VOLUME 44 NUMBEP 1 JANUAPY 2013 17

QUI NTESSENCE I NTERNATI ONAL

PERIODONTOLOGY
root surface exposure to the oral cavity is
frequently associated with esthetic com-
plaints, root hypersensitivity, and difculties
in achieving optimal plaque control.
36
The etiology of gingival recession is com-
plex, commonly related to overcontoured
tooth shape and malposition in the dental
arch, alveolar bone dehiscence, thin bio-
type, muscle attachment, obsessive tooth
brushing, localized or generalized peri-
odontal disease, or iatrogenic dental treat-
ments.
36
As one of the most signicant
predeterminants, a thin gingival biotype is
considered to be the most relevant ana-
tomical factor of gingival recession,
7

although controversial data have been pub-
lished on the minimally sufcient width and
thickness of keratinized gingiva that are
needed for long-term stability of marginal
soft tissue contours.
8,9
Therefore, most soft
A gingival recession is dened as the expo-
sure of the root surface due to the displace-
ment of the gingival margin apical to the
cementoenamel junction (CEJ).
1,2
As a result,
1
Assistant Professor, Department of Periodontology,
Semmelweis University, Budapest, Hungary.
2
Associate Professor, Department of Periodontology, School of
Dental Medicine, University of Bern, Bern, Switzerland.
3
Professor and Chair, Department of Periodontology,
Semmelweis University, Budapest, Hungary.
4
Professor, Department of Periodontology, Semmelweis
University, Budapest, Hungary.
5
Associate Professor, Department of Periodontology and Oral
Gerontology, Royal Dental College, Aarhus, Denmark.
6
Professor and Chair, Department of Periodontology, School of
Dental Medicine, University of Bern, Bern, Switzerland.
Correspondence: Dr Anton Sculean, Department of
Periodontology, School of Dental Medicine, University of Bern,
Freiburgstrasse 7, 3010 Bern, Switzerland. Email: anton.scu-
lean@zmk.unibe.ch
Treatment of multiple adjacent Miller Class I and
II gingival recessions with collagen matrix and
the modied coronally advanced tunnel technique
Blint Molnr, DMD
1
/Sofa Aroca, DMD, PhD
2
/Tibor Keglevich, DMD
1
/
Istvn Gera, DMD, PhD
3
/Pter Windisch, DMD, PhD
4
/Andreas
Stavropoulos, DDS, PhD
5
/Anton Sculean, Prof, Dr Med Dent, MS, Dr hc
6
Objective: To clinically evaluate the treatment of Miller Class I and II multiple adjacent
gingival recessions using the modied 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 modied coronally advanced tunnel technique and collagen matrix. The
following clinical parameters were assessed at baseline and 12 months postoperatively:
ull moutn plaquo sooro (FMPS), ull moutn blooding sooro (FMBS), probing doptn (PD),
rooossion doptn (PD), rooossion widtn (PW), koratinizod tissuo tnioknoss (KTT), and kora-
tinizod tissuo widtn (KTW). Tno primary outoomo variablo was oomploto root oovorago.
Results: Noitnor allorgio roaotions nor sot tissuo irritations or matrix oxoliations ooourrod.
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: Witnin tnoir limits, tno prosont
results indicate that treatment of Miller Class I and II multiple adjacent gingival recessions
by means of the modied coronally advanced tunnel technique and collagen matrix may
result in statistically and clinically signicant complete root coverage. Further studies are
warranted to evaluate the performance of collagen matrix compared with connective tissue
grafts and other soft tissue grafts. (Quintessence Int 2013;44:1724)
Key words: collagen matrix, modied coronally advanced tunnel, multiple adjacent
gingival recessions, root coverage
18 VOLUME 44 NUMBEP 1 JANUAPY 2013
QUI NTESSENCE I NTERNATI ONAL
Mol nr et al
tissue augmentation procedures aim not
only to obtain complete root coverage and
natural tissue blending of the exposed sur-
faces but also to increase gingival width
and thickness to ensure long-term stability.
Systematic reviews have provided exten-
sive evidence that in Miller
10
Class I and II
single gingival recessions, complete root
coverage can predictably be obtained
using various surgical techniques.
11,12

On the other hand, predictable coverage of
multiple adjacent gingival recessions still
represents a challenge for the clinician
because of difculties in managing the soft
tissue and poor wound healing related to
factors such as the large avascular surface,
blood supply, differences in recession
depth, and position of the teeth.
13
From a
clinicians point of view, treatment of multi-
ple adjacent gingival recessions is a
demanding situation due to the extent and
duration of surgery and patient morbidity. A
systematic review evaluating the predict-
ability of various surgical techniques used
for the treatment of multiple adjacent reces-
sion typo dooots (MAPTD) nas indioatod
that the modied coronally advanced ap
with and without soft tissue grafting and the
modied coronally advanced tunnel tech-
nique using soft tissue grafting are the most
predictable methods to obtain complete
root coverage in Miller Class I and II multi-
ple adjacent gingival recessions.
13

Furthermore, the review has also revealed
that the modied coronally advanced tunnel
technique in combination with subepithelial
connective tissue grafting was the only
identied technique that has been shown to
result in predictable coverage of Miller
Class III multiple adjacent gingival reces-
sions.
13,14

Connective tissue graft harvesting is often
associated with increased patient morbidi-
ty, prolonged surgical time, and the possi-
bility of postoperative complications such
as bleeding and numbness in the donor
area.
13
To overcome these inconveniences,
attempts are made to develop new materi-
als aiming to replace connective tissue
grafts, thus improving patient acceptance
and minimizing morbidity.
A newly developed porcine-derived biore-
sorbable collagen matrix (Mucograft,
Geistlich Pharma) has been recently intro-
duced proposed as an alternative to sub-
epithelial connective tissue graft in
periodontal plastic surgery procedures. The
safety and efcacy of the collagen matrix in
root-coverage procedures was reported in
a histologic study of the mini pig,
15
as well
as in controlled human clinical studies com-
paring treatment of Miller Class I and II sin-
gle recessions by means of coronally
advanced ap with collagen matrix or sub-
epithelial connective tissue graft.
16,17
Botn
randomized controlled clinical studies have
indicated that in Miller Class I and II single
recessions, collagen matrix may yield com-
parable outcomes in terms of root coverage
and tissue blending obtained with subepi-
thelial connective tissue grafts. Furthermore,
the use of collagen matrix was associated
with signicantly reduced surgical time and
patient morbidity compared with the use of
subepithelial connective tissue grafts.
16,17

Taken together, the available data suggest
that collagen matrix might represent an
alternative to subepithelial connective tis-
sue grafts, thus warranting further investiga-
tions. To the best of the authors knowledge,
until now, no clinical studies have evaluated
the use of collagen matrix in the treatment
of multiple adjacent gingival recessions.
The aim of the present prospective pilot
case series was to evaluate the safety and
efcacy of collagen matrix in the treatment
of multiple adjacent gingival recessions
using the modied coronally advanced tun-
nel technique.
METHOD AND MATERIALS
Subject selection
Eight adults (3 men and 5 women) 18 to 39
years of age (mean, 29 years) presenting
Miller class I and II multiple adjacent gingi-
val recessions with an overall total of 42
recessions were recruited after having com-
pleted preliminary professional tooth clean-
ing and receiving individual oral hygiene
instructions (Fig 1). The study was per-
formed between July 2009 and June 2010
at tno Dopartmont o Poriodontology,
Sommolwois Univorsity, Budapost, Hungary,
in aooordanoo witn tno Holsinki Doolaration
VOLUME 44 NUMBEP 1 JANUAPY 2013 19
QUI NTESSENCE I NTERNATI ONAL
Mol nr et al
Fig 1 Multiple Miller Class I gingival recessions. Fig 2 Tunnel preparation using specially designed
tunneling knives.
of 1975, as revised in 2000, and following
approval o tno Pogional Biootnioal
Committoo (approval no. ETT TUKEB/365/
P/10/). nolusion oritoria or partioipation in
the study were as follows: at least 18 years
of age, systemically healthy without any
signs of periodontal disease, presence of at
least three adjacent gingival recessions in
the maxilla or mandible, a full mouth plaque
score (FMPS) < 20%,
18
full mouth bleeding
sooro (FMBS) < 20%,
19
a nonsmoker, and
not prognant. Booro onrollmont, writton
informed consent forms were obtained from
all participating patients.
Study material
The collagen matrix (Mucograft, Geistlich
Pharma) has a bilaminar structure, consist-
ing of two adherent layersa supercial,
compact, cell occlusive membranelike layer
incorporating collagen bers and an under-
lying three-dimensional spongious collagen
matrix designed to serve as scaffold con-
ducing the ingrowth of blood vessels and
cells to enhance blood clot stability.
Surgical approach
All eight patients were consecutively treat-
ed using the modied coronally advanced
tunnel technique.
14
Preoperatively, resin
bonding of adjacent contact points at the
operation site was performed to enable sus-
pended suturing. Following local anesthe-
sia (Ultraoain DS Forto, Sanoh Avontis), root
planing of the exposed root surfaces was
porormod witn Graooy ourottos (Hu-Friody).
Intrasulcular incisions around involved teeth
were performed using microsurgical tunnel-
ing knives (Stoma). Mucoperiosteal enve-
lope ap elevation was performed via the
same instruments up to the level of the
mucogingival junction at each recession
site, leaving interdental papillae intact
(Fig 2). Separate mucoperiosteal envelopes
were subsequently interconnected, result-
ing in a tunnel preparation. Mucoperiosteal
tunnel elevation was extended by full thick-
ness preparation apically from the muco-
gingival junction utilising tunneling knives.
Attaching muscles and inserting collagen
bers were separated and released from
the inner aspect of the alveolar mucosa by
means of Gracey curettes. As a result, the
tunneled ap could be mobilized and coro-
nally advanced without tension. To achieve
complete mobilization of the ap, interden-
tal papillae were gently undermined using
microsurgical elevators. Special attention
was paid to not disrupt the interdental papil-
lary tissue. Subsequently, the collagen
matrix was trimmed and adapted to the
recipient site with gentle wetting. The colla-
gen matrix was carefully advanced into the
subperiosteal tunnel through the widest
recession using horizontal mattress sutures
at the mesial and distal aspects of the
matrix (Fig 3). At surgical sites extending to
more than three teeth, the collagen matrix
was cut to multiple segments. The compact
membranelike layer was directed toward
the inner side of the ap. The collagen
matrix was gradually moisturized by sterile
saline during this procedure to prevent
detaching the underlying spongious layer
20 VOLUME 44 NUMBEP 1 JANUAPY 2013
QUI NTESSENCE I NTERNATI ONAL
Mol nr et al
Fig 3 Collagen matrix is inserted in the tunnel and
pulled via horizontal mattress sutures.
Fig 5 The fully mobilized mucoperiosteal tunnel
was moved coronally using crossed horizontal mat-
tress sutures placed into interdental gingiva and
anchored over the preoperatively placed interproxi-
mal resin splints resulting in complete coverage of
the collagen matrix and the recessions.
Fig 4 Collagen matrix adapted to the CEJ and fxed
to the gingiva with horizontal mattress sutures.
Fig 6 At 14 days postsurgery, excellent healing of
the soft tissues is evident.
by ovorwotting. Having roaonod tno dosirod
position with the coronal margin positioned
at the level of the CEJ, the collagen matrix
was xed to gingiva via previously inserted
horizontal mattress sutures (Fig 4). Finally,
suspended sutures (ie, crossed horizontal
mattress sutures, anchored over the preop-
eratively placed interproximal resin splints)
were placed into interdental gingiva to coro-
nally advance the fully mobilized mucoperi-
osteal tunnel, resulting in complete
coverage of the collagen matrix and the
recessions (Fig 5). In cases in which com-
plete collagen matrix coverage could not be
obtained with the rst sutures, additional
vertical mattress sutures were placed inter-
dentally to enable coronal displacement of
the tunnel slightly over the CEJ.
Postsurgically, all patients were given anal-
getics (350 mg diclofenac, Cataam,
Novartis) or 3 days and antibiotios
(3625 mg amoxicillin and clavulanic acid,
Augmontin, GlaxoSmitnKlino) or 7 days to
prevent infection. Patients were not allowed
to brush at surgical sites for 14 days post-
operatively. Patients were advised to use a
0.2% clorhexidine-gluconate mouthrinse
(Curasept 220, Curaden) twice a day for 1
minute during the rst 21 postsurgical days.
Patients resumed toothbrushing 14 days
after surgery. Sutures were removed 14
days after surgery (Fig 6). At that time point,
patients were instructed in mechanical
tooth cleaning of the surgical sites using an
ultrasoft manual toothbrush and the roll
technique, gradually returning to the regu-
VOLUME 44 NUMBEP 1 JANUAPY 2013 21
QUI NTESSENCE I NTERNATI ONAL
Mol nr et al
Fig 7 At 1 month postsurgery, complete root cov-
erage is visible. Please note the excellent tissue
blending and color.
Fig 8 At 12 months, complete root coverage was
achieved at all six recessions. Please note the excel-
lent tissue blending and color.
lar oral hygiene habits at 1 month postsur-
gery. The interproximal resin splints were
romovod at 21 days. Pooall appointmonts,
including professional supragingival tooth
cleaning and individually tailored oral
hygiene instructions, were scheduled at 1,
3, 6, and 12 months postoperatively (Figs 7
and 8).
Clinical assessments
The following clinical parameters were
assessed at baseline and at 12 months
postoporativoly: probing doptn (PD), rooos-
sion doptn (PD), rooossion widtn (PW),
koratinizod tissuo tnioknoss (KTT), and
koratinizod tissuo widtn (KTW). PD and PW
were measured at the midbuccal aspect of
recessions using the CEJ as a reference
lino. KTT was moasurod at 3-mm distanoo
from the gingivae and recorded via sterile
K-hlos ollowing looal anostnosia. Comploto
root coverage and mean root coverage
were indirectly calculated. Postoperative
patient complaints and discomfort, as well
as patient acceptance, were also recorded.
The same calibrated investigator performed
all clinical measurements using a standard
poriodontal probo (PCP-UNC 15, Hu-Friody).
Intraexaminer reproducibility
Three subjects not involved in the study,
each presenting multiple adjacent gingival
recessions, were used to calibrate the
examiner. The examiner evaluated the sub-
jects on two occasions 24 hours apart.
Calibration was accepted if 90% of the
recordings could be reproduced within a
difference of 0.5 mm.
Statistical analysis
Statistical analysis was performed using
Instats 2000 3.05 (GraphPad Software). The
primary outcome variable was complete
root coverage. A subject level analysis was
performed for each parameter. Mean val-
uos and standard doviations (moan SD)
for the clinical variables were calculated for
oaon troatmont. Tno Kolmogorov and
Smirnov test was used to conrm that the
data were sampled from a Gaussian distri-
bution. The signicance of the difference
within group before and after treatment was
evaluated with the paired-sample t test.
Dioronoos woro oonsidorod statistioally
signicant when P < .05.
RESULTS
Postoperative healing was uneventful in all
oignt oasos. No oomplioations suon as
allergic reactions, matrix exfoliations,
abscesses, or infections were observed
throughout the entire study period. All
patients completed the study, and no
patients were lost during follow-up. All
patients expressed improvement in root
sensitivity.
22 VOLUME 44 NUMBEP 1 JANUAPY 2013
QUI NTESSENCE I NTERNATI ONAL
Mol nr et al
Table 1 Clinical parameters (mean SD) at baseline and 12 months
Clinical
parameters Baseline 12 mo postsurgery P value
PD (mm) 2.0 0.5 0.3 0.3 .0001
PW (mm) 3.4 0.8 1.0 1.3 .0001
KTW (mm) 2.9 1.3 3.4 1.3 .0006
KTT (mm) 1.0 0.3 1.3 0.4 .0051
PD (mm) 1.5 0.1 1.4 0.1 .0692
Mean root coverage (%) patient level 84% 15
Comploto root oovorago (%) pationt lovol 2/8 (25%)
Comploto root oovorago (%) tootn lovol 30/42 (71%)
SD, standard doviation, PD, rooossion doptn, PW, rooossion widtn, KTW, koratinizod tissuo widtn, KTT, koratinizod tis-
suo tnioknoss, PD, probing doptn.
Five patients were treated within the maxilla,
and three patients received treatment in the
mandible. Five patients presented reces-
sions involving only anterior teeth (four in
the maxilla and one in the mandible). One
patient presented with a recession site on a
premolar in the maxilla, while two patients
prosontod tnusly in tno mandiblo. Pooossion
sites of two mandibular molars were treated
in one of the cases. The baseline values
and 12-months results are shown in Table 1.
At 12 months, complete root coverage was
obtained in 2 out of the 8 patients and in 30
out of the 42 recessions (71%). Mean root
coverage was 84%.
Moan PD, PW, KTT, and KTW improvod
statistically signicantly (P < .0001) com-
parod witn basolino, wnilo PD did not snow
statistically signicant differences (see
Table 1).
DISCUSSION
Predictable coverage of multiple adjacent
gingival recessions represents a challenge
for the clinician, and data in the literature on
this subject are limited. Until now, the most
predictable results in terms of complete root
coverage and mean root coverage were
reported following the use of either modied
coronally advanced ap or modied coro-
nally advanced tunnel technique combined
with different types of soft tissue grafts.
Among the use of soft tissue grafts, connec-
tive tissue grafts appear to yield the most
predictable outcomes on both the short- (6
months to 1 year) and long-term (up to 5
years) basis.
13
Since the main drawback of
this technique is related to connective tis-
sue graft harvesting, which increases
patient morbidity, postoperative complica-
tion rate, and surgical time, it is logical that
various attempts have been made to devel-
op new soft tissue replacement materials.
The present prospective case series is the
rst to evaluate the possibility to use the
newly developed collagen matrix in the
treatment of Miller Class I and II multiple
adjacent gingival recessions in combination
with the modied coronally advanced tun-
nel technique. The fact that no adverse
events such as allergic reactions, soft tissue
irritations, or matrix exfoliations were found
in any of the treated patients corroborates
previous histologic and clinical ndings
indicating that collagen matrix is tolerated
well.
1518
The safety and efcacy of the col-
lagen matrix in the treatment of single
recessions in conjunction with a coronally
advanced ap was evaluated histologically
in mini pigs.
15
In that study, surgically cre-
ated Miller Class 1 recessions were treated
by means of coronally advanced aps
alone or in conjunction with collagen matrix.
The results have shown that both tech-
VOLUME 44 NUMBEP 1 JANUAPY 2013 23
QUI NTESSENCE I NTERNATI ONAL
Mol nr et al
niques resulted in similar histologic and
clinical outcomes, achieving complete root
coverage, while the collagen matrix was
completely incorporated in the adjacent
host connective tissues without any signs of
inammation.
15

The clinical performance of using collagen
matrix for the treatment of single Miller
Class I and II recessions has been recently
evaluated in two controlled clinical studies
comparing coronally advanced ap with
collagen matrix or connective tissue
grafts.
16,17
In a randomized, controlled, split
mouth-study, McGuire and Scheyer
16
treat-
ed single Miller Class I and II recessions
with coronally advanced aps + collagen
matrix (test) or coronally advanced aps +
connective tissue grafts (control). At 1 year,
the percentage of root coverage averaged
88.5% in the test group and 99.3% in the
oontrol group. Botn troatmonts rosultod in
comparable gains of keratinized tissue
width, while there were no statistically sig-
nicant differences between subject-report-
ed values for esthetic satisfaction and
self-assessment of pain and discomfort.
Comparable outcomes were also reported
in another study.
17
The authors found no
statistically or clinically signicant differ-
ences in any of the evaluated parameters
between the use of collagen matrix or con-
nective tissue graft in conjunction with coro-
nally advanced aps. Mean root coverage
amounted to 94.32% in the collagen matrix
and 96.97% in the connective tissue graft
group.
17

The results reported in the two aforemen-
tioned studies are in line with those from the
present investigation: At 12 months follow-
ing surgery, complete root coverage was
obtained in 2 of the 8 patients (ie, in 71% of
the total number of recessions), while mean
root coverage amounted to 84%. From a
clinicians point of view, the present results
are even more valuable when one consid-
ers that the present patient population com-
prised not only maxillary anterior teeth, but
also mandibular teeth and molars. This is an
important aspect to be considered since
data on treatment of mandibular multiple
adjacent gingival recessions are scarce.
13

Our results are also in agreement with nd-
ings of a systematic review in which Miller
Class I and II multiple adjacent gingival
recessions treatmented with modied coro-
nally advanced tunnel technique and either
connective tissue grafts or an acellular der-
mal matrix may result in complete root cov-
erage varying from 50% to 79.2% and mean
root coverage varying from 60.5% to
99.1%.
13
Moreover, the clinical relevance of
using collagen matrix in the treatment of
multiple adjacent gingival recessions is fur-
ther substantiated by the fact that in all
eight patients, a statistically signicant
inoroaso in KTT and KTW was obsorvod.
An important aspect to be considered when
interpreting the present results is careful
pationt solootion. Nono o tno inoludod
patients was a smoker, and all patients
demonstrated an excellent level of oral
hygiene (evidenced by FMPS < 15%). It is
well known that these factors are essential
for the short- and long-term outcomes fol-
lowing root coverage procedures.
20
One
advantage of the modied coronally
advanced tunnel technique is that this tech-
nique avoids the use of vertical releasing
incisions, thus maximizing the chance for
obtaining complete defect coverage by
enhancing blood supply and decreasing
the risk of graft exposure.
14
Furthermore, in
all treated cases, great efforts were made to
completely cover the collagen matrix with a
tension-free mucoperiosteal ap. The post-
operative level of the ap, ap tension, and
complete graft coverage are also important
aspects to be considered for obtaining pre-
dictable root coverage.
21,22

CONCLUSION
Witnin tnoir limits, tno prosont rosults indi-
cate that treatment of Miller Class I and II
multiple adjacent gingival recessions by
means of the modied coronally advanced
tunnel technique and collagen matrix may
result in statistically and clinically signicant
complete root coverage. Further studies are
thus warranted to evaluate the performance
of collagen matrix compared with connec-
tive tissue grafts and other soft tissue grafts.
24 VOLUME 44 NUMBEP 1 JANUAPY 2013
QUI NTESSENCE I NTERNATI ONAL
Mol nr et al
ACKNOWLEDGMENT
The present study was supported by Geistlich, Wolhusen,
Switzerland.
REFERENCES
1. Armitage GC. Development of a classifcation sys-
tem for periodontal diseases and conditions. Ann
Periodontol 1999;4:16.
2. Wennstrm JL. Mucogingival therapy. Ann
Periodontol 1996;1:671701.
3. Serino G, Wennstrm JL, Lindhe J, Eneroth L. The
prevalence and distribution of gingival recession in
subjects with a high standard of oral hygiene. J Clin
Periodontol 1994;21:5763.
4. Daprile G, Gatto MR, Checchi L. The evolution of
buccal gingival recessions in a student population:
A 5-year follow-up. J Periodontol 2007;78:611614.
5. Susin C, Haas AN, Oppermann RV, Haugejorden O,
Albandar JM. Gingival recession: Epidemiology and
risk indicators in a representative urban Brazilian
population. J Periodontol 2004;75:13771386.
6. Lovegrove J, Leichter J. Exposed root surface:
A review of aetiology, management and evi-
dence-based outcomes of treatment. N Z Dent J
2004;100:7281.
7. Mller HP, Eger T, Schorb A. Gingival dimensions
after root coverage with free connective tissue
grafts. J Clin Periodontol 1998;25:424430.
8. Agudio G, Nieri M, Rotundo R, Franceschi D,
Cortellini P, Pini Prato GP. Periodontal conditions
of sites treated with gingival-augmentation sur-
gery compared to untreated contralateral homolo-
gous sites: A 10- to 27-year long-term study. J
Periodontol 2009;80:13991405.
9. Kennedy JE, Bird WC, Palcanis KG, Dorfman HS. A lon-
gitudinal evaluation of varying widths of attached
gingiva. J Clin Periodontol 1985;12:667675.
10. Miller PD Jr. A classifcation of marginal tissue reces-
sion. Int J Periodontics Restorative Dent 1985;5:813.
11. Cairo F, Pagliaro U, Nieri M. Treatment of gingi-
val recession with coronally advanced fap pro-
cedures: A systematic review. J Clin Periodontol
2008;35:136162.
12. Chambrone L, Sukekava F, Arajo MG, Pustiglioni
FE, Chambrone LA, Lima LA. Root-coverage proce-
dures for the treatment of localized gingival-type
recessions. J Periodontol 2010;81:452478.
13. Hofmnner P, Alessandri R, Laugisch O, et al.
Predictability of surgical techniques used for cover-
age of multiple adjacent gingival recessions. A sys-
tematic review. Quintessence Int 2012;43:545554.
14. Aroca S, Keglevich T, Nikolidakis D, et al. Treatment
of Class III multiple gingival recessions: A random-
ized-clinical trial. J Clin Periodontol 2010;37:8897.
15. Vignoletti F, Nunez J, Discepoli N, et al. Clinical
and histological healing of a new collagen matrix
in combination with the coronally advanced
fap for the treatment of Miller Class I recession
defects: An experimental study in the minipig. J Clin
Periodontol 2011;38:847855.
16. McGuire MK, Scheyer T. Xenogeneic collagen matrix
with coronally advanced fap compared to con-
nective tissue with coronally advanced fap for the
treatment of dehiscence-type recession defects. J
Periodontol 2010;81:11081117.
17. Cardaropoli D, Tamagnone L, Rofredo A, Gaveglio
L. Treatment of gingival recession defects using cor-
onally advanced fap with porcine collagen matrix
compared to coronally advanced fap with connec-
tive tissue graft: A randomized controlled clinical
trial. J Periodontol 2012;83:321328.
18. O`Leary TJ, Drake RB, Naylor JE. The plaque control
record. J Periodontol 1972;43:38.
19. Ainamo J, Bay I. Problems and proposals for record-
ing gingivitis and plaque. Int Dent J 1975;25:229235.
20. Chambrone L, Chambrone D, Pustiglioni FE,
Chambrone LA, Lima LA. The infuence of tobacco
smoking on the outcomes achieved by root-cov-
erage procedures: A systematic review. J Am Dent
Assoc 2009;140:294306.
21. Pini Prato G, Pagliaro U, Baldi C, et al. Coronally
advanced fap procedure for root coverage. Flap
with tension versus fap without tension: A ran-
domized controlled clinical study. J Periodontol
2000;71:188201.
22. Pini Prato GP, Baldi C, Nieri M, et al. Coronally
advanced fap: The post-surgical position of
the gingival margin is an important factor for
achieving complete root coverage. J Periodontol
2005;76:713722.