J Periodontal Implant Sci.  2018 Dec;48(6):395-404. 10.5051/jpis.2018.48.6.395.

Periodontal biotype modification using a volume-stable collagen matrix and autogenous subepithelial connective tissue graft for the treatment of gingival recession: a case series

• Kim HJ
• Chang H
• Kim S
• Seol YJ
• Kim HI

• KMID: 2429867
• DOI: http://doi.org/10.5051/jpis.2018.48.6.395

Abstract

PURPOSE
The purpose of this study was to propose a technique for periodontal biotype modification through thickening of the entire facial aspect using a volume-stable collagen matrix and autogenous subepithelial connective tissue graft (CTG) for the treatment of gingival recession.
METHODS
Four systemically healthy patients showing Miller class I or class II gingival recession in the mandibular incisor area were included in this study. Full-mouth scaling and root planing procedures were performed at least 4 weeks prior to periodontal plastic surgery. A split-thickness flap with a horizontal intrasulcular incision and 2 vertical incisions was used in cases 1-3, and the modified tunnel technique was used in case 4 for coronal advancement of the mucogingival complex. After the exposed root surfaces were debrided thoroughly, double-layered volume-stable collagen matrix was placed on the apical part of the recession and a subepithelial CTG harvested from the palatal area was placed on the coronal part. The amount of root coverage at 3 months postoperatively was evaluated in cases 1-3, and facio-lingual volumetric changes were analyzed in cases 1 and 2.
RESULTS
Healing was uneventful in all 4 cases and complete root coverage was shown in cases 1-3. In case 4, reduction of gingival recession was observed at 3 months after surgery. In cases 1 and 2, a comparison of stereolithographic files from the preoperative and postoperative time points demonstrated that the entire facio-lingual volume had increased.
CONCLUSIONS
The surgical technique suggested herein, using a volume-stable collagen matrix and autogenous subepithelial CTG, may be an effective method for periodontal biotype modification through thickening of the entire facial aspect for the treatment of gingival recession.

Keyword

Connective tissue; Gingival recession; Transplantation

MeSH Terms

Collagen*
Connective Tissue*
Gingival Recession*
Humans
Incisor
Methods
Root Planing
Surgery, Plastic
Transplantation
Transplants*
Collagen

Figure

• 

  Figure 1 Assessment of volumetric changes using stereolithographic files imported into a 3-dimensional measurement software program. (A) The ROI of case 1 showing localized gingival recession, defined as the area extending from the top of the tooth structure to the vestibular area of 4 mandibular incisors. (B) The ROI of case 2 showing multiple recession, defined as the tooth with recession and the adjacent tooth on both ends. ROI: region of interest.

• 

  Figure 2 Clinical photographs of case 1. (A) Presurgical view of the recession. A gingival recession defect was observed in the FDI tooth #31 area with CAL of 6 mm, corresponding to Miller class II recession. (B) The exposed root at the time of surgery. (C) Collagen matrix placement on the apical part and CTG placement on the coronal part of the recession area. (D) Three weeks after surgery. (E) Three months after surgery. FDI: Federation Dentaire Internationale, CAL: clinical attachment loss, CTG: connective tissue graft.

• 

  Figure 3 Clinical photographs of case 2. (A) Presurgical view of the recession. Miller class I gingival recession was observed in the FDI teeth #31, #32, and #41 areas, with CAL of 2.5, 2, and 1 mm, respectively. (B) Collagen matrix placement on the apical part of the recession area. (C) CTG placement on the coronal part of the recession area. (D) Three weeks after surgery. (E) Three months after surgery. FDI: Federation Dentaire Internationale, CAL: clinical attachment loss, CTG: connective tissue graft.

• 

  Figure 4 Clinical photographs of case 3. (A) Presurgical view of the recession. Miller class I gingival recession defect in the FDI tooth #41 area with CAL of 1.5 mm. (B) Collagen matrix placement on the apical part of the recession area. (C) CTG placement on the coronal part of the recession area. (D) Three weeks after surgery. (E) Three months after surgery. FDI: Federation Dentaire Internationale, CAL: clinical attachment loss, CTG: connective tissue graft.

• 

  Figure 5 Clinical photographs of case 4. (A) Presurgical view of the recession. Miller class II gingival recession was shown in the FDI tooth #31 area with CAL of 3 mm. (B) Collagen matrix and a CTG were placed through the incomplete vertical incisions in the apical part and in the coronal part of the recession area, respectively. (C) Three weeks after surgery. (D) Three months after surgery. Reduction of the gingival recession was observed. FDI: Federation Dentaire Internationale, CAL: clinical attachment loss, CTG: connective tissue graft.

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