Flap surgery in conjunction with a collagen matrix and enamel matrix derivative

  • Gingival recession at the upper canine. Healthy interdental tissues.
  • Flap preparation. Incisions according to the coronally advanced flap (CAF) technique.
  • Application of Straumann® Emdogain® onto the exposed root surface.
  • mucoderm® matrix placed over the exposed root and fixed by sutures.
  • Repositioning of the flap and suturing.
  • Resolution of the defect. Complete root coverage.
Depending on the soft tissue situation, a collagen matrix (mucoderm®) may be used to cover exposed roots in Miller class I or II gingival recessions as an alternative to the autologous subepithelial connective tissue graft. mucoderm® helps to maintain or increase gingival tissue thickness, which may be of advantage in thin gingival biotypes. Adding enamel matrix derivative (Straumann® Emdogain®) to a root coverage procedure with mucoderm® improves the quality type of the attachment [1, 2], stimulates angiogenesis [3], which may improve revascularization and integration of the collagen matrix and improves the quantity of keratinized tissue [4], which may be beneficial in case of less or no residual keratinized gingiva.
Multiple recession coverage using MCAT in conjunction with mucoderm® and Emdogain® - Dr. D. Rakasevic
Multiple recession coverage using MCAT in conjunction with mucoderm® and Emdogain® - Dr. D. Rakasevic

Pre-operative situation.

Multiple gingival recessions treated with the modified coronally advanced tunnel in conjunction with mucoderm® and Straumann® Emdogain® - Dr. F. Rathe (1)
Multiple gingival recessions treated by MCAT in conjunction with mucoderm® and Straumann® Emdogain® (1) - Rathe

Pre-operative clinical situation. Gingival recessions at teeth 11 and 21.

Isolated gingival recessions treated with the coronally advanced flap in conjunction with mucoderm® and Straumann® Emdogain® - Prof. Dr. Mario Taba Jr
Isolated gingival recessions treated by CAF in conjunction with mucoderm® and Straumann® Emdogain® - Taba Jr

Pre-surgical clinical situation. Deep gingival recessions at both upper canine.

Gingival contour augmentation and recession coverage with cerabone®, mucoderm® and Straumann® Emdogain®- Dr. D. B. Hangyási
Gingival contour augmentation- Hangyási

Initial clinical situation

Multiple recession coverage with mucoderm® and Straumann® Emdogain® - 4 year follow-up - Prof. G. Zucchelli & Dr. M. Stefanini
Multiple recession coverage with mucoderm® - Prof. G. Zucchelli & Dr. M. Stefanini

Initial clinical situation

Multiple gingival recessions treated with the coronally advanced flap in conjunction with mucoderm® and Straumann® Emdogain® - Prof. Dr. Dr. A. Kasaj
Multiple gingival recessions treated by CAF in conjunction with mucoderm® and Straumann® Emdogain® - Kasaj

Pre-operative clinical view. Multiple adjacent gingival recessions.

Multiple gingival recessions treated with the modified coronally advanced flap in conjunction with mucoderm®, Straumann® Emdogain® and autologous CTG - Dr. F. Benvenuto
Multiple gingival recessions treated by MCAF in conjunction with mucoderm®, Straumann® Emdogain® and CTG - Benvenuto

Pre-operative clinical situation. Multiple adjacent gingival recessions.

Multiple gingival recessions treated with the modified coronally advanced flap in conjunction with mucoderm® and Straumann® Emdogain® - Dr. D. B. Hangyási
Multiple gingival recessions treated by MCAF in conjunction with mucoderm® and Straumann® Emdogain® - Hangyási

Pre-surgical situation. Multiple adjacent gingival recessions at teeth 12, 13 and 14.

Multiple gingival recessions treated with the modified coronally advanced tunnel in conjunction with mucoderm® and Straumann® Emdogain® - Dr. D. B. Hangyási
Multiple gingival recessions treated by MCAT in conjunction with mucoderm® and Straumann® Emdogain® - Hangyási

Pre-operative clinical situation.

Multiple gingival recessions treated with the modified coronally advanced tunnel in conjunction with mucoderm® and Straumann® Emdogain® - Dr. F. Rathe (2)
Multiple gingival recessions treated by MCAT with mucoderm® and Straumann® Emdogain® (2) - Rathe

Pre-operative clinical situation. Shallow multiple adjacent gingival recessions in the first quadrant.

Flap techniques

mucoderm® and Straumann Emdogain® can be used in conjunction with all state-of-the-art mucogingival surgical procedures to treat isolated or adjacent multiple gingival recessions including coronally-advanced flap procedures and tunnel techniques [2].

Coverage of the collagen matrix

Make always sure to cover the mucoderm® matrix completely by the repositioned flap when used in recession coverage procedures. The collagen matrix requires nutrient and blood supply from the overlying soft tissue when placed on avascular root surfaces. Early exposure may lead to soft tissue graft failure.

Rehydration of the collagen matrix

To allow for optimal flexibility and adaptation to the root surfaces, rehydrate the mucoderm® matrix in sterline saline solution or patient blood before defect application for 5 to 10 minutes.

mucoderm® and Straumann® Emdogain® present a possible alternative to the autologous subepithelial connective tissue graft for the treatment of multiple adjacent gingival recessions.

mucoderm® is a natural type I/III collagen matrix originating from porcine dermis with a high interconnected porosity that consists of collagen and elastin [5, 6]. mucoderm® promotes the revascularization and fast soft tissue integration and is a valid alternative to the patient’s own connective tissue [7, 8].

Straumann® Emdogain® is an easy-to-apply gel containing enamel matrix derivative originiating from non-erupted porcine tooth buds. As a component of embryonic tissues it is designed to promote predictable regeneration of hard and soft tissues lost due to periodontal disease or trauma. Straumann® Emdogain® has been shown to significantly improve complete root coverage in coronally advanced flap procedures [9].

 

[1] McGuire et al. J Periodontol. 2003 Aug;74(8):1126-35
[2] Shirakata et al. Clin Oral Investig. 2016 Sep;20(7):1791-800
[3] Kasaj et al. J Periodontal Res. 2012 Aug;47(4):479-87
[4] Pilloni et al. J Periodontol. 2006 Dec;77(12):2031-9
[5] Pabst et al. J Periodontal Res. 2014 Jun;49(3):371-81
[6] Pabst et al. Clin Oral Investig. 2015 Mar;19(2):561-4
[7] Cosgarea et al. Quintessence Int. 2016;47(9):739-47
[8] Cieślik-Wegemund et al. J Periodontol. 2016 Dec;87(12):1436-1443
[9] Cairo et al. J Clin Periodontol. 2008 Sep;35(8 Suppl):136-62