Objective: The introduction of a new collagen substitute, that potentially will reduce the invasiveness of the two techniques, by avoiding the need for a second surgical site, i.e., the donor site, need to be evaluated in relation with the surgical procedure that could benefit the most by the utilization of such a matrix. The aim of this study was to compare the clinical outcomes following treatment of RT 1 multiple adjacent gingival recessions (MAGRs) using the modified coronally advanced tunnel technique (MCAT) or the multiple coronally advanced flap (MCAF) in conjunction with a new volume stable xenogeneic collagen matrix (VXCM). Secondarily, the study evaluated whether patients report a preference in terms of discomfort between the two surgical techniques. Methods: Twenty patients requiring treatment of MAGRs were randomly assigned to one of the two treatment groups (group A: MCAF+VCMX; group B: MCAT+VCMX). The following measurements were recorded at baseline (i.e. prior to surgery), at 6 and 12 months: gingival recession depth (REC), probing pocket depth (PPD), keratinized tissue width (KTW) and gingival thickness (GT). Post-operative pain and discomfort were recorded using a visual analogue scale (VAS) at 1 week. The primary outcome variable was mean root coverage (mRC), secondary outcomes were complete root coverage (CRC), change in KTW and GT, patient discomfort and satisfaction, and duration of surgery. Results: Healing was uneventful in both groups. At 12 months, both treatments resulted in statistically significant improvements of REC and GT compared with baseline (p < 0.05). The mRC measured 79.95 ± 29.92% at MCAF group, whereas 64.74 ± 40.5% MCAT group (p = 0.124). CRC was found at 65.6% of MCAF-treated sites and at 52% of MCAT-treated sites (p=0.181). Conclusions: Similar clinical results should be expected when MAGRs are treated with MCAF or MCAT, with the adjunct of VCMX.

The aim of the present case series was to evaluate the outcomes of the modified coronally advanced tunnel technique (MCAT) using the width of keratinized tissue (KTW) as an indicator to apply the connective tissue graft (CTG) specifically. Seven patients requiring treatment for the presence of multiple gingival RT1 recession defects in the maxilla were enrolled in the study. A total of 36 recessions were treated with MCAT, and the CTG was applied in 16 sites presenting < 2 mm of KTW at baseline. The mean root coverage from baseline to 1 year postsurgery was 90% for the sites treated with MCAT alone and 93.7% for those treated with MCAT+CTG. The increase of KTW was higher in the sites treated with CTG than in the sites treated without it. Within the limitations of the present case series, it can be concluded that the proposed surgical technique is extremely effective in gaining root coverage and reducing the amount of connective tissue harvested from the donor site.

Objectives: The aim of this case presentation was to evaluate the effectiveness of a surgical technique combining vestibuloplasty, and free gingival graft (FGG) transplantation at the same time as uncovering dental implants. Methods: The patient exhibited inadequate soft tissue condition at the buccal aspect of submerged dental implants (45, 46), 3 months after implant insertion: shallow vestibular fold and less than 1 mm, unstable keratinized mucosa (KM) were present. Following local anesthesia a crestal incision was made above submerged implants, continued in a paramarginal incision at the neighboring dentition. Split thickness flap was elevated, and fixed with resorbable sutures to the underlying periosteum 5-7 mm apically from the incision line. After uncovering the implants, temporary abutments were mounted. A FGG was harvested from the palate, adjusted to cover the exposed periosteal layer, and fixed with resorbable sutures to the underlying periosteum, and to the surrounding KM. Periodontal dressing was applied for 7 days at implant site, palatal donor site was covered with an absorbable collagen fleece fixed with mattress sutures. Sutures were removed 14 days postoperatively. Results: 2-3 mm keratinized mucosa was observed at the buccal aspect of 45, 46 dental implants, with no signs of inflammation. 3 months postoperatively, final restauration was cemented. Reestablished soft tissue conditions helped to prevent bacterial irritation resulted from masticatory movements, and helped the patient in oral hygiene maintenance. Conclusions: The presented combination of vestibuloplasty and FGG resulted in a stable, soft tissue environment around dental implants in the presented case. Further investigation needed to compare surgical modalities aiming to create KM around submerged dental implants. Keywords: uncovering implants, FGG, vestibuloplasty, soft tissue reconstruction, periimplantitis

This case report presents a patient who underwent a major correction of malpositioned implants. Two implants were previously placed in a 30-year-old woman to replace the maxillary right central and lateral incisors without any attempt to reconstruct the alveolar and soft tissue defects. This resulted in a significant esthetic problem. The position of the implants was successfully corrected via the mobilization of a bone block in which the implants were maintained. The bone block was then fixed in a predetermined optimal position. After fixing the bone block, gaps were filled with Bio-Oss and covered with a membrane. Nine months after bone healing, a periodontal technique was used to improve soft tissue esthetics. The final result was achieved with the combination of bone surgery, soft tissue management, and progressive adaptation of implant-supported crown restorations.

Objective: To clinically evaluate the treatment of Miller Class I and II multiple adjacent gingival recessions using the modified coronally advanced tunnel technique combined with a newly developed bioresorbable collagen matrix of porcine origin. Method and Materials: Eight healthy patients exhibiting at least three multiple Miller Class I and II multiple adjacent gingival recessions (a total of 42 recessions) were consecutively treated by means of the modified coronally advanced tunnel technique and collagen matrix. The following clinical parameters were assessed at baseline and 12 months postoperatively: full mouth plaque score (FMPS), full mouth bleeding score (FMBS), probing depth (PD), recession depth (RD), recession width (RW), keratinized tissue thickness (KTT), and keratinized tissue width (KTW). The primary outcome variable was complete root coverage. Results: Neither allergic reactions nor soft tissue irritations or matrix exfoliations occurred. Postoperative pain and discomfort were reported to be low, and patient acceptance was generally high. At 12 months, complete root coverage was obtained in 2 out of the 8 patients and 30 of the 42 recessions (71%). Conclusion: Within their limits, the present results indicate that treatment of Miller Class I and II multiple adjacent gingival recessions by means of the modified coronally advanced tunnel technique and collagen matrix may result in statistically and clinically significant complete root coverage. Further studies are warranted to evaluate the performance of collagen matrix compared with connective tissue grafts and other soft tissue grafts. Keywords: collagen matrix, modified coronally advanced tunnel, multiple adjacent gingival recessions, root coverage

Objective: Predictable coverage of multiple adjacent gingival recessions (MAGRs) is a major challenge for clinicians. Although several surgical techniques have been proposed to treat MAGR, it is still unclear as to what extent the proposed approaches may lead to predictable root coverage. The aim of this article is to identify the predictability of the available surgical techniques used to achieve complete root coverage (CRC) of Miller Class I, II, and III MAGRs. Method and Materials: A search of the PubMed database was performed. Additional hand searching and a search for gray literature were also conducted. Due to the heterogeneity of the data, no meta-analysis could be performed. Results: The search resulted in the selection of 16 publications analyzed in this review. In Miller Class I and II MAGRs, the coronalIy advanced flap (CAF) and the modified coronally advanced flap (MCAF) yielded a CRC ranging from 74.6% to 89.3% and a mean root coverage (MRC) ranging from 91.5% to 97.27% at 6 to 12 months following surgery. In Miller Class I and II recessions, the results obtained with MCAF were maintained for up to 5 years (CRC ranging from 35% to 85.1%), as indicated by two studies. One study has indicated that MCAF + connective tissue grafting (CTG) may improve the long-term stability of CRC compared with MCAF (35% CRC without CTG vs 52% CRC with CTG). In Miller Class I and II MAGRs, the use of CTG in conjunction with CAF, MCAF, coronally positioned pedicle (CPP), double pedicle graft (DPG), or the supraperiosteal tunnel technique yielded higher CRC or MRC than with bioabsorbable membranes, acellular dermal matrix (ADM), or platelet-rich fibrin (PRF). In Miller Class III MAGRs, the modified coronally advanced tunnel (MCAT) and CTG with and without an enamel matrix derivative resulted in 38% CRC and in 82% to 83% MRC, respectively. Conclusion: The present findings indicate that in Miller Class I and II MAGRs, CAF or MCAF with or without CTG may lead to predictable CRC; the CRC obtained with MCAF were maintained over a period of 5 years; the use of CTG appears to improve the long-term stability of the MCAF; and the use of CTG in conjunction with CAF, MCAF, CPP, DPG, or the supraperiosteal tunnel technique appear to yield higher CRC or MRC than the use of bioabsorbable membranes, ADM, or PRF. Also, MCAT plus CTG appears to represent a valuable technique for the treatment of Miller Class III MAGRs. Keywords: coronally advanced flap, multiple adjacent gingival recessions, pedicle flap, root coverage, soft tissue grafts, tunnel