Allograft Tissue Matrix With and Without Complete Coverage

Objective. This study was conducted to evaluate two different surgical techniques using Allograft Tissue Matrix (ATM) to obtain root coverage. Background. ATM has been utilized as an alternative to autogenous soft tissue grafting to cover exposed roots on teeth. Methods. ATM was utilized to treat 2 consecutive patients that presented with gingival recession of the mandibular incisors. Full thickness mucoperiosteal flaps were reflected and apical releasing incisions were used to mobilize and coronally advance the flaps. ATM was prepared and adapted to the recipient site at the level of the cemento-enamel junction. In the control case the ATM was completely covered by the flap whereas in the test case the ATM was left partially exposed. Gingival recession and the amount of keratinized tissue were measured at 1, 2, 4, 8, and 30 weeks post operatively. Results. Gingival recession was reduced in both control and test. In the control case complete root coverage was obtained, and a 3 mm zone of keratinized tissue free of inflammation was present at 8 weeks. In the test case, the gingival defect was narrowed but not eliminated, but an increase in the amount of keratinized tissue was noted. Conclusion. Complete coverage of the ATM provided the graft with an adequate blood supply which facilitated healing. Partial coverage of the material did not provide an adequate blood supply and is not recommended. Due to its avascular nature, this grafting material requires complete coverage with a vascularized flap during healing.