A Minimally Invasive Approach for the Treatment of Multiple Adjacent Gingival Recessions with a Volume-Stable Collagen Matrix: A Case Series

PDGF‐BB‐enriched collagen matrix to treat multiple gingival recessions with the tunneled coronally advanced flap

“…are inherent with the CAF or TUN, which traditionally have been denoted distinct from one another 25,26 . The proposed TCAF combines the advantages of the individual techniques of CAF and TUN, according to site‐specific criteria and indications, such as reducing the number of vertical releasing incisions when possible (e.g., in the esthetic zone or a posterior region), increasing visibility for a particular site and enhanced ability for graft stabilization (particularly important as it relates to a biologic factor‐soaked matrix), as well as maintenance of the integrity of weaker papillae such as those with interproximal attachment loss (resulting in a more favorable environment for early nutrition and integration of the graft) 12,13 …”

“…The present manuscript illustrates the combined application of CCM + rhPDGF‐BB with the tunneled coronally advanced flap (TCAF) 12,13 for the treatment of multiple GRs in two nonsmoking systemically and periodontally healthy individuals. Both patients were recruited and treated at the Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan between November 2019 and January 2020, and provided their informed consents.…”

“…It was decided to perform a minimally invasive approach, involving a combination of coronally advanced flap (CAF) and tunnel (TUN) technique (TCAF, as previously described) 12,13 with site‐specific application of a CCM loaded with rhPDGF‐BB for the maxillary right canine. The rationale for this approach was to open the flap only at the right premolar and canine area to gain access for the insertion and stabilization of the CCM soaked with the growth factor, aiming for root coverage and simultaneous gingival phenotype modification (Figure 1D).…”

“…A TCAF with one vertical incision on the mesial aspect of the canine was performed 12,13 . The papilla between the canine and the first premolar was also incised, with an oblique incision anticipating the rotation of the flap when coronally advanced (Figure 2B,C).…”

“…A TCAF with one vertical incision on the mesial aspect of the canine was performed. 12,13 The papilla between the canine and the first premolar was also incised, with an oblique incision anticipating the rotation of the flap when coronally advanced (Figure 2B,C). Miniblades (Salvin Dental Specialties, Charlotte, NC, USA) were used to elevate the two papillae of the canine in a split-thickness manner, while the elevation of the midfacial portion of the flap at the level of the canine proceeded full-thickness until exposing 2 mm of labial bone.…”