Treatment of multiple gingival recessions with tunnel procedure and a new xenogeneic collagen matrix

Abstract

Background Connective tissue graft remains the gold standard of root covering techniques in the treatment of gingival recessions, as well as thickening of periodontal tissues. However, sampling at the donor site, leads to high morbidity rates (pain, necrosis, haemorrhage) and increases the surgical time. Substitutes, such as this new collagen matrix have been considered as alternative to autogenous soft tissue grafts in periodontal plastic surgery. Aim/Hypothesis The aim of this prospective study was to clinically evaluate the treatment of maxillary Miller Class I and II multiple adjacent gingival recessions using the modified coronally advanced tunnel technique combined with a new porcine collagen matrix Creos Mucogain® (Nobel Biocare). Material and Methods Ten patients aged from 23 to 62 years (6 women and 4 men), in good general health and non-smoking, presenting at least three adjacent maxillary Miller Class I or II gingival recessions were included in this prospective clinical study. They all received oral hygiene instruction and were treated consecutively by modified coronally advanced tunnel technique combined with a new three-dimensional 3 mm thick collagen matrix (Creos Mucogain®, Nobel Biocare). At baseline and at 1, 3 and 6 months postoperatively, clinical parameters such as recession depth, recession width, probing depths, height of keratinized tissue, clinical attachment level, mean root coverage and complete root coverage, were recorded. Patients were asked if they were satisfied with the appearance of the operated site, and if they would undergo the same surgery again. The unpaired t test was used to check the significance of the change between baseline and at 6 months. A 95% confidence level was considered with P = 0.05. Results 58 recessions (45 Miller Class I and 13 Miller Class II) were treated. No infectious complication or acute pain was reported during healing, even on the 6 sites where the matrix was not totally covered by the flap. All the clinical parameters were improved and root coverage percentages were satisfactory. The new Creos Mucogain® matrix may show interesting clinical results. The operating time is reduced for the practitioner as for the patient. On the other hand, the extra-cost of the matrix, its animal origin, and its lack of clinical follow-up can be a barrier to using this substitute routinely. Conclusion and Clinical Implications Within the limits of this study, the present findings indicate that this new 3D porcine collagen matrix may be successfully used for the treatment of maxillary Miller Class 1 and II multiple adjacent gingival recessions. However, further split-mouth studies comparing this substitute to the connective tissue graft, are necessary to conclude.