J Clin Pmodoiuil IW8: 25: 24 29 Copyrighi © Munksgaard 1998

Pnnh'J in Denmark . Al! rigim rtni

JDUflKIUDF

periDdontology
ISSN 0J03-6979

Resorbable barrier and envelope Leonardo

Alessandro Scabbia\
Dimjtris N.Tatakis^,
,

flap surgery in the treatment of Luigi Checchj^ and

Giorgio Calura^
^Departmenl og Periodontology, School of
Dentistry, University ot Ferrara, Ferrara, Italy,

human gingival recession defects ^Advanced Education Program in Periodontics

and Implant Surgery, Loma Linda University,
Loma Linda, CA, USA, ^Department ot Oral

Case reports Surgery, School of Dentistry, University of

Boiogna, Bologna, Italy

Tromhelli L, Scabbia A. Talakis DN, Checchi L. Calura G: Resorbable barrier

and envelope flap surgery In ihe treatment of human gingival recession defects.
Case Reports. J Clin Periodontol 1998: 25: 24-29. © Munksgaard. 1998,

Abstract. The present case report evaluates the treatment outcome following muc-
ogingival surgery combined with a bioresorbable barrier in gingival recession de-
fects in humans. A total of 11 buccal, Miller Class I or II. gingival recession
defects in 6 patients were consecutively treated. The exposed root surface was
ultrasonically scaled and conditioned wilh a tetracycline HCI solution (10 mg.-'
ml) for 4 min, A buccal full/splil thickness envelope Hap was Ihen elevated, and a
bioresorbable matrix barrier was positioned to completely cover the exposed root
surface and surrounding bone margins, A flap was then positioned at or slightly
coronal to its original position. In all cases, a variable amount of membrane was
intentionally left uncovered on the exposed root surface. Clinical recordings,
assessed presurgery and al 6 months postsurgcry. included defects-speciiic plaque
and gingival scores, recession depth (RD). probing depth (PD). clinical attach-
ment level (CAL) and keratinized tissue width (KT). Immediately postsurgery.
and at weeks 1. 2, 4. 6 and 8 postsurgery. the location of gingival margin or granu-
lation tissue covering the previously exposed root surface was recorded, as well
as the extent o^ barrier exposure. Statistical analysis showed that RD decreased
from 2,3±0.2 mm presurgery to 0,8±0.5 mm at 6 months postsurgery (/J^0,001 ).
representing a mean root coverage of 65"/! (range: 40-100%), CAL gain paral-
leled RD reduction (l.5±0.5 mm; /J=0,0009). while KT showed a slight increase
(0,3±0,6 mm) at 6 months po.stsurgery. Results indicate that clinical improve-
ment of gingival recession defects may be achieved by means of a barrier-sup-
Key words: resorbabie barrier; envelope tlap
ported envelope technique. The bioresorbable matrix barrier represented an ef- surgery; gingival recession; defects
fective scaffold to support the reconstruction of ihe mucogingival unit.
Accepted for publication 22 Aprii 1997

Several surgical techniques have been
proposed to achieve consistent kera-
tinized tissue increase and root coverage
in gingival recession defects. Surgical
procedures, including lateral sliding
(Grupe & Warren 1956) and coronally
positioned flaps (Harvey 1965), free
gingival grafts (Miller 1982). und con-
nective tissue grafts (Langer & Langer
1985. Nelson 1987. Harris 1992), have
shown highly predictable rates of suc-
cess. In order to eliminate the need for
a 2nd surgical wound site (graft har-
vesting site), the principles and tech-
niques of guided tissue regeneration
(GTR) have been applied lo the treat-
ment of recession defects with consider-
able and consistent success (Tinti et al.
1992. Pini Prato et al. 1992. Pini Prato
et al. 1993. Trombelli et al. 1994. Trom-
belliet al, I995a.b),
Controlled clinical trials have shown
that GTR in deep gingival recession de-
fects resulted in greater recession reduc-
tion and attachment gain compared to
conventional mucogingival surgery
(Pint Prato et al, 1992), GTR treatment
in humans may result in the formation
of a connective tissue attachment with
new cementum on a root surface with
a longstanding human recession defect
(Cortellini et ai, 1993). The use of bi-
oresorbable barriers eliminates the 2nd
surgical procedure required for the re-
moval of non-resorbabie barriers and
has been shown to provide favorable re-
sults in terms of root coverage and soft
tissue gain (Genon et al. 1994, Pini Pra-
to et al. 1995, Roccuzzo et al, 1996).
Whether non-resorbable or biore-
sorbable barriers are used for the treat-
ment of recession defects according to
GTR principles, the clinical technique
always involves the combination of the
barrier with a coronally positioned flap.
 Human ^mgmi! recession defects 25

Since a coronally positioned flap alone
would result in root coverage (Allen &
Miller 1989, Wennstrom & Zucchelli
1996). one could reasonably ask "what
is the contribution, if any. of the barrier
in the case of GTR-trealed recession de-
fects ?", The results of a comparison of
the clinical outcomes following cor-
onally positioned flap and GTR pro-
cedures suggest ihat there is a difference
between the 2 techniques (Trombelli et
al. 1997a),
In the present study, which was
undertaken in an effort to evaluate
fiiriher the contribution of GTR bar-
riers in the treatment of recession de-
fects, human recession defects were
treated by a combination of bioresorb-
able barrier matrix and replaced envel-
ope fiap. Specifically, wound healing dy-
namics, involving the portion of the
barrier intentionally left exposed to the
oral environment, were investigated.
Material and Methods
Systemically healthy patients were se-
lected after informed consent among
subjects who had been referred for
treatment of buccal recession defects.
The patients received oral hygiene in-
struction, and scaling and root planing
as part of their periodontal treatment.
Patient selection was based on the fol-
lowing criteria after completion of the
initial therapy: {1) nonsmoker status;(2)
presence of one or more buccal gingival
recession defects with no bone or soft
tissue loss in the interdental areas
(Millers class I or II) (Miller 1985) (Fig.
la). A total of 11 recession defects in 6
consecutively treated patients were in-
cluded. The study population com-
prised of 5 females and 1 male, aged 22
to 49 years (mean age: 31 years).
Treated teeth included 2 upper and 2
lower cuspids, 4 upper and 1 lower bi-
cuspids, I upper central incisor and I
lower lateral incisor.
Treatment procedure
Following anesthesia, the exposed root
surface was ultrasonically scaled and
conditioned with a tetracycline HCI
solution (10 mg/ml) applied for 4 min-
utes with a light pressure burnishing
technique (Trombelli et al. 1995c). Cot-
ton pellets were changed every 30 s. The
root surface was then thoroughly
rinsed.
An intrasulcular incision was per-
formed including the gingival margin
and the adjacent intedental papillae of
Ihe teeth to be treated. Dissection was
limited to the buccal aspect oi' the pap-
illae, thus preserving an adequate
thickness of soft tissue in the interden-
tal areas. Since vertical releasing in-
cisions were not performed, the mesi-

Fig. I. Healing response of recession defect on tooth 1,4 following the application of resorbable barrier membrane in conjunction with envelope
flap procedure, (a) Preoperative view: (b) barrier membrane was adapted to the defect and secured with preplaced bioresorbable ligaiure; (c)
buccal Hap was replaced without submersion of the membrane; (d) 2 weeks postsurgery: membrane in place, slight inflammation of Ihe gingival
margin; (e) 4 weeks postsurgery: membrane still maintains physical integrity, good response o{ the surrounding soft tissues; (1) 6 weeks
postsurgery: newly formed granulation tissue intermixed with remnants of the exposed membrane is evident; (g) 6 months postsurgery.
26 Tromhelli et ai

odistal length of the intrasulcular in-
cision was extended to provide easy
access to the denuded roots. A full-
thickness envelope flap was elevated up
to 2-3 mm apical to the bone crest,
then a partial thickness dissection was
made to allow for flap repositioning
without tension.
A bioresorbabie barrier matrix with
appropriate configuration for gingival
recession defects (Mucogingival wide;
Guidor Matrix Barrier. Guidor AB.
Huddinge. Sweden) was adequately
trimmed to fit the exposed root portion
and the surrounding bone margins (Kig.
I b). The coronal portion o^ the barrier
was secured by means of the preplaced
bioresorbable ligature tied at the palatal
aspect of the tooth, A small flap was
raised palatally/lingually to allow for
submersion of the ligature knot. The
buccal flap was then replaced and fixed
with interproximal interrupted teflon
sutures (Gore Tex Suture. W. L. Gore
Associates Inc, Flagstaff, AZ). No
attempt was made to either coronally
position the flap or completely sub-
merge the barrier (Fig, !c).
A postsurgery protocol emphasizing
wound stability and infection control
included administration of doxycycline
(200 mg for day 1 postsurgery, 100 mg/
day for 6 days), and Q.\2% chlorhex-
idine rinse twice daily for at least 6
weeks. Gingival sutures were removed
two weeks postsurgery. Mechanical
plaque control in the surgical area was
reinstituted when gingival tissues had
reached sufficient maturity at clinical
evaluation. Patients were seen at week
1. 2, 4, 6 and 8 following surgery. There-
after, patients were recalled for supra-
gingival scaling and oral hygiene re-
inforcement on a monthly basis for the
6-month observation interval.
Recordings
Defect-specific hygiene standards
(DPIl) and gingival condition (DGl)
were determined by averaging the
plaque index (Silness & Loe 1964) and
gingival index {Loe & Silness 1963)
scores, respectively, as recorded at the
mesiobuccat. midbuccal. and dislobuc-
cal aspects of the defect teeth.
The distance from a hxed occlusal
reference point to the cemento-enamel
junction (OR-CEJ). recession depth
(RD). probing depth (PD). and clinical
attachment level (CAL) were assessed at
the midbuccal aspect of the defect. Re-
cession width (RW) was recorded tan-
gential to the CEJ, The amount of kera-
tinized tissue (KT) was determined as
the distance from the gingival margin
to the mucogingival junction. At the
completion of the surgical procedure
(postsurgery). and at week 1. 2. 4. 6 and
8 postsurgery. the distance from the
fixed occlusal reference point to cither
the gingival margin or the newly
formed granulation tissue covering the
previously exposed root surface (OR-
GM) was assessed midbuccally. Barrier
exposure (BF) and resorption time. i.e..
the time when the exposed portion of
the barrier was no longer clinically de-
tected, were also recorded. Measure-
ments were performed using a standard
periodontal probe (CP 15 UNC. Hu
Friedy. Chicago. IL).
To assess the presence of sensitivity, a
stream of air from a 3-way syringe was
applied perpendicular to the root sur-
face at about I cm from the defect.
Clinical photographs were taken to
document defects and progression of
healing. Pathological tissue alterations
or other pertinent clinical observations
related to the surgical procedure were
recorded. The patients were re-evatu-
aled at 6 months postsurgery.
Statistical analysis
The patient was regarded as the statisti-
cal unit for analysis. Measurements
were averaged when multiple defects
were treated in a patient:
root coverage {%) was calculated as:
Rn —R n
•^ '-']iresurgfr\ ^^ '-'(i months
Rn
'*'--'presurgery
The depth of gingival recession (RD)
postsurgery. at week 1, 2. 4., 6 and 8 was
calculated as:
RD=(OR-GM)-(OR-CEJ).
Data were expressed as mean±standard
deviation. ANOVA for repeated meas-
ures was used to determine differences
in RD over time. Post-hoc multiple
comparisons were performed to evalu-
ate within-treatment effects. Signifi-
cance level for the rejection of the null
hypothesis was set at /7<O.O5.
Results
Plaque and gingival scores were low
presurgery and remained almost un-
changed over time, DPII varied from
0,4±0.4 presurgery to 0.7+0.3 at 6
months postsurgery. DGI was 0.4±0.3

Table I. Presurgery and 6-month defect recordings (mm)

Clinical illachmenl Keralinized
Recession deplli Recession width Probing depth level tissue width
pre- pre- pre- pre- pre-
Patient Tooth surgery 6 months surgery 6 months surgery 6 months siirgery 6 months surgery 6 monihs
1 T
1 0,5 3,5 1 3 1,5 0 1
1 23 2.5 1 2 2 0.5 3 2 2 2
1 5 2 0.5 4 3.5 ! 3 1,5 0.5 0,5
2 9 2 1 4.5 3.5 2 .5 4 2.5 3,5 3
3 21 2.5 0.5 3 1 1 3,5 1,5 1.5 1,5
3 12 2 1 3 2 0.5 2,5 -> 5 5
3 13 2.5 L5 3.5 3.5 1 3,5 2,5 5 5,5
4 5 2.5 L5 3 3 1 3.5 2,5 T 3
5 6 2 0.5 4 3 1 p.5 2,5 1 4 4
5 22 2.5 0.5 4 3 0.5 0.5 3 1 1.5 2
6 11 2.5 0 4 0 1.5 ,5 4 1,5 T T

mean 2,3 0,8 3,5 2.5 1.1 3,4 1.9 2-5 2.8
SD 0,2 0,5 0,8 1,2 (),,S 0,4 0,5 0,6 I.I 0,8

g of limited clinical significance, our re-
Q sults provide insight into the influence
X of a bioresorbable wound-stabilizing
0.5
Pnop Portqi
Time (weeks)
fig, 2. Location of the gingival margin, as expressed by mean recession depth (RD (mm)|,
during the study interval.
presurgery, and 0.4±0.4 at 6 months
postsurgery,
Postsurgery BE was l,6±0,4 mm.
The barrier was positioned at the CEJ
in 7 defects, slightly coronal (0,5 to 1
mm) to the CEJ in 3 defects, 0,5 mm
apical to the CHJ iti I defect. Complete
submersion of the barrier by the flap
was not achieved in any of the defects,
BE tended to increase from postsurgery
to week 4 (1.6±0.6 mm at week I,
2.0±l.0 mm at week 2. and 2.0±0.8 at
week 4). The exposed barrier was pres-
ent in small fragments in 6 defects at
week 6. no longer detected in all sites at
week 8 postsurgery.
Pre- and post-surgery delect record-
ings are presented in Table I. RD de-
creased from 2.3i0.2 mm presurgery to
0.8±0.5 at 6 months postsurgery. The
difference was statistically significant
(y7=0,001). RD reduction represented a
mean RC of b5"A. (range: 40-100*^^,).
One defect had IOO':4 RC. 5 delects in
3 patients exhibited a residual recession
of 0.5 mm. A reduction in RW was also
observed at 6 months postsurgery. CAL
gain paralleled RD reduction (!,5±0.5
mm:/'^0.0009). A slight increase in KT
{0.3±0.6 mm) was present at 6 months
postsurgery.
Fig. 2 illustrates the location of the
gingival margin during the study inter-
vals. At the completion of the surgical
procedure. 8 defects presented the gin-
gival margin ^ 1 mm coronal to the pre-
surgery level. 2 defects at the presurgery
level, and 1 defect 0,5 mm apical to the
presurgery level. Postsurgery RD was
l,5±0.5 mm, the difference from pre-
surgery RD being statistically signifi-
cant (/j-0.009). RD remained almost
stable until week 4 (1.4±0.4 mm at
week I. 1.6±I.O mm at week 2, and
1.6±l,0 at week 4) (Figs. Id, e). then a
progressive RD reduction was observed
at week 6 (l,0±0.5) and 8 {0.4±0,9)
postsurgery. The difference between 4-
week RD and 8-week RD did reach the
statistical significance (/;=0.0008). 4 to
8 weeks postsurgery, an increasing
amount of newly formed granulation
tissue intermixed with remnants of the
matrix barrier was present in the supra-
gingival area (Fig. 10. At 6-months
postsurgery, the gingival margin was
located in a more apical position when
compared to 8-week observation inter-
val. The difference between postsurgery
RD and 6-month RD was statistically
significant (/)=0.04) (Fig. lg).
Presurgery sensitivity to air stream
was present in 10 defects. At 6 months
postsurgery. sensitivity had disappeared
in 9 defects and remained unchanged in
1 defect.
Discussion
The results of the present report indi-
cate that consistent improvement of
gingival recession defects may be
achieved by means of a barrier-sup-
ported envelope technique. At 6 months
postsurgery. mean RC was 65"'ii, and
54% of the defects were covered to
within 0,5 mm from the CEJ, These
data favorably compare to previous re-
ports where a similar flap design was as-
sociated with a free connective tissue
graft harvested from the palate. In re-
cession defects of 3.3 mm in depth and
3,6 mm in width, Raetzke (1985)
achieved total root coverage in 5 of the
Human gingival recession defects 27
12 cases, and 60-80% coverage in the
remaining sites. Results in 12 patients
with recession defects ranging from I to
8 mm ill depth included complete cover-
age in 14 sites (b\"/u), with a mean root
coverage of 84'K, (Allen 1994). In spite
device upon healing dynamics of the
periodontal wound.
In all defects, flap replacement inten-
tionally resulted in a variable amount
of barrier exposure. The exposed por-
tion of the barrier maintained its physi-
cal integrity until week 4. the fragmen-
tation/resorption process was generally
complete at week 8 following surgery.
Although the prolonged chlorhex-
idine mouthrinse regimen, the exposed
barrier may have been contaminated by
oral bacteria. This contamination has
been previously associated with com-
promised GTR (Selviget al. 1992), The
extent of ePTFE membrane exposure
has been negatively correlated with the
amount of regenerated tissue at mem-
brane removal and the recession depth
reduction at 12 months postsurgery
(Trombelli et al, 1995a), Nevertheless,
our observations suggested that the ex-
posed barrier was able to act as a "scaf-
fold" for the formation of the granu-
lation tissue originating from the U-
shaped margins of the defect. This ef-
fect may relate to the physico-chemical
properties and design characteristics of
the implanted material (Lundgren et al.
1994). The matrix barrier has a multi-
layered design consisting of 2 perfor-
ated layers separated by an interspace.
The internal layer is supplied with space
holders which ensure room under the
membrane in sites where the device is
in contact with the root surface. These
characteristics may have allowed for the
granulation tissue to penetrate and inte-
grate with the matrix, thus supporting
its formation also in the supragingival
area. Although partly lost due to re-
modeling process and/or trauma from
toothbrushing, the supragingival
granulation tissue significantly contrib-
uted to the coronal shift of the gingival
margin observed following the tissue
maturation phase. These observations
support those by Roccuzzo et al. (1996)
where recession depth reduction was
achieved in sites where the matrix bar-
rier had become exposed following
surgery.
A conservative approach for root in-
strumentation was followed. Ultrasonic
28 Tromhelli ei a}.
scaling and tetracycline conditioning
were limited to the exposed root sur-
face, with no attempt to modify root
morphology. In vitro studies have
shown that tetracycline demineraliza-
tion results in alterations of the root
surface which may enhance periodontal
regeneration {Wikesjo et al. 1986. Ter-
ranova et al. 1986. Trombclli et al.
1995c). Increased tensile strength at
root surface/fibrin clot interface has
been reported following topical appli-
cation of acidic solutions (Poison &
Proye 1982). Therefore, root condition-
ing may have improved barrier-sup-
ported wound stability in areas where
maturing granulation tissue was more
susceptible to mechanical disrupting
forces.
A slight increase (0.3 mm) in mean
KT was observed al 6 months post-
surgery. Differentiation of the keratiniz-
ed gingival epithelium has been shown
to be determined by inductive stimuli
from the underlying connective tissue
(Karring et al, 1975). such as PDL-de-
rived connective tissue, as well as by the
genetically-determined phenotype of
the epithelial cells (De Luca et al. 1990).
It may be hypothesized that the granu-
lation tissue supported by the re-
sorbabte device, which has been demon-
strated to lead to the formation of peri-
odontal tissues (Gottlow ct al, 1994).
possesses the ability to induce gingival
keratinization. It has been suggested
that inductive properties inherent in the
newly formed tissue found al ePTFE
membrane removal may be involved in
regulation and differentiation of the
overlying epithelium (Trombelli et al,
1997a).
Only non-smokers were included for
treatment. Since previous studies have
shown that treatment outcome follow-
ing GTR in intrabony {Tonetti et a!,
1995. Trombclli et al, 1997b) and re-
cession defects (Trombelli & Scabbia
1997c) is impaired in cigarette smokers.
the results of the present study need to
be validated in the general population.
In conclusion, the results o\^ the pres-
ent case report indicate that clinical im-
provement of gingival recession defects
may be achieved by means o'^ a mcm-
brane-supportcd envelope technique.
The bioresorbable matrix barrier repre-
sented an effective scaffold to support
the reconstruction of the mucogingival
unit. Further investigations are needed
to establish whether and to what extent
the additional use of degradable
wound-stabilizing devices may result in
any significant advantage over conven-
tional root coverage procedures.
Ackowledgement
This study was partly supported by
MURST grant #95/60106/014,
Zusammenfassung
Ahdcckctnic Lappfttcliiyiirgk' mit le.wrhitrhti- dans les lesions de recession gingivaie chez
rer Burritre zur Behumlkm^ viin Rtzi:s.\ii>n.'i- I'humain. Ces 11 lesions de recession gingiva-
defekien der Inmumcii Gingivci. Fuilht'iivhie
Der vorliegende Fallbericht evaluierte am
Meiischen den Ert'olg der Behandliing gingi-
valer Rezessionsdefekte nach miikogingivaler
Chirurgie. bei gleichzeitigem Anbringen ei-
ner biorcsorbierbaren Barriere, Insgesamt
wurden bei 6 Palienten 11 bukkale Gingiva-
rezessiotieii der Millerscheii Klassc I oder II ble (Guidor) a ete placee pour recouvrir com-
fortkiufend behandell. Die Beliige der espo-
nierten WurzelobeiHache wurden tiiit dem
Ultraschailgerat entfernt und mit einer Ter-
racyclin HCL Losung (10 mg/ml) 4 Mtnuten
lang konditioniert, Um die exponierte Wur-
zeloberfliiche und die umgebenden Knochen-
rander voll abziidecken, wurde ein bukkaler
Vollhautspalt-Decklappen mobilisiert und
eine biuresorbierbare Matrixbarriere ange-
bracht. Daraufhin wurde der Lappen in sei- et de gcncive. la profondeur de recession
ner, oder leicht koronal zu seiner ursprijngli-
chen Lage positioniert. Bei alien Fallen wur-
de ein Abschnitt der bioresorbierbaren
Membran unterscliiedliclier GriiBe aiil" der
exponierten Wurzeloberflachc absichtlich un-
bcdeckt belassen. Klinischc Bel'undungcn be-
urleillen die pracbirurgiscbe Situation und 6
Monale nach dem Eingriff die postchirurgi-
sche. wobei folgende Parameter einbezogen
wurden: Defektspezifisclie Plaque- und Gin- tre que RD passait de 3.3:1:0,2 mm avant la
giva Scores. Tiefe der Rezession (RD). son-
dierte Taschentiefe (PD). Hohe des klini-
sehen Altaehmentniveaus (CAL) und Breite
des keratinisierten Gewebes der Gingiva
(KT). Direkt nacli dem chirurgischen Ein-
griff. wie auch nach den postchirurgischen
Versuchswochen 1. 2, 4. 6 und K wurde die
Lage des Gingiva- oder Granulationsgcwebs-
saums rcgistriert. der die urspriinglich expo-
nierte Wurzeloberflache deckle, wie auch die
Position des exponierlen Absehnitts der Bar- lambeau. La ttiembrane bioresorbable rc-
rierenmembran. Die statistische Analyse
zeigte. daB sich die RD von 2.3±0,2mm vor
dem chirurgischen Eingriff bis auf
O,8±O,5nim bei der postoperaliven Untersu-
chung nach 6 Monaten (p = 0,001 ) verringert
hatte. was einer mittleren Deckung der
Wurzeln von 65"ii (Slreuung von 40 100"'"}
entspricht, Der Zuwachs an CAL verlief par-
allel zur Reduktion der RD (I,5±O,5 mm:
/i = 0.0009), Bei der Untersuchung 6 Monale
post operationem wurde eine leichte
Erhohung (0,3 *0,6 mm( des KT-Areals kon-
statierl. Die Resultate maehen deutlieh. daft
mit einer. durch Barrieremembrane unter-
sllitzten Abdeckungschirurgie. eine klinische
Verbesserung von Rezessioosdefekien der
Gingiva erreicht werden katin. Die bioresor-
bierbare Matrix dient der Rekonstruktion
der mukogingivalcn Einheil als effektives
Sliitzgerilst.
Resume
Barrii-n- rcsurbuhk e! chirurgie a lambeuu
d'envehppe clan.s le traiiemcnl des lesions de re-
cf.s.sion girif;iviilc' liuniciinc. Rappurl de I i cas
Presentation de onze cas de guerison suivant
la chirurgie muco-gingivale combinee avec
I'utilisation d'une membrane bioresorbable
ie vestibulaire de classe I ou II de Miller cbez
6 patients ont ete traitees. La .surface radicu-
laire exposee a ete detartree par ultra-sons et
conditionnee par une solution de letraeycline
HCL (10 mgn'ml) durant 4 min. L'n lambeau
d'enveloppe d'epaisseur partielle.'totale a en-
suite ete eleve ei une membrane bioresorba-
pletement la surface radiculaire exposee et les
regions osseuses avoisinantes. Le lambeau a
ensuite ete positionne a ou quelque peu en
coronaire de sa position originale. Dans tons
les cas une quantitc variable de membrane
etait intentionellement laissee non-couverte
sur la surface radiculaire exposee. Les mesu-
res eliniques prises avant la ehirurgie et 6
mois apres comprenaient I'indice de plaque
(RD). la profondeur au sondage (PD). le ni-
veau clinique d'attache (CAL) et la largeur
du lissu keratinise (KT). Immediatement ap-
res la chirurgie et 1, 2, 4. 6 et 8 semaines
apres. la localisation de la gencive marginale
ou du tissu de granulation recouvrant ia sur-
faee radieulaire exposee preeedemment a ete
enregistree ainsi que l'etendue de I'exposition
de la membrane. L'analyse statistique ii mon-
chiriurgie a 0,8±0,5 mm 6 mois apres [p-
0,001) representant un reeouvrement radieu-
laire moyen de 65'''! (de 40 a 100%), Le gain
de CAL etait evalue paralellement a ia reduc-
tion de RD (1.5±O,5 mm: ;) = 0.0009). tandis
que KT aecusait une legere augmentation
(0.3±0,6 mm). Les resultats indiquent que
Pamelioration clinique des lesions de reces-
sion gingivaie peut etre obtenue en utilisant
une membrane iors de cette technique par
presente un echafaudage effectif pour ame-
liorer la reconstruction de Funite muco-gin-
givale.
References
Allen. E, P & Miller. P D, (1989) Coronal
positioning of existing gingiva: short term
results m the treiitmenl of marginal tissue
recession, Jourmil of Periodoiilohgv 60,
316-314,
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Address:
Leonardo Trombelli
Department of Periodoniology
School of Dentistry
University of Ferrara
I'ia Savonarola 9
44100 Ferrara
Itatv