Envelope coronally advanced flap with site-specific bilaminar acellular dermal matrix or connective tissue graft for management of multiple marginal tissue recessions: A retrospective analysis of cases.

BACKGROUND

A proper case selection and decision making is essential for management of multiple marginal tissue recessions (MTR) using a conventional or bilaminar approach. Coronally advanced flap (CAF) is one of the commonly used methods for management of MTR. CAF has been advocated in combination with soft tissue grafts as bilaminar technique, which had showed significant success in terms of root coverage.

METHODS AND RESULTS

Aim of this case series was to retrospectively evaluate Zucchelli's modification of envelope CAF (eCAF) and site-specific bilaminar methods using Acellular Dermal Matrix (ADM) and Connective Tissue Graft (CTG) for management of MTR. A total of 15 subjects (five subjects/25 sites per technique, total number of sites = 75) who were managed by three different techniques with 12 months postoperative records were retrospectively evaluated. All patients showed significant clinical improvement in root coverage outcomes when compared to baseline. Mean root coverage achieved at 3 months (90%), 6 months (95%) and 12 months (95%) postoperatively did not reveal significant difference between three methods. Complete root coverage was observed in 86.6% of eCAF cases and in 86.6% and 95% of ADM/CTG with eCAF, respectively. There was an increase in width of keratinised tissue, both individually and collectively across all of the groups.

CONCLUSION

Clinical outcomes suggested that bilaminar techniques should be used only in specific cases. Predictable results can be obtained without the use of a soft tissue graft or substitute if a careful treatment plan for technique selection is developed on an individual case-by-case basis.

KEY POINTS

Why is this case new information? Comparison of site-specific bilaminar modalities with modified coronally advanced flap alone What are the keys to successful management of such cases? Flap advancement and mobilisation Flap passivity What are the primary limitations to success in such cases? Case selection Flap tension Soft tissue phenotype Thickness of graft Operator skills.