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ePaper created 2015-03-04, 10:43:31 | version 1.33.01
I case report Fig. 7_Regio 13, 3-D collagen matrix in situ. Fig. 8_Regio 13, coronal repositioning of the flap. Fig. 9_Regio 13, clinical situation two weeks post-op. Fig. 10_Regio 13, clinical situation six months post-op (3-D collagen matrix). Fig. 11_Regio 23, initial clinical situation. Fig. 12_Regio 23, clinical situation six months post-op (treated using CTG). 14 I implants1_2015 treated on the same day, and both transplants were combined with a coronally advanced flap. _Surgical procedure First, a horizontal incision at the height of the cemento-enamel junction in the region of the in- terdental papillae was performed (Fig. 2). The coronal side of the papillae was de-epithelialised; the resulting connective tissue triangles served for the later fixation of the mucosal flap (Fig. 3). The full width of the interdental papillae was maintained. Two vertical incisions were made and a mucosal flap was raised without compromising the connective tissue triangles in the area of the interdentalpapillae(Figs.4&5).Subsequently,the roots of the affected teeth were cleaned and planed (Fig. 6). The 3-D collagen matrix was first rehydrated in sterile saline, then cut to shape and fixed to the periosteum with resorbable sutures (Fig.7).Next,aperiostealincisionattheapicalend ofthemucosalflapwasperformedtoenablerepo- sitioning of the flap and tension-free fixation to the connective tissue triangles of the interdental papillae with non-resorbable sutures (Fig. 8). Plaque-inhibiting agents were prescribed for the first two weeks after surgery. The sutures were re- moved two weeks post-operatively (Fig. 9). Figure 10 demonstrates the clinical result six months post-operatively. The recession in region 23 was treated with a CTG and a coronally advanced flap. Figures 11 and 12 show the situation preopera- tively and six months after recession coverage. There was no visible difference between the two differently treated regions. _Conclusion The CTG has successfully been applied in peri- odontal surgery for a long time. Because of better colourmatchingwiththegingiva,theCTGshowsbet- ter aesthetic results compared with free gingival grafts. The new 3-D collagen matrix offers a valid al- ternative to the application of a CTG. The surgical technique (coronally advanced flap, tunnel tech- nique,etc.)doesnotrequireadaptationandcanbese- lected according to the individual case. The advan- tage of using the 3-D collagen matrix is circumven- tion of a second surgical site for harvesting of the transplant,whileachievingthedesiredaestheticand functionalresults. Inmypractice,morethan50gin- gival recessions have been treated with a combina- tion of a 3-D collagen matrix with a coronally ad- vanced flap over the last several years, and no com- plications have been observed. Furthermore, the re- sultsofanongoingclinicalstudybyourteamindicate that there is no difference between the results of re- cession coverage after treatment with a CTG or with a3-Dcollagenmatrix._ contact Prof.Dr Gregor-Georg Zafiropoulos Specialist for Periodontology (DGP–German Soc.Periodontology) Expert for Oral Implantology (DGOI_German Soc.Oral Implantology) Diplomate of ICOI Sternstr.61,40479 Düsseldorf zafiropoulos@prof-zafiropoulos.de Fig. 10 Fig. 12Fig. 11 Fig. 7 Fig. 9Fig. 8