Soft-Tissue Regeneration
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Dr. Francesco Cairo
Root coverage at multiple gingival recessions with coronally advanced flap and Geistlich Fibro-Gide®
The Situation A young male patient (23 years) was referred to the clinic for dental sensitivity and esthetic concern in the upper, left quadrant. The patient showed no systemic disease and did not smoke. Upon the clinical examination, multiple recessions were detectable from left lateral incisor to first left molar. Recessions were often associated with enamel abrasions.
The Risk Profile Low Risk
Medium Risk
High Risk
Patient’s health
Intact immune system
Light smoker
Impaired immune system
Patient’s esthetic requirements
Low
Medium
High
Height of smile line
Low
Medium
High
Gingival biotype
Thick – “low scalloped”
Medium – “medium scalloped”
Thin – “high scalloped”
Shape of dental crowns
Rectangular
Infection at implant sight
None
Chronic
Acute
Bone height at adjacent tooth site
≤ 5 mm from contact point
5.5 - 6.5 mm from contact point
≥ 7 mm from contact point
Restorative status of adjacent tooth
Intact
Width of tooth gap
1 tooth (≥ 7 mm)
Soft-tissue anatomy
Intact
Bone anatomy of the alveolar ridge
No defect
Triangular
Compromised 1 tooth (≤ 7 mm)
2 teeth or more Compromised
Horizontal defect
Vertical defect
“The patient request was to reduce dental sensitivity and improve esthetics. At clinical examination, recessions showed 2-5 mm depth.” Francesco Cairo, DDS – Periodontology and Implant Dentistry
Head of the Research Unit in Periodontology and Periodontal Medicine and Director of the full-time Master Program in Periodontology at the University of Florence, Florence, Italy. He is an active member and treasurer of the Italian Society of Periodontology (SIdP). He graduated at Siena University in 1998, then moved at Florence University where was trained in Periodontology, Implant Dentistry and Oral Surgery.
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The Approach
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The goal of treatment was to improve esthetic conditions and to reduce dental hypersensitivity. Before surgery, reconstruction of CEJ area at premolars/first molar site was perfomed. A multiple envelope coronally advanced flap with split-full-split thickness approach was planned in conjunction with Geistlich Fibro-Gide® matrix. The absence of releasing incisions in the coronally advanced envelope reduces scarring and improves the esthetics. According to the recession size and corresponding amount of keratinized tissue, Geistlich FibroGide® was applied at premolars in order to selectively increase thickness at this sites, thus improving the probability of complete root coverage. When handling Geistlich Fibro-Gide®, it is critical to size the matrix 3-4 mm apically to the dehiscence area, in order to improve its stability and to favor blood ingrowth into the matrix. After grafting, care must be taken to advance the envelope sufficiently in order to suture it without any tension. Proper stabilization of the advanced envelope with sutures is crucial for the success of the treatment.
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The Outcome 7
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This case demonstrates how it is possible to improve the clinical and esthetic situation of a multiple soft-tissue recession with a coronally advanced envelop and a Geistlich Fibro-Gide®. The use of the xenogeneic matrix avoids the second surgery for harvesting of autogenous soft-tissue graft. Full stable root coverage was achieved 1 year after surgery.
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| 1 Baseline conditions, with gingival recession from tooth 22 to tooth 26. Note the presence of enamel abrasion. | 2 Restoration of abrasion at teeth 24, 25 and 26 was performed before surgery. | 3 Multiple coronally advanced flap was raised up from central incisor to second molar. | 4 Lateral view, after root planing. | 5 Application of Geistlich Fibro-Gide® at premolar sites . | 6 Matrix stability (lateral view). | 7 Coronally advanced flap to completely cover the matrix . | 8 One year outcome with full root coverage. | 9 One year follow-up (lateral view).
Keys to Success More details about our distribution partners: www.geistlich-biomaterials.com Manufacturer Geistlich Pharma AG Business Unit Biomaterials Bahnhofstrasse 40 6110 Wolhusen, Switzerland Phone +41 41 492 55 55 Fax +41 41 492 56 39 www.geistlich-biomaterials.com
Restoration of enamel abrasion Flap design: coronally advanced envelope flap Application of matrix at deepest recessions Stable suture
Geistlich Fibro-Gide® matrix in combination with coronally advanced flap may be a predictable procedure for multiple recession coverage.
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REFERENCES 1
Cairo F et al. J Clin Periodontol 2014, Apr;41 Suppl 15:S44-62 (Systematic review based on clinical publications).
2 Tonetti M. et al. J Clin Periodontol 2018 Jan;45(1):78-88 (Clinical Study). 3 Cairo F J Clin Periodontol. 2016 Nov;43(11):965-975 (Systematic review based on clinical publications). 4 Cairo F. Periodontology 2000 2017 Oct;75(1):296-316 (Clinical Study). 5 Cairo et al. J Clin Periodontol. 2020 Mar;47(3):362-371 (Systematic review based on clinical publications).
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