Acellular Dermis for Soft Tissue Regeneration

Acellular Dermis (or Acellular Dermal Matrix), or ADM, is a soft connective tissue graft generated by a decellularization process of human tissue, that preserves the intact extracellular skin matrix. ADM has been used in dentistry for many years, for root coverage, gingival augmentation, or soft tissue augmentation around implants, in lieu of a CTG (Connective Tissue Graft) or FGG (Free Gingival Graft) with autogenous tissue, when these are not options for various reasons. The benefit of ADM, of course, is that they provide comparable clinical efficacy to autogenous tissue, thus obviating the need for secondary surgical site, which would be the case with a a CTG or FGG. [1]

Below are two great videos which provide some clinical advice on using Acellular Dermis in your practice. In the first video, Dr. Paresh Patel reviews a case of gingival recession to provide a brief overview of Acellular Dermis. The case presented in this video involved a patient that presented with gingival recession across the entire mouth. As defects are easier to take care of when small, the decision was made to graft the problematic areas. One side was grafted with ADM and the other side used a connective tissue graft, harvested from the patient's palatal tissue. The ADM was placed via the tunnel technique. Topics covered in the video, include: preparing the area for grafting, indications for ADM, the Rule of 3, suturing the site after placing the ADM, and more.

The second video, shows a gingival graft with acellular dermis when there is inadequate keratinized/attached gingiva. A few tips are provided, including the common question about the orientation of the acellular dermis graft material. Due to the nature of tissue processing, the ADM material generally (though not always) has two sides, a basement membrane and a dermal side. As explained in the video you want to place the dermal side towards the wound/bone and the basement membrane towards the facial. A good test for this, when there is no backing material on a minimally processed ADM, is to do a simple blood test. The dermal side absorbs blood. The basement membrane side repels blood. While not addressed in the videos above, we should also note that ADM is also sometimes hydrated with liquid PRF (i-PRF) before placement.

Please note: The first video below was originally a video offered as a part of an Online CE course. However, there is NO longer any CE provided for this video. It just for your viewing pleasure, and offered here for free.

Purchase Information
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  1. Sarah Ivy Gallagher et al. Acellular dermal matrix and subepithelial connective tissue grafts for root coverage: A systematic review. J Indian Soc Periodontol. 2017 Nov-Dec; 21(6): 439–448.

DrT comments:

I do not see what the gingival graft with Perioderm accomplished?? The post op picture did not to my eyes show a significant improvement