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An exploratory clinical study evaluating safety and performance of a volume-stable collagen matrix with coronally advanced flap for single gingival recession treatment

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Clinical Oral Investigations Aims and scope Submit manuscript



To test the safety of a new volume-stable collagen matrix (VCMX) in combination with coronally advanced flap (CAF) for the treatment of single gingival recession.

Material and methods

Ten patients were treated for single RT1 gingival recession. Complete and mean root coverage, gingival thickness and keratinized tissue height, patient-reported outcome measures (PROMs), and safety were assessed up to 180 days. Descriptive statistics were used to analyze the clinical parameters.


VCMX resulted to be safe with no serious adverse events in all patients. At 6 months, root coverage was 96.7% with 90% of defects exhibiting complete coverage. There was an increase in mean width of keratinized tissue (KT) (0.4 ± 0.8 mm) and in gingival thickness (GT) (0.4 ± 0.34 mm); however, the difference was not statistically significant compared to baseline parameters. Pain perception and pain-killer consumption were low and decreasing further at 7 days. Esthetic satisfaction for both patients and experts revealed excellent scores.


VCMX is a safe and well-tolerated device for the treatment of single gingival recessions. In combination with CAF, it resulted in a high performance in terms of mean and complete root coverage, KT width, and GT increase. VCMX may reduce patient discomfort and post-operative morbidity.

Clinical relevance

VCMX is a safe and stable substitute for the treatment of gingival recession in conjunction with coronally advanced technique.

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  1. Albandar JM, Kingman A (1999) Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 70:30–43

    Article  Google Scholar 

  2. Joshipura KJ, Kent RL, DePaola PF (1994) Gingival recession: intra-oral distribution and associated factors. J Periodontol 65:864–871

    Article  Google Scholar 

  3. Rios FS, Costa RS, Moura MS, Jardim JJ, Maltz M, Haas AN (2014) Estimates and multivariable risk assessment of gingival recession in the population of adults from Porto Alegre, Brazil. J Clin Periodontol 41:1098–1107

    Article  Google Scholar 

  4. Cairo F, Nieri M, Pagliaro U (2014) Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol 41(Suppl 15):S44–S62

    Article  Google Scholar 

  5. Del Pizzo M, Modica F, Bethaz N, Priotto P, Romagnoli R (2002) The connective tissue graft: a comparative clinical evaluation of wound healing at the palatal donor site. A preliminary study. J Clin Periodontol 29:848–854

    Article  Google Scholar 

  6. Wessel JR, Tatakis DN (2008) Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures. J Periodontol 79:425–430

    Article  Google Scholar 

  7. Griffin TJ, Cheung WS, Zavras AI, Damoulis PD (2006) Postoperative complications following gingival augmentation procedures. J Periodontol 77:2070–2079

    Article  Google Scholar 

  8. Zucchelli G, Tavelli L, Ravidà A, Stefanini M, Suárez-López del Amo F, Wang HL (2018) Influence of tooth location on coronally advanced flap procedures for root coverage. J Periodontol 89:1428–1441

    Article  Google Scholar 

  9. Sanz M, Lorenzo R, Aranda JJ, Martin C, Orsini M (2009) Clinical evaluation of a new collagen matrix (Mucograft prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial. J Clin Periodontol 36:868–876

    Article  Google Scholar 

  10. Thoma DS, Villar CC, Cochran DL, Hämmerle CH, Jung RE (2012) Tissue integration of collagen-based matrices: an experimental study in mice. Clin Oral Implants Res 23:1333–1339

    Article  Google Scholar 

  11. Jepsen K, Jepsen S, Zucchelli G, Stefanini M, de Sanctis M, Baldini N, Greven B, Heinz B, Wennström J, Cassel B, Vignoletti F, Sanz M (2013) Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial. J Clin Periodontol 40:82–89

    Article  Google Scholar 

  12. Stefanini M, Jepsen K, de Sanctis M, Baldini N, Greven B, Heinz B, Wennström J, Cassel B, Vignoletti F, Sanz M, Jepsen S, Zucchelli G (2016) Patient-reported outcomes and aesthetic evaluation of root coverage procedures: a 12-month follow-up of a randomized controlled clinical trial. J Clin Periodontol 43:1132–1141

    Article  Google Scholar 

  13. Jepsen K, Stefanini M, Sanz M, Zucchelli G, Jepsen S (2017) Long-term stability of root coverage by coronally advanced flap procedures. J Periodontol 88:626–633

    Article  Google Scholar 

  14. McGuire MK, Scheyer ET (2010) Xenogeneic collagen matrix with coronally advanced flap compared to connective tissue with coronally advanced flap for the treatment of dehiscence-type recession defects. J Periodontol 81:1108–1117

    Article  Google Scholar 

  15. Tonetti MS, Cortellini P, Pellegrini G, Nieri M, Bonaccini D, Allegri M, Bouchard P, Cairo F, Conforti G, Fourmousis I, Graziani F, Guerrero A, Halben J, Malet J, Rasperini G, Topoll H, Wachtel H, Wallkamm B, Zabalegui I, Zuhr O (2018) Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life. J Clin Periodontol 45:78–88

    Article  Google Scholar 

  16. Mathes SH, Wohlwend L, Uebersax L, von Mentlen R, Thoma DS, Jung RE, Görlach C, Graf-Hausner U (2010) A bioreactor test system to mimic the biological and mechanical environment of oral soft tissues and to evaluate substitutes for connective tissue grafts. Biotechnol Bioeng 107:1029–1039

    Article  Google Scholar 

  17. Thoma DS, Jung RE, Schneider D et al (2010) Soft tissue volume augmentation by the use of collagen-based matrices: a volumetric analysis. J Clin Periodontol 37:659–666

    Article  Google Scholar 

  18. Thoma DS, Hämmerle CH, Cochran DL et al (2011) Soft tissue volume augmentation by the use of collagen-based matrices in the dog mandible - a histological analysis. J Clin Periodontol 38:1063–1070

    Article  Google Scholar 

  19. Cairo F, Nieri M, Cattabriga M, Cortellini P, de Paoli S, de Sanctis M, Fonzar A, Francetti L, Merli M, Rasperini G, Silvestri M, Trombelli L, Zucchelli G, Pini-Prato GP (2010) Root coverage esthetic score after treatment of gingival recession: an interrater agreement multicenter study. J Periodontol 81:1752–1758

    Article  Google Scholar 

  20. De Sanctis M, Zucchelli G (2007) Coronally advanced flap: a modified surgical approach for isolated recession-type defects: three-year results. J Clin Periodontol 34:262–268

    Article  Google Scholar 

  21. Thoma DS, Zeltner M, Hilbe M, Hämmerle CH, Hüsler J, Jung RE (2016) Randomized controlled clinical study evaluating effectiveness and safety of a volume-stable collagen matrix compared to autogenous connective tissue grafts for soft tissue augmentation at implant sites. J Clin Periodontol 43:874–885

    Article  Google Scholar 

  22. Chambers D (2012) Learning curves: what do dental students learn from repeated practice of clinical procedures? J Dent Educ 76:291–302

    Article  Google Scholar 

  23. Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P (2010) Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up. J Clin Periodontol 37:644–650

    Article  Google Scholar 

  24. Zucchelli G, Mounssif I, Mazzotti C, Stefanini M, Marzadori M, Petracci E, Montebugnoli L (2014) Coronally advanced flap with and without connective tissue graft for the treatment of multiple gingival recessions: a comparative short- and long-term controlled randomized clinical trial. J Clin Periodontol 41:396–403

    Article  Google Scholar 

  25. Huang L, Neiva RE, Wang HL (2005) Factors affecting the outcome of coronally advanced flap root coverage procedure. J Periodontol 76:1729–1734

    Article  Google Scholar 

  26. Leknes KN, Amarante ES, Price DE, Bøe OE, Skavland RJ, Lie T (2005) Coronally positioned flap procedures with or without a biodegradable membrane in the treatment of human gingival recession. A 6-year follow-up study. J Clin Periodontol 32:518–529

    Article  Google Scholar 

  27. Stefanini M, Zucchelli G, Marzadori M, de Sanctis M (2018) Coronally advanced flap with site-specific application of connective tissue graft for the treatment of multiple adjacent gingival recessions: a 3-year follow-up case series. Int J Periodontics Restorative Dent 38:25–33

    Article  Google Scholar 

  28. Stefanini M, Marzadori M, Aroca S, Felice P, Sangiorgi M, Zucchelli G (2018) Decision making in root-coverage procedures for the esthetic outcome. Periodontol 2000 77:54–64

    Article  Google Scholar 

  29. Cairo F, Cortellini P, Pilloni A et al (2016) Clinical efficacy of coronally advanced flap with or without connective tissue graft for the treatment of multiple adjacent gingival recessions in the aesthetic area: a randomized controlled clinical trial. J Clin Periodontol 43:849–856

    Article  Google Scholar 

  30. Tonetti MS, Jepsen S (2014) 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 41(Suppl 15):S36–S43

    Article  Google Scholar 

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The study was funded by Geistlich Pharma AG, Wolhusen, Switzerland.

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Correspondence to Martina Stefanini.

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Conflict of interest

Prof. Zucchelli Giovanni and Dr. Stefanini Martina received honorarium for speaking engagements with Geistlich. The other authors did not declare any conflict of interest.

Ethical approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, informed consent was obtained from all individual participants included in the study.

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Stefanini, M., Mounssif, I., Barootchi, S. et al. An exploratory clinical study evaluating safety and performance of a volume-stable collagen matrix with coronally advanced flap for single gingival recession treatment. Clin Oral Invest 24, 3181–3191 (2020).

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