PMC10060066_01
Preoperative evaluation and surgical procedure. (a) Clinical view before surgery, (b) a surgical flap with a split-full-split thickness configuration was raised, (c) volume-stable collagen matrix (Fibro-Gide, Geistlich Pharma AG, Wolhusen, Switzerland) before platelet-rich fibrin functionalization, (d) functionalization of the collagen matrix with injectable platelet-rich fibrin (i-PRF), (e) collagen matrix after functionalization, (f) positioning of the matrix impregnated with injectable platelet-rich fibrin (i-PRF) in the surgical site, (g) tension-free flap repositioning and sutures.
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Santa Catarina (CEPID/UFSC) in February 2020, due to multiple gingival recessions in the aesthetic area of the maxilla caused by orthodontic treatment and brushing trauma. During clinical examination, a thin gingival phenotype was detected (Figure 1(a)). Since no interproximal involvement was present, the gingival recessions were classified as RT1. A split (interproximal papilla)-full (until mucogingival junction)-split (beyond mucogingival junction) thickness flap was elevated (Figure 1(b)). After i-PRF preparation (Intra-Lock L-PRF Intra Spin, Birmingham, AL, USA), a volume-stable collagen matrix was bisected in the long-axis, impregnated with i-PRF for 15 minutes, and positioned in the receptor bed at cementoenamel junction level (Figures 1(c), 1(d), 1(e), and 1(f)). The tension-free flap was coronally positioned 1 mm beyond the cementoenamel junction and sutured (5-0 Vicryl; Ethicon, Johnson & Johnson, Somerville, NJ, USA; Figure 1(g)). Differences from baseline to the 12-month follow-up were calculated for the following measurements: gingival recession area, root coverage area, gingival recession height, root coverage height, and keratinized tissue band height (Figure 3, Table 1).
Postoperative follow-up. (a) Clinical view on 2-month follow-up, (b) clinical observation on 9-month follow-up, (c) clinical view on 12-month follow-up.
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The surgical area showed a satisfactory healing 2 months after surgery; however, a volumetric soft tissue reduction was detected in comparison with the immediate post-surgical result (Figure 2(a)). At the 9-month re-evaluation, probing depth was <=3 mm in all sites (Figure 2(b)). Gingival margin stability was verified at the 12-month follow-up, with no modification on probing depth, no bleeding on probing, and a stable keratinized mucosa band (Figure 2(c)).
Baseline and 12-month follow-up measurements. (a) Baseline measurements: root recession area (blue); gingival recession height (black line in the blue area); keratinized tissue band (green); keratinized tissue band height (black line in the green area), (b) 12-month follow-up measurements: root recession area (blue); gingival recession height (black line in the blue area); keratinized tissue band (green); keratinized tissue band height (black line in the green area).
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Differences from baseline to the 12-month follow-up were calculated for the following measurements: gingival recession area, root coverage area, gingival recession height, root coverage height, and keratinized tissue band height (Figure 3, Table 1).
Postoperative follow-up after 30 months. Stable results along the time with minimal modifications. Patient presented bleeding on probing and gingivitis that was further treated during the consultation.
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After 30 months of follow-up, clinical parameters were assessed (Figure 4).