Objectives: This systematic literature review aims to explore differences in the main periodontal parameters, periodontal probing depth (PPD), attachment gain (AG) and recession development (REC), after two different minimal invasive surgical flaps used in the periodontal regeneration with enamel matrix derivatives, the modified or simplified papilla preservation flap (MPPF vs SPPF). Methods: RCTs and case series with a minimum of 12 months observation time and at least 10 patients as intervention or observation arm, that used only enamel matrix proteins as biological/augmentation material and that had a pretreatment non-surgical phase were identified. The primary outcomes were PPD, AG, REC. Results: The electronic and manual search resulted in 888 articles out of which 38 met the inclusion criteria. The included studies were found to be equally divided between the two types of surgical flaps, MPPF and SPPF. The average values for the three categories were as follows: PPD reduction: 4,16±1,54mm and 4,07±1,19mm; AG: 3.44±1,5mm and 3.17±1,36mm; REC: 0,56±0,96mm and 0,86±0.99mm respectively. An intended comparison of five years observation time was not possible due to the limited data present in the included studies. This review confirmed through indirect data comparison a relation between the post-surgery use of antibiotics and attachment gain, both surgical intervention groups displaying higher values by approximately one millimetre. Conclusion: The study could not demonstrate the superiority of one surgical intervention (MPPF) over the other (SPPF) at 12 months’ time when the three main clinical parameters of periodontal regeneration (PPD, AG, REC) were analysed.

Zielsetzung: Verschiedene chirugische Techniken sind für die Deckung entblößter Wurzeloberflächen vorgeschlagen worden. Die vorliegende Studie sollte die Ergebnisse koronaler Verschiebelappen mit bzw. ohne Einsatz von Schmelzmatrixprotein (SMP) bei der Therapie fazialer Rezessionen vergleichen. Material und Methode: Die Studie war als intraindividueller longitudinaler Vergleich über 12 Monate in einem doppelt verblindeten plazebo-kontrollierten randomisierten Design gestaltet. 22 Patienten im Alter von 24-64 Jahren, die 2 paarige faziale Rezessionen von mindestens 3 mm aufwiesen, wurden untersucht. Beide Rezessionen wurden in derselben Sitzung nach der Technik des koronalen Verschiebelappens chirurgisch gedeckt. Eine Rezession wurde dabei zusätzlich mit einem kommerziell erhältlichen SMP (Emdogain) und die jeweils andere mit dem entsprechenden Trägergel (Vehikel: Propylen-glykol-alginat) behandelt. Die Zuweisung der Therapien erfolgte zufällig. Präoperativ sowie 1 und 3 Wochen, 3, 6 und 12 Monate postoperativ wurden durch einen verblindeten Untersucher klinische Parameter (Höhe und Breite der Rezession, Breite der keratinisierten Gingiva, Sondierungstiefe, Attachmentniveau, Knochenniveau) mittels manueller sowie elektronischer Parodontalsonde bzw. Schieblehre auf 0,5 mm genau erhoben. Ergebnisse: 12 Monate postoperativ zeigten beider Therapievarianten signifikante Rezessionsdeckungen und Attachmentgewinne. Die fazialen Rezessionen verringerten sich von 4,5 mm auf 1,5 mm in der SMP- und von 4,4 mm auf 1,5 mm in der Vehikel-Gruppe was einer Rezessionsdeckung von 71,7% bzw. 73,6% entspricht. Der Unterschied zwischen den zwei Gruppen war nicht signifikant. Alle anderen klinische Parameter zeigten keine Unterschiede zwischen den Gruppen. Schlußfolgerungen: Der Einsatz von SMP zusätzlich zum koronalen Verschiebelappen zur chirurgischen Rezessionsdeckung ergab keine wesentliche Unterschiede in den klinischen Resultaten im Vergleich zum koronalen Verschiebelappen in Kombination mit dem Trägergel. / Objectives: Various surgical techniques have been proposed for root coverage of denuded root surfaces. The aim of this study was to evaluate a comparison of coronally advanced flap procedure with or without the use of enamel matrix proteins in the treatment of recession defects. Material and methods: This study was an intra-individual longitudinal test of 12 months duration conducted as a blinded, split-mouth, placebo-controlled and randomised design. 22 patients, aged 24-64 years, with 2 paired buccal recession defects of at least 3 mm participated. Surgical recession coverage was performed as coronally advanced flap technique at both sites in the same session. One site was additionally treated with commercially available enamel matrix proteins (Emdogain) and the other site with placebo (propylene glycol alginate) in accordance with the randomisation list. A blinded examiner assessed pre- and post-surgical measurements. Clinical measurements and photographs were taken pre-surgically and after 1 week, 3 weeks, 3 months, 6 months and 12 months postoperatively. Measurements comprised height and width of the gingival recession, height of keratinized tissue, probing attachment level, probing pocket depth and alveolar bone level by periodontal probe, Florida Probe or caliper to the nearet 0.5 mm. Results: Twelve months after therapy, both treatment modalities showed significant root coverage and probing attachment gain. Gingival recession decreased from 4,5 mm to 1,5 mm for the Emdogain treated sites and from 4,4 mm to 1,5 mm for the control sites, corresponding to mean root coverages of 71,7% and 73,6%, respectively. This difference was not significant. All other clinical variables were not different in the between-group comparison. Conclusions: The use of Emdogain together with coronally advanced flap technique for recession coverage appeared to be equally effective in the overall clinical outcome, there is no clear benefit to combine Emdogain with this surgical technique.