Clinical and imunological impact of enamel matriz derivative in root covering surgeries

The aim of the present study was to evaluate the clinical and immunological impact of the enamel-derived matrix (EMD) on periodontal healing, after root-covering surgeries. Sixteen patients, mean age 47.7 years (SD = 7.0), underwent root-graft surgery with graft of subepithelial connective tissue associated or not with enamel-derived matrix. The study followed the split-mouth model and randomized to the sides test and control. The following clinical parameters were analyzed on the day of surgery and 6 months after the surgical procedure: height of the recession (AR), width of keratinized tissue (LFG), width of the recession (LR), probing depth (PS), clinical attachment level (NIC) and gingival thickness (EG). In addition to the clinical analysis, the following inflammatory markers were evaluated: IL-1β, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL IL-13, IL-15, IL-17, EOTAXIN, FGF, GCSF, GMCSF, IFN-γ, IP-10, MCP-1, MIP-1α, PDGF-bb, MIP-1β, RANTES, TNF-α and VEGF in the gingival crevicular fluid at baseline and at 7 and 14 postoperative days. Postoperative pain analysis and aesthetic analysis were performed. The results showed that the side treated with EMD resulted in a significantly higher percentage of root coverage (p = 0.03) when compared to the control side. Seventy-five percent of the sites had complete root coverage on the test side and 43.8% on the control side in 6 months. The EMD did not bring significant results to increase gingival thickness and gain of width keratinized tissue. Immunological analyzes showed an increase in VEGF (p = 0.03) and PDGF (p = 0.03) at 14 days postoperatively with EMD and high expression of inflammatory mediators such as IL-1β (p = 0.04) (P = 0.05), MIP-1α (p = 0.05), TNF-α (p = 0.02, p = 0.02) 02, p = 0.05) with 7 postoperative days, in both groups, test and control, respectively. There was no difference between the groups in the evaluation of postoperative pain and a significant difference between the evaluation of the final aesthetic of the patient and the one performed by a calibrated and experienced professional was demonstrated. Thus, we concluded that EMD appears to have a clinical and immunological impact in root coverage surgeries, with significantly greater percentage of root coverage and complete root coverage, as well as a significantly higher increase in the release of VEGF and PDGF-bb with 14 days of postoperative, suggesting to be an important element for a better wound healing.