BIOBRIEF

Geistlich Mucograft® for the Treatment of Multiple Adjacent Recession Defects: A More “Palatable” Option

Dr. Daniel Gober

THE SITUATION

A 35-year-old male presented in my practice with a chief complaint of recession. Multiple buccal recession defects ranging 2-5 mm were noted by teeth #11-14 with a minimal amount of keratinized tissue on the buccal of #14. Bone levels were within normal limits with no loss of interproximal tissue observed. These recession defects are classified as Miller Class I recession defects. Typically, 100% root coverage is expected for recession defects of this type.

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”
Bone defect(s)	Not present	Slight defect <2mm	Significant >3mm
Keratinized tissue	Adequate 5mm	Inadequate <5mm	Inadequate <3mm
Miller classification	Class I-II	Class III	Class IV

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THE APPROACH

My treatment goals included completing root coverage of the recession defects and augmentation of the width of attached keratinized tissue by tooth #14. My patient had similar recession defects on teeth #3-6 which were previously treated with an autogenous sub-epithelial connective tissue graft. Instead of autogenous tissue grafting, Geistlich Mucograft®, a xenogenic collagen matrix, was used in conjunction with a coronally advanced flap.

Pre-operative view of recession defects that ranges from 2-5 mm. There is minimal keratinized tissue on #14. Pocket depths are within limits with no loss of interproximal tissue.

A 15c blade is used to make sulcular incisions with scooping incisions at the level of the CEJ. A combination flap consisting of full-thickness coronally followed by a partial-thickness dissection apically is reflected.

The papillary tissue is de-epithelialized with a football diamond bur on a rotary hand piece. This exposes a vascular bed for the graft and intended coronal positioning of the flap.

Side-view of the recession defects. It is clearly visible how deep the recession defects are.

Geistlich Mucograft® is trimmed and positioned to extend beyond the root surfaces. A combination of simple interrupted sutures at its coronal edge and mattress sutures extending over the entire graft are used to adapt the graft to the recipient site.

The flap is then advanced and coronally positioned with horizontal mattress sutures to release tension and simple interrupted sutures to approximate the flap edges to the de-epithelialized papillas.

Follow-up after 1 week: note that the flap margins appear stable. Erythema and edema evident with maturation of the tissue beginning.

Follow-up after 3 months: maturation of the tissue evident with complete root coverage. An increase in the zone of keratinized tissue by #14 is also visible.

Follow-up after 1 year: stability of the graft is evident, complete coverage and a healthy and maintainable gingival situation have been achieved.

“The patient was unhappy with the post-operative morbidity he
experienced as a result of the previous connective tissue graft.”

THE OUTCOME

This case illustrates the successful use of Geistlich Mucograft®, a xenogenic collagen matrix, for the treatment of multiple adjacent recession defects. Complete root coverage and an increase in the zone of keratinized tissue was obtained and a dento-gingival complex that is amenable to long-term health and stability was achieved. My patient was spared from the inevitable morbidities associated with a sub-epithelial connective tissue graft from a palatal donor site.

Geistlich Mucograft® is a viable alternative to an autogenous tissue graft for the treatment of recession defects.”
Dr. Daniel Gober

Having a thorough knowledge of wound healing can make all of the difference. Every step of the procedure must be planned with the goal of maximizing vascularization of the graft matrix.”
Dr. Daniel Gober

Due to its ability to smoothly and meticulously guide small suture needles through soft-tissue, the castroviejo needle holder is my instrument of choice when suturing during periodontal plastic procedures.”
Dr. Daniel Gober

Dr. Daniel Gober

Dr. Daniel D. Gober received his DDS from SUNY Stony Brook School of Dental Medicine in 2010. He completed his residency in periodontics and implantology at Nova Southeastern University. Dr. Gober is board certified by the American Academy of Periodontology and is a Diplomate of the International Congress of Oral Implantology. He is also certified in the administration of IV sedation and specializes in soft-tissue procedures around both natural teeth and implants. He currently practices in Cedarhurst, NY at South Island Periodontics & Implantology, PLLC.