Flap surgery in conjunction with enamel matrix derivative

  • Gingival recession at the upper canine with healthy interdental tissues. Cleaning of the root surface.
  • Flap preparation. Incisions according to the coronally advanced flap (CAF) technique.
  • Flap elevation and cutting of the periosteum.
  • Deepithelialization of the papilla.
  • Application of Straumann® PrefGel® onto the exposed root surface.
  • After rinsing, application of Straumann® Emdogain® onto the exposed root surface.
  • Repositioning of the flap in coronal direction and suturing.
Miller class I (recession does not extend to the mucogingival junction (MGJ)) and Miller class II gingival recessions (recession reaches or goes beyond the MGJ) are characterized by intact interdental tissues and have a good prognosis in terms of complete root coverage. Enamel matrix derivative (Straumann® Emdogain®) used in recession type defects has been shown to improve root coverage and to increase the width of keratinized tissue when compared to conventional flap surgery (coronally advanced flap, CAF) alone [1, 2]. For thin gingival biotypes (thickness ≤ 1.0 mm), a volume-supporting approach, i.e. the additional use of an autologous soft tissue graft or a collagen matrix (mucoderm®) may be indicated.

Flap techniques

Straumann® Emdogain® may be used in conjunction with all state-of-the-art mucogingival surgical procedures to treat isolated or adjacent multiple gingival recessions including coronally-advanced flap procedures and tunnel techniques.

Straumann® PrefGel®

Conditioning of the exposed root surfaces with Straumann® PrefGel® is always recommended when Straumann® Emdogain® is used. Straumann® PrefGel® effectively removes the smear layer on the root surface to support optimal protein precipitation and blood clot adhesion.

Post-operative care

The patient should be instructed not to brush in the treated area, but to rinse with an antiseptic mouthwash until 3 weeks after the surgery.

Recession coverage with Straumann® Emdogain® (Dr. F. Rathe)
Recession coverage with Straumann® Emdogain® (Dr. F. Rathe)

In CAF-procedures in conjunction with Straumann® Emdogain®, the exposed root surfaces are cleaned and sulcular incisions at the site of the recessions are made extending horizontally in the adjacent interdental tissues. To elevate a full thickness flap, two vertical slightly divergent releasing incisions are made that connect to the horizontal incisions. The periosteum is cut to allow for tension-free positioning of the flap in coronal direction and the papilla are deepithelized. The root surfaces are conditioned by applying Straumann® PrefGel® for 2 minutes. After thorough rinsing, Straumann® Emdogain® is applied to fully cover the exposed root surfaces. The flap is repositioned coronally and sutured at the level of the cemento-enamel junction.

[1] Cairo et al. J Clin Periodontol. 2008 Sep;35(8 Suppl):136-62
[2] Castellanos et al. J Periodontol. 2006 Jan;77(1):7-14