Root coverage at multiple gingival recessions with coronally advanced flap and Geistlich Fibro-Gide®

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.

Affiliate Australia and New Zealand Geistlich Pharma Australia and New Zealand The Zenith – Tower A Level 19, Suite 19.01 821 Pacific Highway NSW 2067 Chatswood, Australia Phone +61 1800 776 326 Fax +61 1800 709 698 info@geistlich.com.au www.geistlich.com.au Affiliate Great Britain and Ireland Geistlich Sons Limited 1st Floor, Thorley House Bailey Lane Manchester Airport Manchester M90 4AB, Great Britain Phone +44 161 490 2038 Fax +44 161 498 6988 info@geistlich.co.uk www.geistlich.co.uk

Distribution Canada HANSAmed Ltd. 2830 Argentia Road Unit 5–8 L5N 8G4 Mississauga, Canada Phone +1 800 363 2876 Fax +1 800 863 3213 orders@hansamed.net www.hansamed.net

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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