Root coverage at multiple recessions
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 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 Fibro-Gide® 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.
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.
Keys to Success
- Restoration of enamel abrasion
- Flap design: coronally advanced envelope flap
- Application of matrix at deepest recessions
- Stable suture