{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:51:40Z","timestamp":1789685500583,"version":"4.0.1"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,10,13]],"date-time":"2019-10-13T00:00:00Z","timestamp":1570924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Periodontology"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>This study compared clinical and patient\u2010centered outcomes of subepithelial connective tissue graft (CTG) with and without enamel matrix derivative (EMD) in the treatment of multiple Class III\u2010IV Miller periodontal recession (REC) defects on mandibular anterior teeth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This randomized clinical study evaluated 41 patients at 3 years follow\u2010up. One hundred and fifty\u2010six teeth were divided into two groups: test (CTG\u2010EMD, 79 teeth) and control (CTG only, 77 teeth). Clinical REC, keratinized tissue (KT) width, percentage of root coverage, patient\u2010centered outcomes were compared between the two groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At 36 months follow\u2010up, patient level analysis showed that REC in the test group reduced significantly (5.71 \u00b1 0.58\u00a0mm to 1.57 \u00b1 0.85\u00a0mm) compared with the control group (5.94 \u00b1 0.46\u00a0mm to 2.51 \u00b1 0.62\u00a0mm) (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), while KT width increased in the test group (1.51 \u00b1 0.26\u00a0mm to 4.18 \u00b1 0.34\u00a0mm) and was significantly greater than the control group (1.65 \u00b1 0.21\u00a0mm to 2.90 \u00b1 0.20\u00a0mm) (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). At 36 months, tooth level analysis (Class III and Class IV groups) found less residual REC and increased KT in the test group compared with the control group (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01). Significantly less pain was reported at 2, 7, and 14 days follow\u2010up post\u2010surgery in the test group (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The addition of EMD to CTG results in improved root coverage outcomes and higher amounts of KT width 36 months after treatment of Class III\u2010IV REC on mandibular anterior teeth. The adjunctive use of EMD also resulted in significantly reduced pain 14 days post\u2010surgery.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jper.19-0058","type":"journal-article","created":{"date-parts":[[2019,9,27]],"date-time":"2019-09-27T23:59:06Z","timestamp":1569628746000},"page":"473-483","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Subepithelial connective tissue graft with or without enamel matrix derivative for the treatment of multiple Class III\u2010IV recessions in lower anterior teeth: A 3\u2010year randomized clinical trial"],"prefix":"10.1002","volume":"91","author":[{"given":"Faustino","family":"Mercado","sequence":"first","affiliation":[{"name":"School of Dentistry and Oral Health Griffith University  Gold Coast Queensland Australia"},{"name":"School of Dentistry University of Queensland  Brisbane Queensland 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