Fig. 7 A curved tunneling knife is used to finalize
the tunnel. A deep pouch is created beyond the
muco-gingival junction while avoiding to traumatize
the tip of the interproximal papilla. Fig. 8 The depth of the pouch is measured with the
help of the periodontal probe and the presence of a
bony balcony can be assessed. Fig. 9 A Gracey curette is used to mobilize and extend
the pouch to avoid any tension in the subsequent
coronal advancement.
Fig. 10 Transversal sounding of the tunnel with a
periodontal probe without detaching the papillae
peaks. Fig. 11 The 3D collagen matrix, Geistlich Mucograft ® ,
is measured and cut in dry state to the appropriate
defect size (in this case: 7 mm x 30 mm). The matrix
must not be compressed. Fig. 12 A 6-0 Ethicon Vicryl suture is used to
introduce Geistlich Mucograft ® into the tunnel. The
needle enters the papilla from the outside to the
inside of the tunnelized flap and passes behind each
papillae exiting at the largest recession in tooth 26.
Fig. 13 A vertical mattress suture is introduced
into the leading edge of the dry trimmed Geistlich
Mucograft ® in order to slide it under the tunnel. Fig. 14 The needle passes through the tunnel behind
each papilla back to tooth 24. The suture exits at the
same level of the first stitch on the mesial aspect of the
tunnel, but more apically. Fig. 15 The dry Geistlich Mucograft ® is inserted into
the tunnel with a slightly oblique angle and then is
gently pulled into the tunnel.
Fig. 16 Geistlich Mucograft ® is fixed to the elevated
flap. Fig. 17 A horizontal mattress suture is placed at the
base of the papilla. The suture passes to the palatal
aspect back to the buccal aspect, around the splinted
teeth and is closed over the contact point. Each papilla
is fixed with the same procedure. Fig. 18 With this suturing technique, the elevated
flap is advanced coronally and fixed one millimeter
above the cemento-enamel junction. Care must be
taken that the Geistlich Mucograft ® remains com-
pletely submerged under the tunnel and that the
flap remains completely immobilized.
Fig. 19 15 days post-operative: uneventful healing. Fig. 20 7 months after surgery: complete recession
coverage. Fig. 21 13 months after surgery: stable conditions and
maintained complete recession coverage.
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