Mucograft® as an Alternative Treatment in the Management of Multiple Gingival Recessions: A Case Report

Radiographically, there were no suggestive images of caries or periapical alterations. Initially, the patient was treated with basic periodontal procedures of supragingival scaling and root planing, and oral hygiene instruction were given. The upper right canine tooth to first molar tooth showed 2.5mm to 3mm of gingival recession. The planning included root coverage surgery with a 15 × 20 mm Mucograft® collagen matrix (Geistlich Pharma AG, Wolhusen, Switzerland) associated with coronally positioned flap. After local anesthesia, an intrasulcular incision was performed on the buccal aspect from the upper right central incisor tooth to the distal of the right second molar. A partial thickness flap was then executed, except on the central and lateral incisors, where a total thickness flap was carried out (Figure 2).

Root planing was performed with Gracey curettes and decontamination of the surfaces was executed using tetracycline hydrochloride and saline solutions for 30 seconds in each root surface. After preparation of the exposed root, the graft was adapted according to the size of each tooth root and positioned following the manufacturer’s instructions (Figure 3).

Two simple sutures were performed to stabilize the graft using Vicryl 6.0 suture material (Ethicon, São Paulo, Brazil). Suspensory sutures in the coronally positioned flap were finally executed (Figure 4).

Post-operative Instructions

Medications:

• Anti-inflammatory (nimesulide 100mg, every 12 h for 5 days),
• Analgesic (Paracetamol 500 mg, every 6 h for 3 days) and
• Antibiotic (Amoxicillin 500 mg, every 8 h for 7 days) were prescribed postoperatively.

Oral hygiene measures:

• Mouthwashe of 0.12% chlorhexidine were prescribed twice a day for 7 days.
• The patient was advised to suspend brushing in the operated area.

Follow-up

The sutures were removed 14 days after surgery (Figure 5).

The measurements were performed after every 6 months. After 12 months (Figure 6), the results were again measured and satisfactory root coverage was obtained.

Discussion

Several techniques have been presented as treatment for gingival recession, all of them aiming to achieve full coverage of the recession, improve the esthetic condition and decrease sensitivity, while maintaining periodontal health.9

The subepithelial connective tissue graft associated with coronally positioned flap is a technique with high predictability, which has been presenting the best esthetic results among other procedures. However, the morbidity of removing connective tissue from palate is a frailty of this technique; thus, there is an interest in searching for less invasive alternatives, such as the one reported in this case.

To exclude the need for the connective tissue grafts, the Mucograft® was developed; it consists of a xenogenous collagen matrix originated from porcine and composed of collagen Type I and III. It has a bilayer structure, where

• the less porous surface is elastic, ensuring structural integrity of the material and allowing the suture stabilization in the surgical area that receive the matrix; and
• more porous surface that allows adherence, which promotes healing and cell integration.

Thus, as performed in this case, the more porous surface of the collagen matrix contacts the bone defect to facilitate tissue growth and stabilize the clot. This collagen matrix is specific to regenerate soft tissues and may be used alternatively to increase the volume of keratinized gingiva.7 In the present case, the matrix was used to cover the multiple gingival recessions and increase the tissue thickness. The clinical use of Mucograft® have presented satisfactory clinical results. The results using collagen matrix are similar to the results obtained for subepithelial connective tissue grafts, especially regarding the color.

Conclusion

The root coverage with a coronally positioned flap using Mucograft®, a bilayered collagen matrix for this clinical case was effective. A significant increase in thickness of the gingival tissue that received the collagen matrix was observed; thus, it can be considered a viable treatment option and a suitable graft for soft tissue augmentation.