{"paper_id":"233f55ef-478c-4190-a07c-ca58e6f03ed1","body_text":"Histologic Comparison of Gingival Recession Treatment: CTG vs. Bovine ACM in Rabbits | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Histologic Comparison of Gingival Recession Treatment: CTG vs. Bovine ACM in Rabbits Svetlana Tuleutayeva, Olga Ponamareva, Zhadyra Ashirbekova, Yerzhan Sharapatov, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8018568/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Gingival recession is wide spread pathology of oral cavity. Standard treatment presented by of connective tissue grafts with coronally advanced flap has significant limitation, such as creating donor site wound. Currently, alternative xenogenic materials are gaining popularity. We have conducted research on a material based on bovine peritoneum as an economically accessible and easy-to-obtain product. Methods Experiment was conducted on 56 rabbits. After creating GR model, animals were divided into two treatment groups: CAF + ACM (experimental group), and CAF + CTG (control group). Clinical and histological evaluations were performed on days 14, 30, and 60. Assessed parameters included gingival recession height, keratinized tissue width, gingival thickness, alveolar bone condition, vascularization, and inflammatory response. Results Both methods demonstrated comparable and satisfactory outcomes. No significant difference was observed in keratinized tissue width. However, the ACM group showed greater gingival thickness over time and better alveolar bone formation by day 60. Histological analysis also indicated more organized tissue structure, reduced inflammation, and earlier neovascularization in ACM group. Conclusion ACM showed good biocompatibility and well integrated at all stages of the research. Considering its regenerative properties and absence of donor site trauma, ACM may be considered as a perspective alternative to CAF. gingival recession connective tissue graft acellular collagen matrix bovine peritoneum histomorphometric analysis animal study Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Gingival recession (GR) is the cheek exposure of the root surface due to apical migration of the gingival margin associated with clinical loss of attachment [ 1 ]. Approximately 50% of the population has at least one 1 mm recession zone, with 5–32% of the adult population having persistent progressive gingival recession [ 2 ]. Currently, gingival bone and soft tissue deficiency is a serious problem in dentistry, especially in aesthetically significant areas [ 3 , 4 ]. Patients with a thin gingival biotype are believed to be more susceptible to gingival recession than patients with a thick biotype [ 5 ]. In patients with a thin gingival phenotype and soft tissue deficiency, the risk of developing single or multiple gingival recessions after orthodontic treatment [ 3 ] or dental implant placement remains high [ 6 ]. In addition to aesthetics and lack of dentin sensitivity [ 7 ], with respect to root coverage procedures, the widely recognized endpoints are complete root coverage, reduced recession, and increased height of keratinized tissue [ 8 ]. In this regard, the coronally advanced flap (CAF) and its modifications in combination with autologous connective tissue graft (CTG) provide the best prognosis for the treatment of single recessions [ 9 , 10 ]. The popularity of using connective tissue graft is due to the high bioavailability of autologous tissues, absence of risks of immune reactions. Nevertheless, this technique has its own disadvantages. Taking a sample of connective tissue graft adds additional pain to the pain caused by gingival recession closure surgery itself [ 11 ], as well as to the development of postoperative complications such as bleeding or paresthesia in the donor site [ 12 ]. In multiple gingival recessions, the resource of donor tissue in the palatal region may be limited. All these factors contribute to the search for alternative methods and materials to solve this problem [ 13 ]. Alternative materials include various hydrogels [ 14 ], degradable biomedical elastomers [ 15 ], xenografts, the latter in turn represented by acellular collagen dermal matrixes. ADM was initially developed and used to treat burns as a temporary dermal equivalent. Subsequently, this material has found its application in dental reconstructive surgery as a replacement for connective tissue grafts without the risk of rejection in the treatment of gingival recession [ 16 ]. To date, many biological materials are similar in their target properties, but differ in raw materials, methods of processing, sterilization, and storage [ 17 , 18 ], which significantly affects their effectiveness and cost. Biological coatings available on the market have a high market cost, which limits their use in developing countries and countries with medium and low income. In 2010, a group of Kazakhstani scientists represented by Abugaliev K.R., Ogay V.B., and others developed and patented a domestic wound coating based on decellularized parietal peritoneum of cattle under the commercial name “X-GRAFT” [ 19 , 20 , 21 , 22 ]. The choice of cattle as a raw material is due to its prevalence in global livestock production, and the high yield of the final product per unit of livestock [ 23 ]. The decellularization process enabled to obtain a collagen plate devoid of antigenic structures and similar in structure to human collagen to the fullest extent [ 24 ]. To date, preclinical trials of ACM derived from bovine peritoneum have been conducted as a material for the replacement of tympanic membrane defects [ 25 ], hernia defects [ 26 ], and a clinical trial in burns [ 27 ]. In hernia defect replacement, the graft is surrounded by soft tissue on all sides, allowing for widespread neovascularization and tissue integration of the graft. At tympanic membrane defects, the graft has a task in persistent and dense scarring with the formation of a dense and solid film, which in its turn, requires less blood supply. In case of burns, ACM performs the role of a temporary covering, which is not required for engraftment and full tissue integration. In gingival defects, the technique of ACM application has its own specificity. ACM placement in gingival defects requires complete engraftment and tissue integration in anatomical conditions, where there is alveolar bone on one side and a gingival flap with reduced trophicity on the other side and the concurrent recession and plastic displacement. Despite the difficulty of the task, the study of similar products [ 19 ] showed promising results, which makes the issue of using ACM based on bovine peritoneum in gingival recessions relevant and promising. Many studies have performed histologic analysis of CTG, ADM of porcine origin from different manufacturers for gingival defect closure [ 28 , 29 , 30 , 31 , 32 ]. Yet, the histologic analysis of ACM obtained from bovine peritoneum has not been performed for the treatment of gingival recession. This study aims to histologically evaluate and compare CTG and ACM obtained from bovine peritoneum in combination with CAF for the treatment of gingival recessions. Therefore, the aim of this study was to compare the morphologic changes of soft tissue healing processes and closure of gingival recessions using CTG and ACM by using rabbits as experimental animals. Materials and Methods This study adhered to the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines 2.0. Ethical approval of the research program was obtained by the local ethical committee of the KMU, NJSC (dated 30.04.24 under No. 41). This study was not preregistered. The datasets generated during the current study are available from the corresponding author upon reasonable request. Animals The study was conducted on male Chinchilla rabbits at the age of 160-180 days, weighing 3.5±0.5 kg, obtained from vivarium of National Center for Biotechnology. The animals were kept in individual cages under standard housing and feeding regimen at the premises of the vivarium of the research laboratory of Karaganda Medical University, non-profit joint stock company over the April to August 2024 period. Inclusion criteria included healthy male Chinchilla rabbits without signs of systemic or oral disease. Exclusion criteria were: presence of systemic or oral disease, surgical complications, or perioperative death. Female rabbits or non-Chinchilla breeds were also excluded. Sample Size Calculation A priori sample size calculation could not be performed due to the lack of prior studies evaluating gingival recession treatment using ACM derived from bovine peritoneum. Interventions At the beginning of the experiment, gingival recession was modeled in all the experimental animals in the frontal region of the lower incisor on the left side. After gingival recession formation in 4 weeks, the animals were randomly divided into 2 groups: Group 1 – Experimental group with the recession correction performed by using ACM, Group 2 – Control group with the recession correction performed by using CTG. The parameters of gingiva and bone of rabbits were considered to be baselines from the moment of gingiva formation and up to recession closure using ACM and CTG. The experimental animals underwent randomized allocation to groups using computer-generated tables. This randomization was carried out by a researcher not involved in the surgical procedures. To maintain allocation concealment, a numerical assignment system was utilized. Furthermore, both the examiner assessing the outcomes and the statistician analyzing the data were masked to the experimental group assignments. Observation periods were at the 7th, 14th, 30th, 60th days. On 14th, 30th, 60th days, 8 rabbits from each group were removed from the experiment by being euthanized with an overdose of anesthetic drug (Propofol 10 mg/kg). Description of surgical procedures Anesthesia was administered by injection of 10 mg/ml Propofol in the area of the ear vein based on body weight of 2.5mg/kg. In the postoperative period during 7 days, anesthesia by 10% solution of Lidocaine had been administered 3 times a day in order to prevent painful sensations. Phase 1 – Modeling of gingival recession Gingival recession was formed on the lower incisor on the left side. Two parallel incisions were made on the vestibular surface in the apical direction with a height of 5-6 mm. After that, the incision lines were connected. The area between the incision lines was removed. The exposed area of the maxilla was ground with a micro milling machine to form a bone recession defect. The edges of the defect were sutured between the periosteum and gingival mucosa with Prolene 6/0 thread, Ethicon US, LLC. Subsequently, the experimental sites were left to heal for 30 days. The sutures were removed in 7 days after the surgery. In the postoperative period, teeth were visually inspected and brushed daily to prevent infectious complications. Phase 2 — Gingival recession coverage The second stage of surgery was performed 1 month after recession modeling (Refer to Fig. 1b). After anesthesia, two horizontal oblique incisions were made mesially and distally to the recession, 1-2 mm coronal to the most apical part of the recession. Afterwards, vertical incisions were made through the alveolar mucosa. The recessional flap was elevated in a coronal-apical direction. The mesial and distal papillae under the horizontal incisions were de-epithelialized, and the root surface was mechanically treated. To determine the graft for recession closure, the selection was randomized as follows: CAF + ACM or CAF+CTG. The graft is placed 2-3 mm apical to the recipient bed. The graft is secured in place with t-mattress absorbable sutures (Vicryl, 4.0). The flap is then lowered and stabilized using marginal straight sutures on the vertical incisions and a final sling suture to adapt the flap to the tooth neck at the interdental papillae (Fig. 1c). Clinical evaluation A graduated NC15 periodontal probe (PCP-UNC 15, Hu-Friedy Manufacturing Co., Chicago, IL, USA) was used to measure clinical parameters like keratinized gingival width and recession length. Keratinized tissue width is the distance from the gingival margin to the tooth enamel. Length of recession is the difference between the height of the attached gingiva of the tooth where the gingival recession is formed with the neighboring intact tooth. Histomorphometric analysis Microscopic examination of the preparations was performed on a Zeiss AxioLab 4.0 microscope at ×400 magnification. AxioVision 7.2 software for Windows was used to analyze and take photographs. The central slices (with clearly distinguishable apical and coronal notches in the defect area) were selected for histometric analysis (Figure 2). The following histomorphometric parameters were calculated: - alveolar bone and fibrovascular tissues: morphometry was performed using Avtandilov G.G. planimetric grid. [33]; - distance from the gingival attachment to the crest of the alveolar bone; - gingival recession depth: the difference between the distance from the gingival attachment to the crest of the alveolar bone; - gingival thickness: the average horizontal thickness of the labial gingiva measured at the level of the distance of the mean value from the apical portion of the tooth to the crest of the alveolar bone 0.5 mm above and 0.5 mm below; Тissue response and angiogenesis Тissue response was assessed quantitatively and semi-quantitatively by morphometry of inflammatory cell infiltrate in the implantation area and assessment of neovascularization according to 10993–6 Guidelines (ISO10993-6) [34]; - the inflammatory response (acute/chronic) was assessed quantitatively by morphometry of granulocytes/lymphocytes and plasma cells in the implantation zone at x200 magnification for 10 fields of view - granulation tissue was assessed as the presence/absence of granulation tissue in the defect area - angiogenesis was evaluated by counting the area of vessels for each sample for 10 fields of view at x10 magnification. Statistical analysis The statistical analysis was carried out by using Microsoft Excel®, Microsoft, New York, NY, USA, SPSS Statistics® V 26, Armonk, NY, USA. The sample size was calculated with a two-sided t-test performed with 0.05 types 1 error, power of 0.80–0.90, and effect size 0.8. For descriptive statistics, average values with standard deviation were used. For the ease of interpretation and use, all data are rounded to 0.00. The statistically significant value was considered at p value > 0.05. The quantitative variables were initially analyzed using the Kolmogorov–Smirnov test for normal distribution. One-way analysis of variance (ANOVA) and post-hoc testing with Bonferroni’s correction for multiple comparisons was used for between group comparisons. Results Gingival recession was successfully induced in all 56 animals, with no exclusions from the study. Postoperative recovery proceeded uneventfully in both groups. No signs of infection, suppuration, hyperemia, edema, or tissue necrosis were observed in the surgical sites or adjacent papillae at day 30 (Fig. 1 b). Baseline clinical parameters showed no statistically significant differences between groups. After defect closure, healing was uneventful in both treatment groups. Animals maintained normal behavior and stable health throughout the observation period. Clinical outcomes are presented in Table 1 . There were no statistically significant differences in clinical parameters between the CTG and ACM groups at any postoperative time point (p ≥ 0.05). Table 1 Clinical measurements of keratinized tissue width and recession length and histomorphometry results Parameter (Мean ± SD, mm) Experimental Control Baseline 14 days 30 days 60 days 14 days 30 days 60 days Keratinized tissue 1,32 ± 0,17 2,26 ± 0,3 * 2,17 ± 0,32 * 2,15 ± 0,48 * 2,15 ± 0,23 * 2,06 ± 0,21 * 1,92 ± 0,24 * Recession 1,7 ± 0,32 1,05 ± 0,16 * 1,05 ± 0,17 * 0,3 ± 0,18 * 0,84 ± 0,17 * 0,85 ± 0,21 * 0,44 ± 0,33 * Distance to the alveolar bone crest (Ме [Q1; Q3]), mm 8.7 [7.8; 9.3] 8.3 [7.3; 9.1] 6.3 [5.7; 6.6] 4.1 * [3.6; 4.4] 8.6 [8.2; 8.9] 7.6 [7.1; 9.0] 7.3 † [6.8; 7.7] Gingival recession depth (Ме [Q1; Q3]), mm 6.7 [5.8; 7.3] 6.3 [5.3; 7.1] 4.3 * [3.7; 4.6] 2.1 * [1.6; 2.4] 6.6 [6.2; 6.9] 5.6 [5.1;7.0] 5.3 † [4.8; 5.7] Gingival thickness (Ме [Q1; Q3]), mm 0.8 [0.7; 0.8] 1.5 * [1.4; 1.5] 1.3 * [1.2; 1.3] 1.3 * [1.2; 1.3] 1.5 * [1.4; 1.5] 1.1 * [1.1; 1.2] 0.9 [0.7; 1.2] Alveolar bone , (Ме [Q1; Q3]), % 17 [12.75; 19] 19 [17.5; 21.25] 25 * [21.25; 28.25] 34.5 * [25; 39] 12.5 * † [9.25; 16.75] 14.5 † [10.25; 17.25] 17 † [13.25; 22.5] Fibrovascular tissues , (Ме [Q1; Q3]), % 83 [81; 87.25] 81 [78.75; 82.5] 75 * [71.75; 78.75] 65.5 * [61; 75] 87.5 [83.25; 90.75] 85.5 † [82.75; 89.75] 83 † [77.5; 86.75] Non-mineralized bone , (Ме [Q1; Q3]), % 3.5 [2; 4] 10.5 * [8.5; 19] 15.5 * [13.5; 17] 11.5 * [10.75; 12.75] 19 * [7.75; 22.75] 17.5 * [15.5; 20.25] 16 * † [14.25; 17.75] Acute inflammation (Ме [Q1; Q3]) 0 [0; 0] 1 [0; 1.25] 0 [0; 0] 0 [0; 0] 2 * † [1.75;3.25] 1 * [0.75; 2] 0 [0; 0] Chronic inflammation (Ме [Q1; Q3]) 1 [0.75; 1] 91.5 * [49.8; 142.5] 6.5 * [3.5;8.25] 1 [0.75;2] 88.5 *† [31.5;102.25] 22.5 *† [18.75; 56.25] 5 * [3;5.75] Granulation tissue n (%) Yes 0 (0%) 1(12.5%) 0 (0%) 0 (0%) 3 (37.5%) 1(12.5%) 0 (0%) No 8(100%) 7(87.5%) 8(100%) 8(100%) 5 (62.5%) 7(87.5%) 8(100%) Vessel area, µm (Ме [Q1; Q3]) 2 [1; 3.5] 14 * [8.25; 16.75] 8.5 * [6.5; 11.25] 10 * [8.5; 12.5] 21 * [14; 27.25] 16.5 *† [8; 19.5] 17.5 *† [5; 19] * p < 0,05 – statistically significant difference compared to baseline † p 1 < 0,05 – statistically significant difference compared to the experimental group Following full healing, increased gingival thickness was noted in the previously recessed areas, compared with adjacent intact sites, with no visible complications (Fig. 1 d). Histomorphometric analysis The central slices (with clearly distinguishable apical and coronal notches in the defect area) in two groups were selected for histometric analysis (Table 1 ). A gradual improvement in soft tissues was observed in both groups. The distance to the crest of the alveolar bone decreased directly and proportionally after 60 days by a factor of 2 after the ACM placement. In the control group there was a less dynamic decrease in the distance to the crest of the alveolar bone, but the differences between the baseline and 60 days after were statistically insignificant (p = 0.05). The depth of gingival recession in the experimental group 60 days after the treatment statically significantly decreased 3 times from baseline (p < 0.05). In the control group, the depth of gingival recession decreased from the baseline by an average of 1.5 mm, which was statically not significant (p ≥ 0.05). Gingival thickness got increased in the two groups after treatment. In the dynamics there was a statically significant decrease in thickness in the experimental group on Day 30 and Day 60. A similar situation was in the control group. In the experimental group after surgical intervention there was a gradual recovery of alveolar bone. On the 60th day, the increase was 34.5%, which was 2 times higher than the initial level. In the control group after CTG placement on Day 14, there was a statically significant decrease in alveolar bone level (p < 0.05). After 60 days, the alveolar bone in the control group recovered to the baseline level. In the control group, the percentage of fibrovascular tissue remained unchanged, but there was a statistically insignificant increase at the beginning of the study (р≥0,05). In the experimental group, there was a statistically significant decrease in the percentage of fibrovascular tissues. The amount of non-mineralized tissues in both groups statistically significantly increased in the course of treatment, which is associated with active repair processes. Histomorphometric evaluation of tissue response and angiogenesis after treatment of gingival recession Representative microphotographs of soft gingival tissues of animals in the control and experimental groups are presented in Figs. 3 and 4 . Experimental Group On day 14, mild focal infiltration was observed, indicating an early reparative response. Scattered polymorphonuclear leukocytes were located at the graft–host interface with limited penetration into the graft. Diffuse lympho-macrophage infiltration and active neovascularization were present. Most vessels were dilated with perivascular edema and leukocyte margination (Table 1 , Fig. 3 a). By day 30, inflammation had notably decreased. No signs of acute inflammation were seen. Occasional lymphocytes and plasma cells were present (p < 0.05 vs. baseline). Granulation tissue was absent. Blood vessels appeared constricted, with few erythrocytes (Fig. 3 b). At day 60, polymorphonuclear leukocytes were absent, and lymphocyte/plasma cell counts were similar to baseline (p > 0.05). No granulation tissue or signs of necrosis or foreign body reaction were observed. Vascular structures were sparse and composed mainly of capillaries with isolated erythrocytes (Fig. 3 c). Control Group On day 14, moderate diffuse infiltration indicated an active reparative response. Keratinization defects, neutrophilic and lymphocytic infiltration, and deeper polymorphonuclear leukocytes penetration into the graft were noted (p < 0.05). Lympho-macrophage infiltration, vasodilation, perivascular edema, and neoangiogenesis were prominent, along with chronic inflammation in the lamina propria (Table 1 , Fig. 4 a). By day 30, inflammation had decreased. Acute signs were absent; sparse lymphocytes and plasma cells remained (p < 0.05 vs. baseline). Granulation tissue was no longer observed. Blood vessels were constricted with isolated erythrocytes. Angiogenesis remained more pronounced than in the experimental group (p < 0.05) (Fig. 4 b). At day 60, inflammatory cell counts returned to baseline (p > 0.05). No granulation tissue, necrosis, or foreign body reaction was found. Vessels were few, mainly small arterioles and capillaries with scattered erythrocytes (Fig. 4 c). Discussion This experimental study aimed to evaluate and compare the healing potential of bovine peritoneum-derived acellular collagen matrix (ACM) and autogenous subepithelial connective tissue graft (CTG) when used with a coronally advanced flap (CAF) to treat surgically induced gingival recession in a rabbit model. The working hypothesis assumed that ACM would provide regenerative and integration outcomes at least equivalent to CTG. Based on the clinical and histological data, the hypothesis was supported. Clinically, both treatment groups showed improvement in keratinized tissue width and reduction of recession height over the observation period [ 35 ]. While statistical significance between groups was not achieved in most clinical parameters (p ≥ 0.05), the ACM group consistently showed slightly better outcomes in gingival thickness and root coverage. These findings are consistent with prior studies that explored the use of collagen matrices in mucogingival procedures, highlighting their capacity to support soft tissue augmentation and maintain clinical stability without the need for harvesting autogenous grafts [ 36 , 37 ]. The histological and histomorphometric data provided further insights. In the ACM group, a more structured pattern of healing was observed, particularly in soft tissue thickness, epithelial regeneration, and alveolar bone remodeling. By Day 60, these parameters demonstrated statistically significant improvement compared to baseline (p < 0.05), suggesting an ongoing and organized reparative process. In contrast, the CTG group showed a positive response, but the extent of hard tissue regeneration was lower and fibrous tissue content was greater, which may indicate a slower or less effective remodeling trajectory. Importantly, both materials demonstrated favorable tissue compatibility. No signs of graft rejection, necrosis, or inflammation were observed macroscopically. Histologically, the ACM group displayed an early reparative response with angiogenesis and moderate inflammatory infiltration by Day 14, followed by stabilization of the tissue environment. By Day 60, signs of active inflammation or granulation tissue were absent, indicating proper integration and resolution of the healing phase. These features may reflect the biological activity of the collagen matrix and its ability to support cellular migration and tissue remodeling without provoking adverse immune reactions. CTG remains the most predictable and widely accepted method for treating gingival recession, especially in cases requiring substantial tissue volume and stability. However, its application has limitations—most notably, the need for a second surgical site and associated patient morbidity. In this context, ACM offers distinct advantages: standardization, availability, and simplified surgical protocols. From a clinical perspective, this reduces procedure time and eliminates donor site complications, making it especially useful in patients with thin biotypes or contraindications for autografts. Nevertheless, certain limitations of this study should be considered. The follow-up period was limited to 60 days, which may not capture the full course of tissue maturation or long-term stability. In addition, the recession defects were surgically created and not influenced by typical etiological factors such as trauma or inflammation, which are commonly involved in clinical cases. Treatment was also initiated relatively early—only one month after recession modeling—possibly before chronic tissue changes could fully develop. Despite these limitations, the findings suggest that ACM can be a viable alternative to CTG in specific clinical contexts. Its performance in this preclinical model showed promising soft and hard tissue responses, good integration, and absence of adverse effects. The results justify further investigation in clinical settings with longer observation periods and a broader range of patient conditions. Conclusion The use of ACM derived from bovine peritoneum to restore gingival recession has demonstrated comparable efficiency (restoration of gingival volume and bone) and safety (absence of local and systemic inflammatory reaction) to the known CTG graft. The lower cost of ACM and comparable efficiency makes this graft more attractive for gingival recession repair. Abbreviations Abbreviation Definition ARRIVE Animal Research: Reporting of In Vivo Experiments GR Gingival recession ADM acellular dermal matrix ACM acellular collagen matrix CTG connective tissue graft CAF coronally advanced flap KMU Karaganda Medical University Declarations Ethics approval statement: The study was conducted in accordance with the Declartion of Helsinki and approved by the local ethical committee of MUK NJSC dated 30.04.2024 No 41 Consent for publication Not aplicable Availability of data and materials: The data supporting findings of this study are available from the corresponding author upon request. Please contact Zhadyra Ashirbekova, [email protected] ; Competing interests: The authors declare no conflict of interest Funding: This research was conducted and the manuscript was written using the authors’ per-sonal funds. No external funding was received. Authors' contributions: CRediT Classification Svetlana Tuleutayeva Olga Ponamareva Zhadyra Ashirbekova Yerzhan Sharapatov Dinara Zharlyganova Zhandos Burkitbayev Baurzhan Anapiya Conceptualization + + + Data Curation + + Formal Analysis + + + Funding Acquisition + + + + Investigation + + + Methodology + + + + Project Administration + Resources + + + + Software + + + + Supervision + Validation + Visualization + + Writing – Original Draft Preparation + + Writing – Review & Editing + + Acknowledgements: No acknowledgments References Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations. J Clin Periodontol. 2018;45(Suppl 20):S190–S198. Mythri S, Arunkumar SM, Hegde S, Rajesh SK, Munaz M, Ashwin D. Etiology and occurrence of gingival recession—an epidemiological study. J Indian Soc Periodontol. 2015;19(6):671–675. doi:10.4103/0972-124X.156881 Koteneva P, Kosheleva N, Fayzullin A, et al. 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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;36:523–531. doi:10.1111/j.1600-051X.2009.01413.x Sculean A, Mihatovic I, Shirakata Y, et al. Healing of localized gingival recessions treated with coronally advanced flap alone or combined with either a resorbable collagen matrix or subepithelial connective tissue graft: a preclinical study. Clin Oral Investig. 2015;19(4):903–909. doi:10.1007/s00784-014-1299-x Stähli A, Párkányi L, Aroca S, et al. The effect of connective tissue graft or a collagen matrix on epithelial differentiation around teeth and implants: a preclinical study in minipigs. Clin Oral Investig. 2023;27(8):4553–4566. doi:10.1007/s00784-023-05080-5 Suárez-López Del Amo F, Rodriguez JC, Asa’ad F, Wang HL. Comparison of two soft tissue substitutes for the treatment of gingival recession defects: an animal histological study. J Appl Oral Sci. 2019;27:e20180584. doi:10.1590/1678-7757-2018-0584 Vignoletti F, Nuñez J, Discepoli N, et al. Clinical and histological healing of a new collagen matrix in combination with the coronally advanced flap for the treatment of Miller class I recession defects: an experimental study in the minipig. J Clin Periodontol. 2011;38(9):847–855. doi:10.1111/j.1600-051X.2011.01767.x Avtandilov GG. Fundamentals of quantitative pathologic anatomy. Moscow, Russia: Medicine; 2002. GOST ISO 10993-1-2011. Evaluation of the biological effect of medical devices. Part 6. Studies of local action after implantation. Tonetti MS, Cortellini P, Pellegrini G, et al. Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life. J Clin Periodontol. 2018;45(1):78–88. doi:10.1111/jcpe.12834 Pietruska M, Skurska A, Podlewski Ł, Milewski R, Pietruski J. Clinical evaluation of Miller class I and II recession treatment with the use of modified coronally advanced tunnel technique with either collagen matrix or subepithelial connective tissue graft: a randomized clinical study. J Clin Periodontol. 2019;46(1):86–95. doi:10.1111/jcpe.13021 Parween S, George JP, Prabhuji M. Treatment of multiple mandibular gingival recession defects using MCAT technique and SCTG with and without RHPDGF-BB: a randomized controlled clinical trial. Int J Periodontics Restor Dent. 2020;40(2):e43–e51. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 23 Mar, 2026 Reviews received at journal 16 Mar, 2026 Reviews received at journal 02 Mar, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers invited by journal 05 Feb, 2026 Editor invited by journal 23 Jan, 2026 Editor assigned by journal 25 Nov, 2025 Submission checks completed at journal 25 Nov, 2025 First submitted to journal 25 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8018568\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":586707828,\"identity\":\"368d38fc-2cc2-4bbd-abf4-8511c5ad66ed\",\"order_by\":0,\"name\":\"Svetlana Tuleutayeva\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Karaganda Medical University NPJSC\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Svetlana\",\"middleName\":\"\",\"lastName\":\"Tuleutayeva\",\"suffix\":\"\"},{\"id\":586707829,\"identity\":\"f9596076-6347-4af8-9da6-e19cafd5ec2f\",\"order_by\":1,\"name\":\"Olga Ponamareva\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Karaganda Medical University NPJSC\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Olga\",\"middleName\":\"\",\"lastName\":\"Ponamareva\",\"suffix\":\"\"},{\"id\":586707830,\"identity\":\"23397a0b-a458-435c-a719-72f5e342d34b\",\"order_by\":2,\"name\":\"Zhadyra Ashirbekova\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYDACdiDmYTggB2IfeECUFmaIFmOwlgRStCQ2gDhEaeFvZn4m8abiTvr8sMMPgbbYyek2ENAicZjNTHLOmWe5G2+nGQC1JBubHSBkzWEGM2netsO5G2cngLQcSNxGSIv8YfZvIC3phrPTPxCnxeAwD9iWBHnpHCJtMTzMU2wJ9IvhBumcggMJBkT4Re54+8YbwBCTl5+dvvnDhwo7OcLeZ2BgkQC7EKzSgLByEGD+ACLlG4hTPQpGwSgYBSMQAADak0hV9zu8RwAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Karaganda Medical University NPJSC\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Zhadyra\",\"middleName\":\"\",\"lastName\":\"Ashirbekova\",\"suffix\":\"\"},{\"id\":586707831,\"identity\":\"ff11ebf3-ddca-4763-a6a0-07c57c6a7776\",\"order_by\":3,\"name\":\"Yerzhan Sharapatov\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Astana Medical University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yerzhan\",\"middleName\":\"\",\"lastName\":\"Sharapatov\",\"suffix\":\"\"},{\"id\":586707832,\"identity\":\"6dd72879-e07f-4cc9-af1b-ff460f811d4c\",\"order_by\":4,\"name\":\"Dinara Zharlyganova\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"National Research Oncology Center LLP\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Dinara\",\"middleName\":\"\",\"lastName\":\"Zharlyganova\",\"suffix\":\"\"},{\"id\":586707833,\"identity\":\"a8ea95e7-5683-4bc0-a692-1d92268bc1eb\",\"order_by\":5,\"name\":\"Zhandos Burkitbayev\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"National Research Oncology Center LLP\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Zhandos\",\"middleName\":\"\",\"lastName\":\"Burkitbayev\",\"suffix\":\"\"},{\"id\":586707834,\"identity\":\"d6208701-05cc-491d-984d-2b7744c21508\",\"order_by\":6,\"name\":\"Baurzhan Anapiya\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"National Research Oncology Center LLP\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Baurzhan\",\"middleName\":\"\",\"lastName\":\"Anapiya\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-11-03 11:23:38\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8018568/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8018568/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":102227584,\"identity\":\"de08c895-9907-40ca-88a1-a31e260b72fb\",\"added_by\":\"auto\",\"created_at\":\"2026-02-09 14:58:38\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1965205,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e(a) intact rabbit gingiva; (b) clinical picture of gingival recession after 1 month; (c) mattress and sling sutures securing the coronally advanced flaps; (d) clinical picture 60 days after surgical intervention (CAF+ACM);\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8018568/v1/3e75d924a63e4483432f2ef0.jpg\"},{\"id\":102227606,\"identity\":\"e3058493-34c1-4f31-98c0-590ee076d172\",\"added_by\":\"auto\",\"created_at\":\"2026-02-09 14:58:43\",\"extension\":\"jpg\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1199088,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eTeeth parameters for histomorphometric measurements (structure in normal). (d) dentin; (e) enamel;\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure2.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8018568/v1/b30e7166a1a5d00520abd796.jpg\"},{\"id\":102227539,\"identity\":\"6cc4875e-d177-4f34-8005-09769f089984\",\"added_by\":\"auto\",\"created_at\":\"2026-02-09 14:58:33\",\"extension\":\"jpg\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1936673,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eRepresentative soft tissue micrographs in the experimetal group. Haematoxylin and eosin staining, x40. (a) 14 days. Morphological signs of gingival mucosa regeneration with active regeneration of superficial epithelium (long arrows) were revealed. Absence of destructive-necrotic and expressed exudative processes. In deep layers of the mucous membrane under the epithelium, there are layers of loose connective tissue and cellular inflammatory infiltrate represented by diffuse lymphoplasmacytic infiltration (asterisks); (b) 30 days. The superficial epithelium is restored (long arrows). Local remodeling of connective tissue and bone tissue is noted (arrowhead); (c) 60 days. The epithelial lining and connective tissue are normal. The superficial epithelium is restored (long arrows). In addition to epithelial cells, a small amount of various cellular elements (lymphocytes and plasma cells) is detected in the gingival epithelium. Yet, their number corresponds to the average norm. Micro-vessels are dilated; their lumen is empty (short arrows). The alveolar bone is restored (arrowhead);\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure3.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8018568/v1/edc1ed926820dedfcbee61e9.jpg\"},{\"id\":102227605,\"identity\":\"fba383ec-1133-4b86-8e4f-7ec3d8d5ec88\",\"added_by\":\"auto\",\"created_at\":\"2026-02-09 14:58:43\",\"extension\":\"jpg\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1456543,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eRepresentative micrographs of soft tissues in the сontrol group. Hematoxylin and eosin staining, x40. (a) 14 days. Partially necrotized allograft (long arrows) with necrosis and diffuse infiltration with inflammatory cells (asterisks). Hematoxylin and eosin staining, x100; (b) 30 days. The superficial epithelium is partially restored (long arrows). Local remodeling of connective tissue is noted. A moderate infiltrate of lymphocytes and plasma cells (asterisks) is detected in the connective tissue. Hematoxylin and eosin staining, x40; (c) 60 days. The epithelial lining is partially restored (long arrows). In addition to epithelial cells, a small amount of various cellular elements (lymphocytes and plasma cells) is detected in the gingival epithelium (asterisks). The alveolar bone is partially remodeled (arrowhead) Hematoxylin and eosin staining, x40;\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure4.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8018568/v1/da0e442a110df2f811e283b1.jpg\"},{\"id\":102297361,\"identity\":\"a5c6fe71-5333-44af-8cac-648888ec9ef8\",\"added_by\":\"auto\",\"created_at\":\"2026-02-10 10:27:12\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":29041895,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8018568/v1/e749b50e-c237-4968-abe2-2149e6610ab3.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Histologic Comparison of Gingival Recession Treatment: CTG vs. Bovine ACM in Rabbits\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003e \\u003cdiv class=\\\"BlockQuote\\\"\\u003e \\u003cp\\u003eGingival recession (GR) is the cheek exposure of the root surface due to apical migration of the gingival margin associated with clinical loss of attachment [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Approximately 50% of the population has at least one 1 mm recession zone, with 5\\u0026ndash;32% of the adult population having persistent progressive gingival recession [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Currently, gingival bone and soft tissue deficiency is a serious problem in dentistry, especially in aesthetically significant areas [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Patients with a thin gingival biotype are believed to be more susceptible to gingival recession than patients with a thick biotype [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. In patients with a thin gingival phenotype and soft tissue deficiency, the risk of developing single or multiple gingival recessions after orthodontic treatment [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e] or dental implant placement remains high [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIn addition to aesthetics and lack of dentin sensitivity [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e], with respect to root coverage procedures, the widely recognized endpoints are complete root coverage, reduced recession, and increased height of keratinized tissue [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIn this regard, the coronally advanced flap (CAF) and its modifications in combination with autologous connective tissue graft (CTG) provide the best prognosis for the treatment of single recessions [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. The popularity of using connective tissue graft is due to the high bioavailability of autologous tissues, absence of risks of immune reactions. Nevertheless, this technique has its own disadvantages. Taking a sample of connective tissue graft adds additional pain to the pain caused by gingival recession closure surgery itself [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e], as well as to the development of postoperative complications such as bleeding or paresthesia in the donor site [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. In multiple gingival recessions, the resource of donor tissue in the palatal region may be limited.\\u003c/p\\u003e \\u003cp\\u003eAll these factors contribute to the search for alternative methods and materials to solve this problem [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Alternative materials include various hydrogels [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e], degradable biomedical elastomers [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e], xenografts, the latter in turn represented by acellular collagen dermal matrixes. ADM was initially developed and used to treat burns as a temporary dermal equivalent. Subsequently, this material has found its application in dental reconstructive surgery as a replacement for connective tissue grafts without the risk of rejection in the treatment of gingival recession [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. To date, many biological materials are similar in their target properties, but differ in raw materials, methods of processing, sterilization, and storage [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e], which significantly affects their effectiveness and cost.\\u003c/p\\u003e \\u003cp\\u003eBiological coatings available on the market have a high market cost, which limits their use in developing countries and countries with medium and low income. In 2010, a group of Kazakhstani scientists represented by Abugaliev K.R., Ogay V.B., and others developed and patented a domestic wound coating based on decellularized parietal peritoneum of cattle under the commercial name \\u0026ldquo;X-GRAFT\\u0026rdquo; [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. The choice of cattle as a raw material is due to its prevalence in global livestock production, and the high yield of the final product per unit of livestock [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. The decellularization process enabled to obtain a collagen plate devoid of antigenic structures and similar in structure to human collagen to the fullest extent [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eTo date, preclinical trials of ACM derived from bovine peritoneum have been conducted as a material for the replacement of tympanic membrane defects [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e], hernia defects [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e], and a clinical trial in burns [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]. In hernia defect replacement, the graft is surrounded by soft tissue on all sides, allowing for widespread neovascularization and tissue integration of the graft. At tympanic membrane defects, the graft has a task in persistent and dense scarring with the formation of a dense and solid film, which in its turn, requires less blood supply. In case of burns, ACM performs the role of a temporary covering, which is not required for engraftment and full tissue integration. In gingival defects, the technique of ACM application has its own specificity. ACM placement in gingival defects requires complete engraftment and tissue integration in anatomical conditions, where there is alveolar bone on one side and a gingival flap with reduced trophicity on the other side and the concurrent recession and plastic displacement.\\u003c/p\\u003e \\u003cp\\u003eDespite the difficulty of the task, the study of similar products [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e] showed promising results, which makes the issue of using ACM based on bovine peritoneum in gingival recessions relevant and promising. Many studies have performed histologic analysis of CTG, ADM of porcine origin from different manufacturers for gingival defect closure [\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]. Yet, the histologic analysis of ACM obtained from bovine peritoneum has not been performed for the treatment of gingival recession.\\u003c/p\\u003e \\u003cp\\u003eThis study aims to histologically evaluate and compare CTG and ACM obtained from bovine peritoneum in combination with CAF for the treatment of gingival recessions. Therefore, the aim of this study was to compare the morphologic changes of soft tissue healing processes and closure of gingival recessions using CTG and ACM by using rabbits as experimental animals.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cp\\u003eThis study adhered to the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines 2.0. Ethical approval of the research program was obtained by the local ethical committee of the KMU, NJSC (dated 30.04.24 under No. 41). This study was not preregistered.\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated during the current study are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003eAnimals\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was conducted on male \\u003cem\\u003eChinchilla rabbits\\u003c/em\\u003e at the age of 160-180 days, weighing 3.5\\u0026plusmn;0.5 kg, obtained from vivarium of National Center for Biotechnology. The animals were kept in individual cages under standard housing and feeding regimen at the premises of the vivarium of the research laboratory of Karaganda Medical University, non-profit joint stock company over the April to August 2024 period.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eInclusion criteria included healthy male\\u0026nbsp;\\u003cem\\u003eChinchilla rabbits\\u003c/em\\u003e without signs of systemic or oral disease.\\u003cbr\\u003e\\u0026nbsp;Exclusion criteria were: presence of systemic or oral disease, surgical complications, or perioperative death. Female rabbits or non-Chinchilla breeds were also excluded.\\u003c/p\\u003e\\n\\u003cp\\u003eSample Size Calculation\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;A priori sample size calculation could not be performed due to the lack of prior studies evaluating gingival recession treatment using ACM derived from bovine peritoneum.\\u003c/p\\u003e\\n\\u003cp\\u003eInterventions\\u003c/p\\u003e\\n\\u003cp\\u003eAt the beginning of the experiment, gingival recession was modeled in all the experimental animals in the frontal region of the lower incisor on the left side. After gingival recession formation in 4 weeks, the animals were randomly divided into 2 groups: Group 1 \\u0026ndash; Experimental group with the recession correction performed by using ACM, Group 2 \\u0026ndash; Control group with the recession correction performed by using CTG. The parameters of gingiva and bone of rabbits were considered to be baselines from the moment of gingiva formation and up to recession closure using ACM and CTG. The experimental animals underwent randomized allocation to groups using computer-generated tables. This randomization was carried out by a researcher not involved in the surgical procedures. To maintain allocation concealment, a numerical assignment system was utilized. Furthermore, both the examiner assessing the outcomes and the statistician analyzing the data were masked to the experimental group assignments.\\u003c/p\\u003e\\n\\u003cp\\u003eObservation periods were at the 7th, 14th, 30th, 60th days.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eOn 14th, 30th, 60th days, 8 rabbits from each group were removed from the experiment by being euthanized with an overdose of anesthetic drug (Propofol 10 mg/kg).\\u003c/p\\u003e\\n\\u003cp\\u003eDescription of surgical procedures\\u003c/p\\u003e\\n\\u003cp\\u003eAnesthesia was administered by injection of 10 mg/ml Propofol in the area of the ear vein based on body weight of 2.5mg/kg. In the postoperative period during 7 days, anesthesia by 10% solution of Lidocaine had been administered 3 times a day in order to prevent painful sensations. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003ePhase 1 \\u0026ndash; Modeling of gingival recession\\u003c/p\\u003e\\n\\u003cp\\u003eGingival recession was formed on the lower incisor on the left side. Two parallel incisions were made on the vestibular surface in the apical direction with a height of 5-6 mm. After that, the incision lines were connected. The area between the incision lines was removed. The exposed area of the maxilla was ground with a micro milling machine to form a bone recession defect. The edges of the defect were sutured between the periosteum and gingival mucosa with Prolene 6/0 thread, Ethicon US, LLC. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eSubsequently, the experimental sites were left to heal for 30 days. The sutures were removed in 7 days after the surgery. \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eIn the postoperative period, teeth were visually inspected and brushed daily to prevent infectious complications.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003ePhase 2 \\u0026mdash; Gingival recession coverage \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe second stage of surgery was performed 1 month after recession modeling (Refer to Fig. 1b). After anesthesia, two horizontal oblique incisions were made mesially and distally to the recession, 1-2 mm coronal to the most apical part of the recession. Afterwards, vertical incisions were made through the alveolar mucosa. The recessional flap was elevated in a coronal-apical direction. The mesial and distal papillae under the horizontal incisions were de-epithelialized, and the root surface was mechanically treated. To determine the graft for recession closure, the selection was randomized as follows: CAF + ACM or CAF+CTG.\\u003c/p\\u003e\\n\\u003cp\\u003eThe graft is placed 2-3 mm apical to the recipient bed. The graft is secured in place with t-mattress absorbable sutures (Vicryl, 4.0). The flap is then lowered and stabilized using marginal straight sutures on the vertical incisions and a final sling suture to adapt the flap to the tooth neck at the interdental papillae (Fig. 1c).\\u003c/p\\u003e\\n\\u003cp\\u003eClinical evaluation\\u003c/p\\u003e\\n\\u003cp\\u003eA graduated NC15 periodontal probe (PCP-UNC 15, Hu-Friedy Manufacturing Co., Chicago, IL, USA) was used to measure clinical parameters like keratinized gingival width and recession length.\\u003c/p\\u003e\\n\\u003cp\\u003eKeratinized tissue width is the distance from the gingival margin to the tooth enamel.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eLength of recession is the difference between the height of the attached gingiva of the tooth where the gingival recession is formed with the neighboring intact tooth.\\u003c/p\\u003e\\n\\u003cp\\u003eHistomorphometric analysis\\u003c/p\\u003e\\n\\u003cp\\u003eMicroscopic examination of the preparations was performed on a Zeiss AxioLab 4.0 microscope at \\u0026times;400 magnification. AxioVision 7.2 software for Windows was used to analyze and take photographs.\\u003c/p\\u003e\\n\\u003cp\\u003eThe central slices (with clearly distinguishable apical and coronal notches in the defect area) were selected for histometric analysis (Figure 2).\\u003c/p\\u003e\\n\\u003cp\\u003eThe following histomorphometric parameters were calculated:\\u003c/p\\u003e\\n\\u003cp\\u003e- alveolar bone and fibrovascular tissues: morphometry was performed using Avtandilov G.G. planimetric grid. [33];\\u003c/p\\u003e\\n\\u003cp\\u003e- distance from the gingival attachment to the crest of the alveolar bone;\\u003c/p\\u003e\\n\\u003cp\\u003e- gingival recession depth: the difference between the distance from the gingival attachment to the crest of the alveolar bone;\\u003c/p\\u003e\\n\\u003cp\\u003e- gingival thickness: the average horizontal thickness of the labial gingiva measured at the level of the distance of the mean value from the apical portion of the tooth to the crest of the alveolar bone 0.5 mm above and 0.5 mm below;\\u003c/p\\u003e\\n\\u003cp\\u003eТissue response and angiogenesis\\u003c/p\\u003e\\n\\u003cp\\u003eТissue response was assessed quantitatively and semi-quantitatively by morphometry of inflammatory cell infiltrate in the implantation area and assessment of neovascularization according to 10993\\u0026ndash;6 Guidelines (ISO10993-6) [34];\\u003c/p\\u003e\\n\\u003cp\\u003e- the inflammatory response (acute/chronic) was assessed quantitatively by morphometry of granulocytes/lymphocytes and plasma cells in the implantation zone at x200 magnification for 10 fields of view\\u003c/p\\u003e\\n\\u003cp\\u003e- granulation tissue was assessed as the presence/absence of granulation tissue in the defect area\\u003c/p\\u003e\\n\\u003cp\\u003e- angiogenesis was evaluated by counting the area of vessels for each sample for 10 fields of view at x10 magnification.\\u003c/p\\u003e\\n\\u003cp\\u003eStatistical analysis\\u003c/p\\u003e\\n\\u003cp\\u003eThe statistical analysis was carried out by using Microsoft Excel\\u0026reg;, Microsoft, New York, NY, USA, SPSS Statistics\\u0026reg; V 26, Armonk, NY, USA. The sample size was calculated with a two-sided t-test performed with 0.05 types 1 error, power of 0.80\\u0026ndash;0.90, and effect size 0.8. For descriptive statistics, average values with standard deviation were used. For the ease of interpretation and use, all data are rounded to 0.00. The statistically significant value was considered at p value \\u0026gt; 0.05. The quantitative variables were initially analyzed using the Kolmogorov\\u0026ndash;Smirnov test for normal distribution. One-way analysis of variance (ANOVA) and post-hoc testing with Bonferroni\\u0026rsquo;s correction for multiple comparisons was used for between group comparisons.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e \\u003cdiv class=\\\"BlockQuote\\\"\\u003e \\u003cp\\u003eGingival recession was successfully induced in all 56 animals, with no exclusions from the study. Postoperative recovery proceeded uneventfully in both groups. No signs of infection, suppuration, hyperemia, edema, or tissue necrosis were observed in the surgical sites or adjacent papillae at day 30 (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003eb). Baseline clinical parameters showed no statistically significant differences between groups.\\u003c/p\\u003e \\u003cp\\u003eAfter defect closure, healing was uneventful in both treatment groups. Animals maintained normal behavior and stable health throughout the observation period.\\u003c/p\\u003e \\u003cp\\u003eClinical outcomes are presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. There were no statistically significant differences in clinical parameters between the CTG and ACM groups at any postoperative time point (p\\u0026thinsp;\\u0026ge;\\u0026thinsp;0.05).\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eClinical measurements of keratinized tissue width and recession length and histomorphometry results\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"9\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" morerows=\\\"1\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eParameter\\u003c/p\\u003e \\u003cp\\u003e(Мean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD, mm)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c6\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eExperimental\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c9\\\" namest=\\\"c7\\\"\\u003e \\u003cp\\u003eControl\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eBaseline\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14 days\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e30 days\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e60 days\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e14 days\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e30 days\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e60 days\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eKeratinized tissue\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1,32\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2,26\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,3 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2,17\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,32 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2,15\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,48 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e2,15\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,23 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e2,06\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,21 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1,92\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,24 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eRecession\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1,7\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,32\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1,05\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,16 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1,05\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,17 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0,3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,18 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0,84\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,17 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0,85\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,21 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0,44\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0,33 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDistance to the alveolar bone crest (Ме [Q1; Q3]), mm\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8.7\\u003c/p\\u003e \\u003cp\\u003e[7.8; 9.3]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8.3\\u003c/p\\u003e \\u003cp\\u003e[7.3; 9.1]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6.3\\u003c/p\\u003e \\u003cp\\u003e[5.7; 6.6]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e4.1\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[3.6; 4.4]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e8.6\\u003c/p\\u003e \\u003cp\\u003e[8.2; 8.9]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e7.6\\u003c/p\\u003e \\u003cp\\u003e[7.1; 9.0]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e7.3\\u003csup\\u003e\\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[6.8; 7.7]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eGingival recession depth\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003e(Ме [Q1; Q3]), mm\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6.7\\u003c/p\\u003e \\u003cp\\u003e[5.8; 7.3]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6.3\\u003c/p\\u003e \\u003cp\\u003e[5.3; 7.1]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4.3\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[3.7; 4.6]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2.1\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[1.6; 2.4]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e6.6\\u003c/p\\u003e \\u003cp\\u003e[6.2; 6.9]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e5.6\\u003c/p\\u003e \\u003cp\\u003e[5.1;7.0]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e5.3 \\u003csup\\u003e\\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[4.8; 5.7]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eGingival thickness\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003e(Ме [Q1; Q3]), mm\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.8\\u003c/p\\u003e \\u003cp\\u003e[0.7; 0.8]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.5\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[1.4; 1.5]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.3\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[1.2; 1.3]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.3\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[1.2; 1.3]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.5\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[1.4; 1.5]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.1\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[1.1; 1.2]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.9\\u003c/p\\u003e \\u003cp\\u003e[0.7; 1.2]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAlveolar bone\\u003c/b\\u003e,\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003e(Ме [Q1; Q3]), %\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003cp\\u003e[12.75; 19]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e19\\u003c/p\\u003e \\u003cp\\u003e[17.5; 21.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e25\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[21.25; 28.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e34.5\\u003csup\\u003e*\\u003c/sup\\u003e [25; 39]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e12.5\\u003csup\\u003e* \\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[9.25; 16.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e14.5\\u003csup\\u003e\\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[10.25; 17.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e17 \\u003csup\\u003e\\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[13.25; 22.5]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFibrovascular tissues\\u003c/b\\u003e,\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003e(Ме [Q1; Q3]), %\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e83\\u003c/p\\u003e \\u003cp\\u003e[81; 87.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e81\\u003c/p\\u003e \\u003cp\\u003e[78.75; 82.5]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e75\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[71.75; 78.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e65.5\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[61; 75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e87.5\\u003c/p\\u003e \\u003cp\\u003e[83.25; 90.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e85.5 \\u003csup\\u003e\\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[82.75; 89.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e83 \\u003csup\\u003e\\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[77.5; 86.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eNon-mineralized bone\\u003c/b\\u003e,\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003e(Ме [Q1; Q3]), %\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.5\\u003c/p\\u003e \\u003cp\\u003e[2; 4]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10.5\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[8.5; 19]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e15.5\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[13.5; 17]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e11.5\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[10.75; 12.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e19\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[7.75; 22.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e17.5\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[15.5; 20.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e16\\u003csup\\u003e* \\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[14.25; 17.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAcute inflammation\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003e(Ме [Q1; Q3])\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0 [0; 0]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003cp\\u003e[0; 1.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003cp\\u003e[0; 0]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003cp\\u003e[0; 0]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e2\\u003csup\\u003e* \\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[1.75;3.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[0.75; 2]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003cp\\u003e[0; 0]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eChronic inflammation\\u003c/b\\u003e\\u003c/p\\u003e \\u003cp\\u003e\\u003cb\\u003e(Ме [Q1; Q3])\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003cp\\u003e[0.75; 1]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e91.5 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[49.8; 142.5]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6.5\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[3.5;8.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003cp\\u003e[0.75;2]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e88.5 \\u003csup\\u003e*\\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[31.5;102.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e22.5 \\u003csup\\u003e*\\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[18.75; 56.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e5 \\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[3;5.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eGranulation tissue n (%)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eYes\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0 (0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1(12.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 (0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0 (0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e3 (37.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1(12.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0 (0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eNo\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7(87.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e8(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e5 (62.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e7(87.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e8(100%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eVessel area, \\u0026micro;m (Ме [Q1; Q3])\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003cp\\u003e[1; 3.5]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[8.25; 16.75]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8.5\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[6.5; 11.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e10\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[8.5; 12.5]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e21\\u003csup\\u003e*\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[14; 27.25]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e16.5 \\u003csup\\u003e*\\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[8; 19.5]\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e17.5\\u003csup\\u003e*\\u0026dagger;\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003e[5; 19]\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"9\\\"\\u003e\\u003csup\\u003e*\\u003c/sup\\u003ep\\u0026thinsp;\\u0026lt;\\u0026thinsp;0,05 \\u0026ndash; statistically significant difference compared to baseline\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"9\\\"\\u003e\\u003csup\\u003e\\u0026dagger;\\u003c/sup\\u003e p\\u003csub\\u003e1\\u003c/sub\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0,05 \\u0026ndash; statistically significant difference compared to the experimental group\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eFollowing full healing, increased gingival thickness was noted in the previously recessed areas, compared with adjacent intact sites, with no visible complications (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003ed).\\u003c/p\\u003e \\u003cp\\u003eHistomorphometric analysis\\u003c/p\\u003e \\u003cp\\u003eThe central slices (with clearly distinguishable apical and coronal notches in the defect area) in two groups were selected for histometric analysis (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eA gradual improvement in soft tissues was observed in both groups. The distance to the crest of the alveolar bone decreased directly and proportionally after 60 days by a factor of 2 after the ACM placement. In the control group there was a less dynamic decrease in the distance to the crest of the alveolar bone, but the differences between the baseline and 60 days after were statistically insignificant (p\\u0026thinsp;=\\u0026thinsp;0.05). The depth of gingival recession in the experimental group 60 days after the treatment statically significantly decreased 3 times from baseline (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). In the control group, the depth of gingival recession decreased from the baseline by an average of 1.5 mm, which was statically not significant (p\\u0026thinsp;\\u0026ge;\\u0026thinsp;0.05).\\u003c/p\\u003e \\u003cp\\u003eGingival thickness got increased in the two groups after treatment. In the dynamics there was a statically significant decrease in thickness in the experimental group on Day 30 and Day 60. A similar situation was in the control group.\\u003c/p\\u003e \\u003cp\\u003eIn the experimental group after surgical intervention there was a gradual recovery of alveolar bone. On the 60th day, the increase was 34.5%, which was 2 times higher than the initial level. In the control group after CTG placement on Day 14, there was a statically significant decrease in alveolar bone level (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). After 60 days, the alveolar bone in the control group recovered to the baseline level.\\u003c/p\\u003e \\u003cp\\u003eIn the control group, the percentage of fibrovascular tissue remained unchanged, but there was a statistically insignificant increase at the beginning of the study (р\\u0026ge;0,05). In the experimental group, there was a statistically significant decrease in the percentage of fibrovascular tissues. The amount of non-mineralized tissues in both groups statistically significantly increased in the course of treatment, which is associated with active repair processes.\\u003c/p\\u003e \\u003cp\\u003eHistomorphometric evaluation of tissue response and angiogenesis after treatment of gingival recession\\u003c/p\\u003e \\u003cp\\u003eRepresentative microphotographs of soft gingival tissues of animals in the control and experimental groups are presented in Figs.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e and \\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eExperimental Group\\u003c/p\\u003e \\u003cp\\u003eOn day 14, mild focal infiltration was observed, indicating an early reparative response. Scattered polymorphonuclear leukocytes were located at the graft\\u0026ndash;host interface with limited penetration into the graft. Diffuse lympho-macrophage infiltration and active neovascularization were present. Most vessels were dilated with perivascular edema and leukocyte margination (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003ea).\\u003c/p\\u003e \\u003cp\\u003eBy day 30, inflammation had notably decreased. No signs of acute inflammation were seen. Occasional lymphocytes and plasma cells were present (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 vs. baseline). Granulation tissue was absent. Blood vessels appeared constricted, with few erythrocytes (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003eb).\\u003c/p\\u003e \\u003cp\\u003eAt day 60, polymorphonuclear leukocytes were absent, and lymphocyte/plasma cell counts were similar to baseline (p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). No granulation tissue or signs of necrosis or foreign body reaction were observed. Vascular structures were sparse and composed mainly of capillaries with isolated erythrocytes (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003ec).\\u003c/p\\u003e \\u003cp\\u003eControl Group\\u003c/p\\u003e \\u003cp\\u003eOn day 14, moderate diffuse infiltration indicated an active reparative response. Keratinization defects, neutrophilic and lymphocytic infiltration, and deeper polymorphonuclear leukocytes penetration into the graft were noted (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Lympho-macrophage infiltration, vasodilation, perivascular edema, and neoangiogenesis were prominent, along with chronic inflammation in the lamina propria (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e, Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003ea).\\u003c/p\\u003e \\u003cp\\u003eBy day 30, inflammation had decreased. Acute signs were absent; sparse lymphocytes and plasma cells remained (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 vs. baseline). Granulation tissue was no longer observed. Blood vessels were constricted with isolated erythrocytes. Angiogenesis remained more pronounced than in the experimental group (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003eb).\\u003c/p\\u003e \\u003cp\\u003eAt day 60, inflammatory cell counts returned to baseline (p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). No granulation tissue, necrosis, or foreign body reaction was found. Vessels were few, mainly small arterioles and capillaries with scattered erythrocytes (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003ec).\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003e \\u003cdiv class=\\\"BlockQuote\\\"\\u003e \\u003cp\\u003eThis experimental study aimed to evaluate and compare the healing potential of bovine peritoneum-derived acellular collagen matrix (ACM) and autogenous subepithelial connective tissue graft (CTG) when used with a coronally advanced flap (CAF) to treat surgically induced gingival recession in a rabbit model. The working hypothesis assumed that ACM would provide regenerative and integration outcomes at least equivalent to CTG. Based on the clinical and histological data, the hypothesis was supported.\\u003c/p\\u003e \\u003cp\\u003eClinically, both treatment groups showed improvement in keratinized tissue width and reduction of recession height over the observation period [\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]. While statistical significance between groups was not achieved in most clinical parameters (p\\u0026thinsp;\\u0026ge;\\u0026thinsp;0.05), the ACM group consistently showed slightly better outcomes in gingival thickness and root coverage. These findings are consistent with prior studies that explored the use of collagen matrices in mucogingival procedures, highlighting their capacity to support soft tissue augmentation and maintain clinical stability without the need for harvesting autogenous grafts [\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe histological and histomorphometric data provided further insights. In the ACM group, a more structured pattern of healing was observed, particularly in soft tissue thickness, epithelial regeneration, and alveolar bone remodeling. By Day 60, these parameters demonstrated statistically significant improvement compared to baseline (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05), suggesting an ongoing and organized reparative process. In contrast, the CTG group showed a positive response, but the extent of hard tissue regeneration was lower and fibrous tissue content was greater, which may indicate a slower or less effective remodeling trajectory.\\u003c/p\\u003e \\u003cp\\u003eImportantly, both materials demonstrated favorable tissue compatibility. No signs of graft rejection, necrosis, or inflammation were observed macroscopically. Histologically, the ACM group displayed an early reparative response with angiogenesis and moderate inflammatory infiltration by Day 14, followed by stabilization of the tissue environment. By Day 60, signs of active inflammation or granulation tissue were absent, indicating proper integration and resolution of the healing phase. These features may reflect the biological activity of the collagen matrix and its ability to support cellular migration and tissue remodeling without provoking adverse immune reactions.\\u003c/p\\u003e \\u003cp\\u003eCTG remains the most predictable and widely accepted method for treating gingival recession, especially in cases requiring substantial tissue volume and stability. However, its application has limitations\\u0026mdash;most notably, the need for a second surgical site and associated patient morbidity. In this context, ACM offers distinct advantages: standardization, availability, and simplified surgical protocols. From a clinical perspective, this reduces procedure time and eliminates donor site complications, making it especially useful in patients with thin biotypes or contraindications for autografts.\\u003c/p\\u003e \\u003cp\\u003eNevertheless, certain limitations of this study should be considered. The follow-up period was limited to 60 days, which may not capture the full course of tissue maturation or long-term stability. In addition, the recession defects were surgically created and not influenced by typical etiological factors such as trauma or inflammation, which are commonly involved in clinical cases. Treatment was also initiated relatively early\\u0026mdash;only one month after recession modeling\\u0026mdash;possibly before chronic tissue changes could fully develop.\\u003c/p\\u003e \\u003cp\\u003eDespite these limitations, the findings suggest that ACM can be a viable alternative to CTG in specific clinical contexts. Its performance in this preclinical model showed promising soft and hard tissue responses, good integration, and absence of adverse effects. The results justify further investigation in clinical settings with longer observation periods and a broader range of patient conditions.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003e \\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eThe use of ACM derived from bovine peritoneum to restore gingival recession has demonstrated comparable efficiency (restoration of gingival volume and bone) and safety (absence of local and systemic inflammatory reaction) to the known CTG graft.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eThe lower cost of ACM and comparable efficiency makes this graft more attractive for gingival recession repair.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"662\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAbbreviation\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 491px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDefinition\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003eARRIVE\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 491px;\\\"\\u003e\\n \\u003cp\\u003eAnimal Research: Reporting of In\\u0026nbsp;Vivo Experiments\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003eGR\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 491px;\\\"\\u003e\\n \\u003cp\\u003eGingival recession\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003eADM\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 491px;\\\"\\u003e\\n \\u003cp\\u003eacellular dermal matrix\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003eACM\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 491px;\\\"\\u003e\\n \\u003cp\\u003eacellular collagen matrix\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003eCTG\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 491px;\\\"\\u003e\\n \\u003cp\\u003econnective tissue graft\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003eCAF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 491px;\\\"\\u003e\\n \\u003cp\\u003ecoronally advanced flap\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 170px;\\\"\\u003e\\n \\u003cp\\u003eKMU\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 491px;\\\"\\u003e\\n \\u003cp\\u003eKaraganda Medical University\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eEthics approval statement: The study was conducted in accordance with the Declartion of Helsinki and approved by the local ethical committee of MUK NJSC dated 30.04.2024 No 41\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot aplicable\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials:\\u0026nbsp;\\u003c/strong\\u003eThe data supporting findings of this study are available from the corresponding author upon request. Please contact \\u0026nbsp;Zhadyra Ashirbekova, alaydob@gmail.com;\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests:\\u0026nbsp;\\u003c/strong\\u003eThe authors declare no conflict of interest\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u003c/strong\\u003e This research was conducted and the manuscript was written using the authors\\u0026rsquo; per-sonal funds. No external funding was received.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"77%\\\" class=\\\"fr-table-selection-hover\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCRediT Classification\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003eSvetlana Tuleutayeva\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003eOlga Ponamareva\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003eZhadyra Ashirbekova\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003eYerzhan Sharapatov\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003eDinara Zharlyganova\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003eZhandos Burkitbayev\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003eBaurzhan Anapiya\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eConceptualization\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eData Curation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eFormal Analysis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eFunding Acquisition\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eInvestigation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eMethodology\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eProject Administration\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eResources\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eSoftware\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eSupervision\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eValidation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eVisualization\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eWriting \\u0026ndash; Original Draft Preparation\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 32px;\\\"\\u003e\\n \\u003cp\\u003eWriting \\u0026ndash; Review \\u0026amp; Editing\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 9px;\\\"\\u003e\\n \\u003cp\\u003e+\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eAcknowledgements: No acknowledgments\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eCortellini P, Bissada NF. Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations. J Clin Periodontol. 2018;45(Suppl 20):S190\\u0026ndash;S198.\\u003c/li\\u003e\\n\\u003cli\\u003eMythri S, Arunkumar SM, Hegde S, Rajesh SK, Munaz M, Ashwin D. Etiology and occurrence of gingival recession\\u0026mdash;an epidemiological study. J Indian Soc Periodontol. 2015;19(6):671\\u0026ndash;675. doi:10.4103/0972-124X.156881\\u003c/li\\u003e\\n\\u003cli\\u003eKoteneva P, Kosheleva N, Fayzullin A, et al. Gene therapeutic drug pCMV-VEGF165 plasmid (\\u0026lsquo;Neovasculgen\\u0026rsquo;) promotes gingiva soft tissue augmentation in rabbits. Int J Mol Sci. 2024;25:10013. doi:10.3390/ijms251810013\\u003c/li\\u003e\\n\\u003cli\\u003eAlmuratova AS. Gingival recession. Med Ecol. 2018;86(1):15\\u0026ndash;22.\\u003c/li\\u003e\\n\\u003cli\\u003eKim DM, Neiva R. Periodontal soft tissue non-root coverage procedures: a systematic review from the AAP Regeneration Workshop. J Periodontol. 2015;86(Suppl 12):S56\\u0026ndash;S72.\\u003c/li\\u003e\\n\\u003cli\\u003eCosyn J, Hooghe N, De Bruyn H. A systematic review on the frequency of advanced recession following single immediate implant treatment. J Clin Periodontol. 2012;39(6):582\\u0026ndash;589. doi:10.1111/j.1600-051X.2012.01888.x\\u003c/li\\u003e\\n\\u003cli\\u003eNieri M, Pini Prato GP, Giani M, et al. Patient perceptions of buccal gingival recessions and requests for treatment. J Clin Periodontol. 2013;40(7):707\\u0026ndash;712. doi:10.1111/jcpe.12114\\u003c/li\\u003e\\n\\u003cli\\u003eTonetti MS, Jepsen S; Working Group 2 of the European Workshop on Periodontology. Clinical efficacy of periodontal plastic surgery procedures: consensus report of Group 2 of the 10th European Workshop on Periodontology. J Clin Periodontol. 2014;41(Suppl 15):S36\\u0026ndash;S43. doi:10.1111/jcpe.12219\\u003c/li\\u003e\\n\\u003cli\\u003eCairo F, Pagliaro U, Nieri M. Treatment of gingival recession with coronally advanced flap procedures: a systematic review. J Clin Periodontol. 2008;35(Suppl 8):136\\u0026ndash;162. doi:10.1111/j.1600-051X.2008.01267.x\\u003c/li\\u003e\\n\\u003cli\\u003eChambrone L, Salinas Ortega MA, Sukekava F, et al. Root coverage procedures for treating localized and multiple recession-type defects. Cochrane Database Syst Rev. 2018;10(10):CD007161. doi:10.1002/14651858.CD007161.pub3\\u003c/li\\u003e\\n\\u003cli\\u003eZucchelli G, Tavelli L, McGuire MK, et al. Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction. J Periodontol. 2020;91(1):9\\u0026ndash;16. doi:10.1002/JPER.19-0350\\u003c/li\\u003e\\n\\u003cli\\u003eGriffin TJ, Cheung WS, Zavras AI, Damoulis PD. Postoperative complications following gingival augmentation procedures. J Periodontol. 2006;77:2070\\u0026ndash;2079.\\u003c/li\\u003e\\n\\u003cli\\u003eBurkhardt R, Hammerle CH, Lang NP. Research group on oral soft tissue biology \\u0026amp; wound healing: self-reported pain perception of patients after mucosal graft harvesting in the palatal area. J Clin Periodontol. 2015;42(3):281\\u0026ndash;287.\\u003c/li\\u003e\\n\\u003cli\\u003eHuang H, Dong Z, Ren X, et al. High-strength hydrogels: fabrication, reinforcement mechanisms, and applications. Nano Res. 2023;16(2):3475\\u0026ndash;3515. doi:10.1007/s12274-022-5129-1\\u003c/li\\u003e\\n\\u003cli\\u003eJia B, Huang H, Dong Z, et al. Degradable biomedical elastomers: paving the future of tissue repair and regenerative medicine. Chem Soc Rev. 2024;53:4086\\u0026ndash;4153. doi:10.1039/D4CS00055A\\u003c/li\\u003e\\n\\u003cli\\u003eWainwright DJ. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns. 1995;21(4):243\\u0026ndash;248.\\u003c/li\\u003e\\n\\u003cli\\u003eAragoneses J, Suarez A, Rodr\\u0026iacute;guez C, Aragoneses JM. Histomorphometric comparison between two types of acellular dermal matrix grafts: a mini-pig animal model study. Int J Environ Res Public Health. 2021;18(8):3881. doi:10.3390/ijerph18083881\\u003c/li\\u003e\\n\\u003cli\\u003eSnyder DL, Sullivan N, Schoelles KM. Skin substitutes for treating chronic wounds. Technology Assessment Report. Plymouth Meeting, PA: ECRI Institute Evidence-based Practice Center; 2012.\\u003c/li\\u003e\\n\\u003cli\\u003eMinistry of Justice of the Republic of Kazakhstan. Patent No. 30382. Biological coating for treatment of burns and wounds. April 18, 2014.\\u003c/li\\u003e\\n\\u003cli\\u003eMinistry of Justice of the Republic of Kazakhstan. Patent No. 31456. Biological wound coating. May 30, 2014.\\u003c/li\\u003e\\n\\u003cli\\u003eMinistry of Justice of the Republic of Kazakhstan. Patent No. 31029. Biological wound coating based on the cattle abdominal membrane. April 7, 2015.\\u003c/li\\u003e\\n\\u003cli\\u003eEurasian Patent Organization. Eurasian Patent No. 029103. Biological wound coating. February 28, 2018.\\u003c/li\\u003e\\n\\u003cli\\u003eLivestock Data For Decisions. Livestock population trends. Accessed December 10, 2022. https://www.livestockdata.org/dataobject/livestock-population-trends\\u003c/li\\u003e\\n\\u003cli\\u003eJunqueira L, Carneiro J. Connective tissue. In: Basic Histology: Text \\u0026amp; Atlas. 11th ed. New York, NY: McGraw-Hill Medical; 2005.\\u003c/li\\u003e\\n\\u003cli\\u003eYesniyazov D, Tussupbekova M, Abatov N, et al. Myringoplasty with morphological rationale of application of xenoperitoneum decellularized matrix in experiment. Open Access Maced J Med Sci. 2021;9(A):811\\u0026ndash;816. doi:10.3889/oamjms.2021.6350\\u003c/li\\u003e\\n\\u003cli\\u003eBadyrov RM. Experimental substantiation of the applied extracellular matrix of xeno abdominal membrane for plastic repair of the defects of the anterior abdominal wall [dissertation]. Karaganda, Kazakhstan: Karaganda State Medical University; 2018.\\u003c/li\\u003e\\n\\u003cli\\u003eTuleubayev B, Ogay V, Anapiya B, et al. Therapeutic treatment of 2A grade burns with decellularized bovine peritoneum as a xenograft: multicenter randomized clinical trial. Medicina. 2022;58:819. doi:10.3390/medicina58060819\\u003c/li\\u003e\\n\\u003cli\\u003eNu\\u0026ntilde;ez J, Caffesse R, Vignoletti F, 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\\u0026ndash;531. doi:10.1111/j.1600-051X.2009.01413.x\\u003c/li\\u003e\\n\\u003cli\\u003eSculean A, Mihatovic I, Shirakata Y, et al. Healing of localized gingival recessions treated with coronally advanced flap alone or combined with either a resorbable collagen matrix or subepithelial connective tissue graft: a preclinical study. Clin Oral Investig. 2015;19(4):903\\u0026ndash;909. doi:10.1007/s00784-014-1299-x\\u003c/li\\u003e\\n\\u003cli\\u003eSt\\u0026auml;hli A, P\\u0026aacute;rk\\u0026aacute;nyi L, Aroca S, et al. The effect of connective tissue graft or a collagen matrix on epithelial differentiation around teeth and implants: a preclinical study in minipigs. Clin Oral Investig. 2023;27(8):4553\\u0026ndash;4566. doi:10.1007/s00784-023-05080-5\\u003c/li\\u003e\\n\\u003cli\\u003eSu\\u0026aacute;rez-L\\u0026oacute;pez Del Amo F, Rodriguez JC, Asa\\u0026rsquo;ad F, Wang HL. Comparison of two soft tissue substitutes for the treatment of gingival recession defects: an animal histological study. J Appl Oral Sci. 2019;27:e20180584. doi:10.1590/1678-7757-2018-0584\\u003c/li\\u003e\\n\\u003cli\\u003eVignoletti F, Nu\\u0026ntilde;ez J, Discepoli N, et al. Clinical and histological healing of a new collagen matrix in combination with the coronally advanced flap for the treatment of Miller class I recession defects: an experimental study in the minipig. J Clin Periodontol. 2011;38(9):847\\u0026ndash;855. doi:10.1111/j.1600-051X.2011.01767.x\\u003c/li\\u003e\\n\\u003cli\\u003eAvtandilov GG. Fundamentals of quantitative pathologic anatomy. Moscow, Russia: Medicine; 2002.\\u003c/li\\u003e\\n\\u003cli\\u003eGOST ISO 10993-1-2011. Evaluation of the biological effect of medical devices. Part 6. Studies of local action after implantation.\\u003c/li\\u003e\\n\\u003cli\\u003eTonetti MS, Cortellini P, Pellegrini G, et al. Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life. J Clin Periodontol. 2018;45(1):78\\u0026ndash;88. doi:10.1111/jcpe.12834\\u003c/li\\u003e\\n\\u003cli\\u003ePietruska M, Skurska A, Podlewski Ł, Milewski R, Pietruski J. Clinical evaluation of Miller class I and II recession treatment with the use of modified coronally advanced tunnel technique with either collagen matrix or subepithelial connective tissue graft: a randomized clinical study. J Clin Periodontol. 2019;46(1):86\\u0026ndash;95. doi:10.1111/jcpe.13021\\u003c/li\\u003e\\n\\u003cli\\u003eParween S, George JP, Prabhuji M. Treatment of multiple mandibular gingival recession defects using MCAT technique and SCTG with and without RHPDGF-BB: a randomized controlled clinical trial. Int J Periodontics Restor Dent. 2020;40(2):e43\\u0026ndash;e51.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-oral-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ohea\",\"sideBox\":\"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/ohea/default.aspx\",\"title\":\"BMC Oral Health\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"gingival recession, connective tissue graft, acellular collagen matrix, bovine peritoneum, histomorphometric analysis, animal study\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8018568/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8018568/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eGingival recession is wide spread pathology of oral cavity. Standard treatment presented by of connective tissue grafts with coronally advanced flap has significant limitation, such as creating donor site wound. Currently, alternative xenogenic materials are gaining popularity. We have conducted research on a material based on bovine peritoneum as an economically accessible and easy-to-obtain product.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eExperiment was conducted on 56 rabbits. After creating GR model, animals were divided into two treatment groups: CAF\\u0026thinsp;+\\u0026thinsp;ACM (experimental group), and CAF\\u0026thinsp;+\\u0026thinsp;CTG (control group). Clinical and histological evaluations were performed on days 14, 30, and 60. Assessed parameters included gingival recession height, keratinized tissue width, gingival thickness, alveolar bone condition, vascularization, and inflammatory response.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eBoth methods demonstrated comparable and satisfactory outcomes. No significant difference was observed in keratinized tissue width. However, the ACM group showed greater gingival thickness over time and better alveolar bone formation by day 60. Histological analysis also indicated more organized tissue structure, reduced inflammation, and earlier neovascularization in ACM group.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eACM showed good biocompatibility and well integrated at all stages of the research. Considering its regenerative properties and absence of donor site trauma, ACM may be considered as a perspective alternative to CAF.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Histologic Comparison of Gingival Recession Treatment: CTG vs. Bovine ACM in Rabbits\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-02-09 14:57:58\",\"doi\":\"10.21203/rs.3.rs-8018568/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-03-23T07:37:21+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-16T06:03:07+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-02T09:53:45+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"123759688780997829096482010079452864432\",\"date\":\"2026-02-10T10:00:39+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"142631010141721907713013582301186268534\",\"date\":\"2026-02-06T04:36:59+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-02-05T08:36:02+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2026-01-23T10:03:03+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-11-25T12:22:56+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-11-25T11:40:34+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Oral Health\",\"date\":\"2025-11-25T11:35:41+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-oral-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ohea\",\"sideBox\":\"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/ohea/default.aspx\",\"title\":\"BMC Oral Health\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"c9b328b3-3439-46bf-bc1a-4509e880354d\",\"owner\":[],\"postedDate\":\"February 9th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-23T15:08:29+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-02-09 14:57:58\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8018568\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8018568\",\"identity\":\"rs-8018568\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}