Techniques for recession lining

Currently there are different techniques for recession resurfacing, such as: coronal repositioning flaps, tunnel technique, free or subepithelial connective grafts, being autologous connective tissue with or without resurfacing the technique of choice. However, these implants involve a second surgical field with consequent postoperative discomfort in the palatal area.

With biomaterials, such as three-dimensional collagen matrices, we achieve similar results both in terms of increased root coverage and inserted gingiva, allowing us to improve the gingival biotype. This matrix has two layers: a dense one that gives more stability and allows us to fix it with sutures; and another one that is porous and in contact with the root. The latter layer is colonized laterally by blood vessels and increases in volume as it fills with blood.

The matrix should be handled dry and should be seated on the amelocemental border. The flap should cover 2 or 3 millimeters more of the matrix, and the suture should press on the enamel, allowing the porous part to allow blood to accumulate.

For the viability of the biomaterial, the lack of mobility of the flap is fundamental. The Mucograft is reabsorbed between 15 and 20 days, with a slight inflammation appearing after 30 days, since it is an immature tissue and should not be brushed until 6 weeks. At 3 months the tissue is mature with the appearance of rete pegs.

Actual case

We present a young patient with bilateral recessions in upper first molars caused by brushing trauma and with great dental sensitivity. The patient consulted us about the possibility of covering his recessions without connective tissue grafting and thus solving his hypersensitivity.

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Once his brushing technique had been corrected, root coverage techniques were proposed to the patient, one with connective tissue grafting and the other with the use of Mucograft collagen matrices. Once the pros and cons of both techniques were explained to the patient, he opted for the use of collagen matrices. Langer and modified Langer flaps are performed in 1.6 and 2.6. The photographic sequence shows the surgical procedure and the follow-up of the case at ten days, one month and one year, verifying the stability and increase of tissue volume.