#Preventive 10. Sep 2017

Mucogingival surgery around teeth and implants in the anterior zone – why the goal is complete coverage

Prof. Giovanni Zucchelli – Courses in mucogingival surgery – March, June and November 2018 in Bologna

NOTE: March session already booked out – register now for the sessions in June and November! Gingival recession around teeth and soft tissue dehiscence around metallic implants are common grounds for dissatisfaction among patients. Exposure during smiling or function of portions of the root or implant surface are the main indications for surgical coverage procedures. Generally only the most coronal millimeter(s) of the recession is/are exposed during smiling or function, therefore the presence and/or the persistence of a shallow recession after therapy may be a problem for the patient. Thus, the goal is complete root (or implant) coverage when patients are dissatisfied with the esthetic appearance of their teeth or implant(s).

Enhance your skills in periodontal plastic surgery with Prof. Zucchelli

In 2018 we are again delighted to sponsor two international courses in March, June and October on Reconstructive periodontal plastic surgery around teeth and implants in the esthetic zone with one of the leading plastic surgeons Prof. Giovanni Zucchelli. In this course, you will learn about Prof. Zucchelli’s techniques6,7 to help you achieve complete root and implant coverage.

How to achieve complete coverage – insights from the literature

Recent systematic reviews and consensus reports on root coverage procedures1,2 concluded that the addition of autologous connective tissue graft (CTG) or Emdogain® (EMD) under a Coronally Advanced Flap (CAF) are the procedures of choice to achieve complete root coverage as they both have extensive evidence showing that they significantly improve root coverage compared with CAF alone.

A split mouth, randomized clinical trial3, has shown that treatment of gingival recession defects with either CAF+CTG or CAF+ EMD appears stable, clinically effective, and similar to each other on all measured parameters, even after 10 years. Because the CAF+EMD procedure avoids the need for a CTG harvesting procedure, it is the preferred treatment of most patients.

A randomized clinical study4 has shown that the addition of EMD to CAF procedures not only enhances root coverage but also increases the formation of keratinized gingiva, which together may contribute to improved esthetics of the clinical results.

A split mouth, randomized clinical trial5 which compared the treatment of gingival recession defects with either CAF+CTG or CAF + a xenogenic collagen matrix (CAF + CMX) after 6 months and 5 years concludes that CMX+CAF appears to present a viable and long-term alternative to traditional CTG+CAF therapy.

Prof. Zucchelli’s technique for the treatment of single and multiple recession defects affecting adjacent teeth in patients with esthetic demands has been shown to achieve complete root coverage in most patients, irrespective of the number of recessions treated in each intervention.  You will have the opportunity to practice this technique on pig jaws, watch two live surgeries and are invited to bring your own cases for an open discussion with the expert. In this course, Prof. Zucchelli will also present his approach for soft tissue dehiscence coverage around single implants which has proven successful in fully correcting severe vertical and horizontal peri-implant soft tissue defects and achieving high patient satisfaction8,9.

(Click on the picture for a larger resolution) Stages of treatment with Straumann® Emdogain® under a Coronally Advanced Flap (CAF): Before treatment (5 mm recession defect) – 8 months after treatment – 7 years after treatment: root is completely covered. With courtesy of Prof. Zucchelli.

References

1 Tonetti MS, Jepsen S; Working Group 2 of the European Workshop on Periodontology. Clinical efficacy of periodontal plastic surgery procedures: consensus report of Group 2 of the 10th European Workshop on Periodontology. J Clin Periodontol. 2014 Apr;41 Suppl 15:S36-43 
2 Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol. 2014 Apr;41 Suppl 15:S44-62. 
3 McGuire MK, Scheyer ET, Nunn M. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue: comparison of clinical parameters at 10 years. J Periodontol. 2012 Nov;83(11):1353-62 
4 Pilloni A, Paolantonio M, Camargo PM. Root coverage with a coronally positioned flap used in combination with enamel matrix derivative: 18-month clinical evaluation. J Periodontol. 2006 Dec;77(12):2031-9. 
5 McGuire MK, Scheyer ET. Long-Term Results Comparing Xenogeneic Collagen Matrix and Autogenous Connective Tissue Grafts With Coronally Advanced Flaps for Treatment of Dehiscence-Type Recession Defects. J Periodontol. 2015 Oct 15:1-12. 
6 Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands.J Periodontol. 2000 Sep;71(9):1506-14. 
7 Zucchelli G, De Sanctis M. Long-term outcome following treatment of multiple Miller class I and II recession defects in esthetic areas of the mouth. J Periodontol. 2005 Dec;76(12):2286-92. 
8 Zucchelli G, Mazzotti C, Mounssif I, Marzadori M, Stefanini M. Esthetic treatment of peri-implant soft tissue defects: a case report of a modified surgical-prosthetic approach. Int J Periodontics Restorative Dent. 2013 May-Jun;33(3):327-35. 
9 Zucchelli G, Mazzotti C, Mounssif I, Mele M, Stefanini M, Montebugnoli L. A novel surgical-prosthetic approach for soft tissue dehiscence coverage around single implant. Clin Oral Implants Res. 2013 Sep;24(9):957-62.