment of Miller Class I and II recession defects was conducted according to PRISMA guidelines. PubMed, Excerpta Medica Database, and Cochrane Central Register of Controlled Trials databases were searched up to March 2016 for controlled trials with minimum 6 months duration. The primary outcome was root coverage; secondary outcomes included attachment level change, keratinized tissue (KT) change, and patient-based outcomes. Both authors independently assessed the quality of each included trial and extracted the relevant data. Results: From 158 potential titles, 17 controlled trials were included in the meta-analysis. There were no differences between ADMG and SCTG for mean root coverage, percent root coverage, and clinical attachment level gain. ADMG was statistically better than SCTG for gain in width of KT (−0.43 mm; 95% confidence interval: −0.72, −0.15). Only one study compared patient-based outcomes. Conclusion: This review found that an ADMG would be a suitable root coverage substitute for an SCTG when avoidance of the second surgical site is preferred.

Keywords: Acellular dermis, connective tissue, gingival recession, meta-analysis, systematic review

How to cite this article:
Gallagher SI, Matthews DC. Acellular dermal matrix and subepithelial connective tissue grafts for root coverage: A systematic review. J Indian Soc Periodontol 2017;21:439-48

How to cite this URL:
Gallagher SI, Matthews DC. Acellular dermal matrix and subepithelial connective tissue grafts for root coverage: A systematic review. J Indian Soc Periodontol [serial online] 2017 [cited 2021 Sep 23];21:439-48. Available from:

   Introduction Top

Gingival recession is the apical migration of the gingival margin, exposing the root surface. It may affect more than half of adults.[1] It is prevalent in a wide range of the population, from those with periodontal disease [1] to those with high standards of oral hygiene.[2] It is associated with increasing age.[2] Several different periodontal plastic surgery procedures were developed to obtain root coverage, with varying degrees of success; these include the free gingival graft, lateral pedicle flap, coronally positioned flap, and guided tissue regeneration.[3],[4] The primary goal of these procedures is esthetic. Secondary goals include decreasing sensitivity, restoring root caries, and facilitating oral hygiene.

In 1985, Langer and Langer introduced the subepithelial connective tissue graft (SCTG) to improve the predictability of root coverage for teeth with gingival recession. The dual blood supply from the graft and the overlying flap is crucial to this goal.[5] SCTG is the gold standard for localized recession defects due to its predictability in increasing the width of keratinized gingiva and in obtaining root coverage.[3]

However, the need for a donor site restricts the applications of SCTG. The size and number of sites that can be treated during one procedure are limited. Tissue thickness in the palate and anatomical limitations, including the size and depth of the palate, affect the amount of donor tissue that can be harvested.[6] Although Langer and Langer argue that the SCTG donor site is closed, and therefore, less uncomfortable than that of a free gingival graft,[5] the donor site still increases morbidity. There is the potential for necrosis, increased postoperative pain, and hemorrhage.[7]

The shortcomings of SCTG have driven the search for allograft alternatives. Some of the allograft substitutes utilized in mucogingival surgery have included sclera, dura mater, and freeze-dried skin grafts. However, the use of these materials did not result in tissue that is identical to that of host tissue.[8]

Life Cell, Inc. developed the first acellular dermal matrix material (ADM). ADM was first used in 1992 in the treatment of burns and subsequently in a wide variety of plastic surgeries.[9] The first reported use of ADM in gingival grafting for the purpose of root coverage was in 1994 (Silverstein et al., 1996 cited in [9]). Since then, it has been used in many types of periodontal plastic surgery, including the treatment of alveolar ridge deficiencies, guided tissue regeneration, and the alteration of gingival pigmentation.[10] There are now five main products on the market from different companies.[11] Comparisons between products have been very limited. There are no significant differences in root coverage or other clinical parameters between the most commonly used products, AlloDerm ® (BioHorizons, Birmingham, AL) and Puros ® Dermis (Zimmer Dental, Carlsbad, CA).[12.13]

In the formation of ADM, a proprietary process strips the epidermis and cells from donated human skin and freeze-dries the remaining basement membrane and extracellular matrix. With the elimination of the cells, any potential source of infection or immunological reaction has also been eliminated, rendering ADM biocompatible.[14] ADM serves as an architectural scaffold to facilitate the migration of and repopulation by the host's fibroblasts, blood vessels, and epithelial cells.[15] It is subsequently replaced by and fully integrated into the host tissues.[16]

ADM has two different sides. The basal lamina side is compatible with repopulation by epithelial cells. The connective tissue side allows for the migration of fibroblasts and blood vessels.[17] Some authors argue that the orientation of the ADM affects the outcome of periodontal plastic procedures.[7] However, in a randomized controlled trial (RCT) of a root coverage procedure, there were no differences in clinical outcomes when comparing the basal lamina side against the tooth and the connective tissue side against the tooth.[18]

SCTG and ADM graft (ADMG) differ in their healing processes. As SCTG is an autograft, it survives through anastomoses between the graft's vessels and those of the recipient site.[19] Hence, the flap does not need to completely cover the connective tissue graft. In contrast, the nonvital ADMG relies entirely on the migration of host cells and vessels for nutrition and repair. It depends on direct contact between the graft and the flap, and thus, it requires complete coverage with a tensionless flap. Exposure of ADMG may result in partial failure of the graft.[20] Due to these differences, some authors recommend different surgical techniques for ADMG than those Langer and Langer had proposed for SCTG, including broader flaps, with or without vertical releasing incisions, to allow for a greater blood supply, and thus, greater access to nutrition and cells.[19],[21],[22]

The resulting mucosa is histologically similar in SCTG and ADMG.[7],[16] There is complete incorporation of the graft without any gross inflammatory reaction. Hence, the ADMG does not initiate a foreign body reaction.[15],[16] Root resorption and ankylosis do not occur.[15] In both SCTG and ADMG, the interface consists of a long junctional epithelium coronally and connective tissue attachment apically. Núñez et al. found regeneration with newly formed cementum and alveolar bone in both graft types in an experiment on mini-pigs.[15] The abundance of elastin in ADM, which is retained after incorporation of the graft, allows for its histological differentiation from the surrounding tissues because elastin is not a primary component of human gingiva.[7],[16]

Although systematic reviews that evaluate the use of ADMG exist, they are wide in scope and include all major root coverage procedures together. The most recent review included literature up to 2013 and included systematic reviews, randomized clinical trials, controlled clinical trials, case series, and case reports.[23] The only meta-analysis that limited itself to ADMG in mucogingival surgery is from 2005.[24] A focused comparison of ADMG to SCTG has not been done to date.

The purpose of this systemic review is to evaluate whether patients with gingival recession will benefit from an ADMG in ways that are comparable to the gold standard of the SCTG.

   Materials and Methods Top


The following is the systematic review's focused question in a PICOs format:[25] Population (P): Adults with gingival recession on natural dentition; intervention (I): ADMG; comparison (C): SCTG; outcome (O): Primary-root coverage; secondary-attachment level change, keratinized tissue (KT) change, change in esthetics, patient preference for type of procedure, and adverse effects; study type (S): Controlled clinical trials with follow-ups of 6 months or longer. For the primary outcome, root coverage, recession reduction, and change in the recession were considered synonyms.

Search strategy

The review was conducted according to PRISMA guidelines.[26] Comprehensive search strategies were developed for PubMed, Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL). The searches were performed for articles published up to and including March 31, 2016, without language restrictions [Table 1]. For PubMed, combinations of Medical Subject Headings (MeSH) terms, key words, and free terms were utilized. The search strategies were as follows:
Table 1: Search strategy for the Cochrane Central Register of Controlled Trials

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(((((((((acellular allograft*[tw]) OR acellular dermal matrix[tw]) OR alloderm[tw]) OR puros dermis[tw]) OR perioderm*[tw]) OR oracell[tw]) OR surederm[tw]) OR acellular dermis[tw])) AND ((((“gingival recession”[MeSH Terms] OR “gingival recession”[All Fields])) OR gingiva atroph*[tiab]) OR gingival atroph*[tiab]).


'gingival recession'/exp OR 'gingiva recession':ab, ti OR 'gingival recession':ab, ti AND ('acellular dermal matrix'/exp OR 'allopatch' OR 'enduragen' OR 'primatrix' OR 'surederm' OR 'surgimend' OR 'acellular dermal matrix' OR 'acellular dermis' OR 'acellular human dermis' OR 'alloderm'/exp OR alloderm: ab, ti OR perioderm: ab, ti OR 'puros dermis':ab, ti OR oracell: ab, ti OR surederm: ab, ti).

In addition, the references of any potential clinical trials and prior systematic reviews were examined to identify any relevant studies not found through the database search. The grey literature search was conducted through,, and

Screening process

Two reviewers independently screened and selected the included studies. The initial screening involved the analysis of titles and abstracts. The authors then read the full text of all articles that appeared to fit the inclusion criteria or were unclear. Any disagreements were settled through discussion. In the case where the same data were reported in two articles, the study with the longer follow-up was used.

Quality assessment

Both authors independently evaluated the methodological quality of the included studies, following the Cochrane Collaboration's criteria for assessing the risk of bias.[27] The authors classified each of the studies as low risk of bias, high risk of bias, or unclear in the categories of sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessors, incomplete outcome data, selective outcome reporting, and other sources of bias. In terms of blinding of participants or personnel, the authors followed the Cochrane Collaboration's guidelines that a study is at low risk of bias when a lack of blinding was unlikely to affect its findings.

Data extraction

For each of the included studies, both authors independently extracted and recorded the data regarding the setting, population, intervention, comparison, outcomes, and study design. In one case of missing data, the author of the included study was contacted through e-mail for clarification.

Statistical analysis

Continuous and dichotomous variables that were reported in more than one study were analyzed using Review Manager (RevMan) software (RevMan [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). The mean differences with 95% confidence intervals were calculated for continuous variables. The level of statistical significance was set at P < 0.05. The random-effects model for heterogeneity was used. Heterogeneity was evaluated using the I2 statistical tests. Publication bias was assessed through graphical analysis of the symmetry of a funnel plot.

   Results Top

Literature search

The search of PubMed, EMBASE, and the CENTRAL generated 158 titles after the elimination of duplicates. Duplicates were eliminated automatically using Covidence software (Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia. Available at The search of the grey literature and reading of references did not yield any additional articles. After the initial screening of titles and abstracts, both authors read the full texts of 31 articles. At that point, 14 records were excluded for not meeting the inclusion criteria [Supplementary Table 1]. The remaining 17 studies were included in the meta-analysis [Figure 1].
Figure 1: Flow diagram of the screening and selection process. n – number of papers

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Study characteristics

The characteristics of the included studies are presented in [Table 2]. They were all university-based, randomized controlled trials with sample sizes of 5 to 30. The duration ranged from 6 months to 5 years. Ten studies employed split-mouth designs and six used parallel designs. One used a combination of split-mouth and parallel design.[47] All but one study [49] excluded smokers.
Table 2: Characteristics of included studies

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Inclusion criteria for 16 studies were limited to patients with Miller Class I or II gingival recession defects. An additional study was restricted to Miller Class II defects.[42] The ADM product used was AlloDerm ®, except in one study where the product was not specified.[50] Of the studies that provided the ADM orientation, the number of studies (eight) where the connective tissue side was placed toward the tooth treated was nearly equal to the number (seven) that placed the basement membrane side toward the tooth. In ten studies, amoxicillin was prescribed,[6],[10],[20],[39],[40],[41],[44],[48],[49],[52] and in one, doxycycline hyclate was prescribed postoperatively.[42] All but one [6] prescribed chlorhexidine rinses post-operatively for varying lengths or time. Six studies [10],[20],[40],[41],[42],[50] used root conditioning with tetracycline as part of the surgical protocol; one [39] used ethylenediaminetetraacetic acid.

Quality assessment

There were methodological flaws in the majority of the included trials; only one study [39] was judged to be at low risk of bias in all seven categories [Table 3]. Many of the RCTs did not adequately blind the outcome assessors. Some trials did not provide the method of randomization. In Paolantonio et al.'s 2002 trial, the recession on the same side as the subject's dominant hand was chosen as the experimental site. If there was more than one recession, the worst site was chosen.[46] This presents selection bias, preventing the study from being truly randomized.
Table 3: Risk of bias of included studies

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Mean root coverage

Eleven studies reported the mean root coverage in mm. The mean difference was -0.03 mm (95% confidence interval [CI]: -0.26, 0.21; P = 0.83) In Taiyeb's study, with a 3-month follow-up,[50] the mean difference was 1 mm (95% CI: 0.20, 1.80; P = 0.01). De Souza's study reported a 12-month follow-up [40] with a mean difference of -0.15 mm (95% CI: -0.81, 0.5; P = 0.66). For the studies with the 6-month follow-up,[6],[10],[40],[42],[44],[46],[47],[48],[49],[50],[52] the mean difference was -0.11 mm (95% CI: -0.33, 0.11; P = 0.31). The data overall exhibited moderate heterogeneity [53] with an I2 value of 40% [Supplementary Figure 1].

Percent root coverage

Eight studies reported the root coverage in terms of percentage. The mean difference was -0.80% (95% CI: -5.98, 4.37; P = 0.76). The data exhibited low heterogeneity [53] with an I2 of 30% [Figure 2].
Figure 2: Forest plot for percent root coverage

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Gain in clinical attachment

Twelve studies reported the gain in clinical attachment in mm. The mean difference was -0.13 mm (95% CI: -0.40, 0.14; P = 0.35). The data exhibited low to moderate heterogeneity [53] with an I2 of 34% [Figure 3].
Figure 3: Forest plot for gain in clinical attachment

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Gain in width of keratinized tissue

Thirteen studies reported the gain in width of KT in mm. The mean difference was -0.43 mm (95% CI: -0.72, -0.15; P = 0.003), in favor of ADMG. However, there was substantial heterogeneity [53] with an I2 of 57% [Figure 4].
Figure 4: Forest plot for gain in keratinized tissue

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Other data

Patient-related outcomes, postoperative complications, and adverse events could not be included in the meta-analysis as only one study [6] reported on patient-related outcomes.

Publication bias

The funnel plot [54] for the outcome of root coverage was relatively symmetrical, indicating that there was no evidence of publication bias [Supplementary Figure 2].

   Discussion Top

The results of this systematic review and meta-analysis found that ADMG had a small but statistically significant advantage in terms of KT. At <1 mm, this difference is not clinically significant.[55] There was no statistically significant difference between the treatment modalities in terms of mean root coverage, percent root coverage, and mean gain in clinical attachment. Hence, patients with gingival recession will benefit from an ADMG in ways that are comparable to the gold standard of SCTG.

In contrast to this review's findings, Chambrone et al.'s 2008 systematic review found SCTG to be superior in reducing gingival recession. Although their later 2010 systematic review did not find a statistically significant difference between SCTG and ADMG, they emphasized that this finding was based on a small number of RCTs.[28] Neither review found statistically significant differences in gain in clinical attachment between the treatment modalities.[3],[28] They did not discuss how the two treatment modalities related in terms of KT gains, except to say that they both significantly increased KT.[3],[28] Chambrone et al.'s 2015 systematic review also found similar gains overall for ADMG and SCTG; however that review continued to argue for the superiority of SCTG.[23] Gapski et al.'s 2005 meta-analysis did not find differences between the treatment modalities in terms of gingival recession coverage and KT gains; they could not analyze clinical attachment gain. No previous systematic review could make strong comparisons between the SCTG and the ADMG.

Interestingly, our meta-analysis found in favor of ADMG in terms of KT gains. This goes against the findings of five included studies, which found that SCTG had an advantage with this parameter.[20],[41],[46],[49],[51] The remainder of the studies did not find statistically significant differences between the treatment modalities.[6],[10],[39],[40],[42],[43],[44],[45],[47],[48],[50],[52] The finding of this meta-analysis should be tempered by the substantial heterogeneity of the studies. The mechanism by which ADMG could increase KT has not been identified.[7] The keratinizing influence could be primarily from the dermal source of the graft or, more likely, from the migration by host cells with the potential to induce keratinization of the overlying epithelium.[6],[20],[42],[46],[49] Some authors report the keratinization of ADMG takes longer than SCTG.[10],[40],[52] However, this could not be evaluated in this meta-analysis.

There are distinct limitations to the evidence. Each included study was university-based and thus, was conducted under ideal conditions. Only one study [45] had a long-term follow-up. Hence, the applicability to clinical situations is limited. Many of the studies had significant sources of bias; for example, the description of the method of randomization was inadequate in some cases.

Further research of better methodological quality and larger sample sizes would provide better confidence in the results of this review. As there is only one RCT [45] that evaluated relapse of root coverage (and found it to be significant for both treatment modalities), the stability of ADMG needs to be measured with longer-term follow-ups. Additional research particularly into patient-based outcomes, including post-operative discomfort, would also be beneficial as this information should be a major consideration, after efficacy, in the decision-making process. Future studies should more fully report complications, such as ADMG exposure. An area of clinical interest that has not been evaluated is whether ADMG should be avoided with thin gingival tissues to prevent dehiscence.

Based on weak-to-moderate evidence from a systematic review conducted according to PRISMA [26] principles, there appears to be no clinical difference between the two treatment modalities. In conclusion, for patients with gingival recession, for whom the additional cost is not a barrier and who would prefer not to have a second surgical site, an ADMG appears to be comparable to the gold standard of the SCTG.


The authors would like to thank Dr. Martha Brillant and Dr. Sayed Mirbod for their assistance with this review.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Susin C, Haas AN, Oppermann RV, Haugejorden O, Albandar JM. Gingival recession: Epidemiology and risk indicators in a representative urban Brazilian population. J Periodontol 2004;75:1377-86.  Back to cited text no. 1
Serino G, Wennström JL, Lindhe J, Eneroth L. The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene. J Clin Periodontol 1994;21:57-63.  Back to cited text no. 2
Chambrone L, Chambrone D, Pustiglioni FE, Chambrone LA, Lima LA. Can subepithelial connective tissue grafts be considered the gold standard procedure in the treatment of Miller Class I and II recession-type defects? J Dent 2008;36:659-71.  Back to cited text no. 3
Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA, et al. Root coverage procedures for the treatment of localised recession-type defects. Cochrane Database Syst Rev 2009;2:CD007161.  Back to cited text no. 4
Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol 1985;56:715-20.  Back to cited text no. 5
Aichelmann-Reidy ME, Yukna RA, Evans GH, Nasr HF, Mayer ET. Clinical evaluation of acellular allograft dermis for the treatment of human gingival recession. J Periodontol 2001;72:998-1005.  Back to cited text no. 6
Harris RJ. Root coverage with a connective tissue with partial thickness double pedicle graft and an acellular dermal matrix graft: A clinical and histological evaluation of a case report. J Periodontol 1998;69:1305-11.  Back to cited text no. 7
Wei PC, Laurell L, Lingen MW, Geivelis M. Acellular dermal matrix allografts to achieve increased attached gingiva. Part 2. A histological comparative study. J Periodontol 2002;73:257-65.  Back to cited text no. 8
Buinewicz B, Rosen B. Acellular cadaveric dermis (AlloDerm): A new alternative for abdominal hernia repair. Ann Plast Surg 2004;52:188-94.  Back to cited text no. 9
Novaes AB Jr., Grisi DC, Molina GO, Souza SL, Taba M Jr., Grisi MF, et al. Comparative 6-month clinical study of a subepithelial connective tissue graft and acellular dermal matrix graft for the treatment of gingival recession. J Periodontol 2001;72:1477-84.  Back to cited text no. 10
Silc JT, Petrungaro PS. Acellular dermal matrix grafts for root coverage procedures: Review of products and introduction of a new technique. Compend Contin Educ Dent 2013;34:408-14.  Back to cited text no. 11
Barker TS, Cueva MA, Rivera-Hidalgo F, Beach MM, Rossmann JA, Kerns DG, et al. A comparative study of root coverage using two different acellular dermal matrix products. J Periodontol 2010;81:1596-603.  Back to cited text no. 12
Wang HL, Romanos GE, Geurs NC, Sullivan A, Suárez-López Del Amo F, Eber RM, et al. Comparison of two differently processed acellular dermal matrix products for root coverage procedures: A prospective, randomized multicenter study. J Periodontol 2014;85:1693-701.  Back to cited text no. 13
Mahajan A, Dixit J, Verma UP. A patient-centered clinical evaluation of acellular dermal matrix graft in the treatment of gingival recession defects. J Periodontol 2007;78:2348-55.  Back to cited text no. 14
Núñez J, Caffesse R, Vignoletti F, Guerra F, San Roman F, Sanz M, et al. Clinical and histological evaluation of an acellular dermal matrix allograft in combination with the coronally advanced flap in the treatment of Miller Class I recession defects: An experimental study in the mini-pig. J Clin Periodontol 2009;36:523-31.  Back to cited text no. 15
Cummings LC, Kaldahl WB, Allen EP. Histologic evaluation of autogenous connective tissue and acellular dermal matrix grafts in humans. J Periodontol 2005;76:178-86.  Back to cited text no. 16
Livesey SA, Herndon DN, Hollyoak MA, Atkinson YH, Nag A. Transplanted acellular allograft dermal matrix. Potential as a template for the reconstruction of viable dermis. Transplantation 1995;60:1-9.  Back to cited text no. 17
Henderson RD, Greenwell H, Drisko C, Regennitter FJ, Lamb JW, Mehlbauer MJ, et al. Predictable multiple site root coverage using an acellular dermal matrix allograft. J Periodontol 2001;72:571-82.  Back to cited text no. 18
Barros RR, Novaes AB, Grisi MF, Souza SL, Taba MJ, Palioto DB, et al. A 6-month comparative clinical study of a conventional and a new surgical approach for root coverage with acellular dermal matrix. J Periodontol 2004;75:1350-6.  Back to cited text no. 19
Tal H, Moses O, Zohar R, Meir H, Nemcovsky C. Root coverage of advanced gingival recession: A comparative study between acellular dermal matrix allograft and subepithelial connective tissue grafts. J Periodontol 2002;73:1405-11.  Back to cited text no. 20
Felipe ME, Andrade PF, Grisi MF, Souza SL, Taba M, Palioto DB, et al. Comparison of two surgical procedures for use of the acellular dermal matrix graft in the treatment of gingival recessions: A randomized controlled clinical study. J Periodontol 2007;78:1209-17.  Back to cited text no. 21
Andrade PF, Felipe ME, Novaes AB Jr., Souza SL, Taba M Jr., Palioto DB, et al. Comparison between two surgical techniques for root coverage with an acellular dermal matrix graft. J Clin Periodontol 2008;35:263-9.  Back to cited text no. 22
Chambrone L, Tatakis DN. Periodontal soft tissue root coverage procedures: A systematic review from the AAP Regeneration Workshop. J Periodontol 2015;86:S8-51.  Back to cited text no. 23
Gapski R, Parks CA, Wang HL. Acellular dermal matrix for mucogingival surgery: A meta-analysis. J Periodontol 2005;76:1814-22.  Back to cited text no. 24
Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak 2007;7:16.  Back to cited text no. 25
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009;6:e1000097.  Back to cited text no. 26
Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. The Cochrane Collaboration; 2011. Available from [Last updated on 2011 Mar].  Back to cited text no. 27
Chambrone L, Sukekava F, Araújo MG, Pustiglioni FE, Chambrone LA, Lima LA, et al. Root-coverage procedures for the treatment of localized recession-type defects: A Cochrane systematic review. J Periodontol 2010;81:452-78.  Back to cited text no. 28
Griffin TJ, Cheung WS, Zavras AI, Damoulis PD. Postoperative complications following gingival augmentation procedures. J Periodontol 2006;77:2070-9.  Back to cited text no. 29
Haghighati F, Mousavi M, Moslemi N, Kebria MM, Golestan B. A comparative study of two root-coverage techniques with regard to interdental papilla dimension as a prognostic factor. Int J Periodontics Restorative Dent 2009;29:179-89.  Back to cited text no. 30
Harris RJ. A comparative study of root coverage obtained with an acellular dermal matrix versus a connective tissue graft: Results of 107 recession defects in 50 consecutively treated patients. Int J Periodontics Restorative Dent 2000;20:51-9.  Back to cited text no. 31
Harris RJ. Clinical evaluation of 3 techniques to augment keratinized tissue without root coverage. J Periodontol 2001;72:932-8.  Back to cited text no. 32
Harris RJ. A short-term and long-term comparison of root coverage with an acellular dermal matrix and a subepithelial graft. J Periodontol 2004;75:734-43.  Back to cited text no. 33
Hirsch A, Goldstein M, Goultschin J, Boyan BD, Schwartz Z. A 2-year follow-up of root coverage using sub-pedicle acellular dermal matrix allografts and subepithelial connective tissue autografts. J Periodontol 2005;76:1323-8.  Back to cited text no. 34
Hofmänner P, Alessandri R, Laugisch O, Aroca S, Salvi GE, Stavropoulos A, et al. Predictability of surgical techniques used for coverage of multiple adjacent gingival recessions – A systematic review. Quintessence Int 2012;43:545-54.  Back to cited text no. 35
Novaes AB Jr., de Barros RR. Acellular dermal matrix allograft. The results of controlled randomized clinical studies. J Int Acad Periodontol 2008;10:123-9.  Back to cited text no. 36
Pini-Prato G, Nieri M, Pagliaro U, Giorgi TS, La Marca M, Franceschi D, et al. Surgical treatment of single gingival recessions: Clinical guidelines. Eur J Oral Implantol 2014;7:9-43.  Back to cited text no. 37
Tatakis DN, Chambrone L, Allen EP, Langer B, McGuire MK, Richardson CR, et al. Periodontal soft tissue root coverage procedures: A consensus report from the AAP regeneration workshop. J Periodontol 2015;86:S52-5.  Back to cited text no. 38
Barros RR, Macedo GO, de Queiroz AC, Novaes AB Jr. A modified surgical flap for root coverage in association with grafting materials. J Esthet Restor Dent 2015;27:84-91.  Back to cited text no. 39
Gholami GA, Saberi A, Kadkhodazadeh M, Amid R, Karami D. Comparison of the clinical outcomes of connective tissue and acellular dermal matrix in combination with double papillary flap for root coverage: A 6-month trial. Dent Res J (Isfahan) 2013;10:506-13.  Back to cited text no. 40
Joly JC, Carvalho AM, da Silva RC, Ciotti DL, Cury PR. Root coverage in isolated gingival recessions using autograft versus allograft: A pilot study. J Periodontol 2007;78:1017-22.  Back to cited text no. 41
Goyal N, Gupta R, Pandit N, Dahiya P. Analysis of patient acceptance following treatment of Miller's Class II gingival recession with acellular dermal matrix and connective tissue graft. J Indian Soc Periodontol 2013;18:352-6.  Back to cited text no. 42
Joly JC, Carvalho AM, da Silva RC, Ciotti DL, Cury PR. Root coverage in isolated gingival recessions using autograft versus allograft: A pilot study. J Periodontol 2007;78:1017-22.  Back to cited text no. 43
Koudale SB, Charde PA, Bhongade ML. A comparative clinical evaluation of acellular dermal matrix allograft and sub-epithelial connective tissue graft for the treatment of multiple gingival recessions. J Indian Soc Periodontol 2012;16:411-6.  Back to cited text no. 44
[PUBMED]  [Full text]  
Moslemi N, Mousavi Jazi M, Haghighati F, Morovati SP, Jamali R. Acellular dermal matrix allograft versus subepithelial connective tissue graft in treatment of gingival recessions: A 5-year randomized clinical study. J Clin Periodontol 2011;38:1122-9.  Back to cited text no. 45
Paolantonio M, Dolci M, Esposito P, D'Archivio D, Lisanti L, Di Luccio A, et al. Subpedicle acellular dermal matrix graft and autogenous connective tissue graft in the treatment of gingival recessions: A comparative 1-year clinical study. J Periodontol 2002;73:1299-307.  Back to cited text no. 46
Rahmani ME, Lades MA. Comparative clinical evaluation of acellular dermal matrix allograft and connective tissue graft for the treatment of gingival recession. J Contemp Dent Pract 2006;7:63-70.  Back to cited text no. 47
Sadat Mansouri S, Ayoubian N, Eslami Manouchehri M. A comparative 6-month clinical study of acellular dermal matrix allograft and subepithelial connective tissue graft for root coverage. J Dent (Tehran) 2010;7:156-64.  Back to cited text no. 48
Shori T, Kolte A, Kher V, Dharamthok S, Shrirao T. A comparative evaluation of the effectiveness of subpedicle acellular dermal matrix allograft with subepithelial connective tissue graft in the treatment of isolated marginal tissue recession: A clinical study. J Indian Soc Periodontol 2013;17:78-81.  Back to cited text no. 49
[PUBMED]  [Full text]  
Taiyeb Ali TB, Shapeen IM, Ahmed HB, Javed F. Efficacy of acellular dermal matrix and autogenous connective tissue grafts in the treatment of gingival recession defects among asians. J Investig Clin Dent 2015;6:125-32.  Back to cited text no. 50
Thakare P, Baliga V, Bhongade ML. Comparative evaluation of the effectiveness of acellular dermal matrix allograft and subepithelial connective tissue to coronally advanced flap alone in the treatment of multiple gingival recessions: A clinical study. J Indian Soc Periodontol 2015;19:537-44.  Back to cited text no. 51
[PUBMED]  [Full text]  
Thomas LJ, Emmadi P, Thyagarajan R, Namasivayam A. A comparative clinical study of the efficacy of subepithelial connective tissue graft and acellular dermal matrix graft in root coverage: 6-month follow-up observation. J Indian Soc Periodontol 2013;17:478-83.  Back to cited text no. 52
[PUBMED]  [Full text]  
Crombie IK, Davies HT. What is Meta-Analysis. What is. Newmarket UK: Hayward Medical Communciations; 2009. p. 1-8.  Back to cited text no. 53
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-34.  Back to cited text no. 54
Hujoel PP, Armitage GC, García RI. A perspective on clinical significance. J Periodontol 2000;71:1515-8.  Back to cited text no. 55


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1], [Table 2], [Table 3]


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