Giovanni Zucchelli: Mucogingival surgery around teeth and implants in the anterior zone – why the goal is complete coverage (Straumann® Emdogain/botiss mucoderm®)
Gingival recession around teeth and soft tissue dehiscence around metallic implants are common grounds for dissatisfaction among patients. Exposure during smiling or function of portions of the root or implant surface are the main indications for surgical coverage procedures. Generally only the most coronal millimeter(s) of the recession is/are exposed during smiling or function, therefore the presence and/or the persistence of a shallow recession after therapy may be a problem for the patient. Thus, the goal is complete root (or implant) coverage when patients are dissatisfied with the esthetic appearance of their teeth or implant(s).
Enhance your skills in periodontal plastic surgery with Prof. Zucchelli
In 2017 we are again delighted to sponsor two international courses in June and October on Reconstructive periodontal plastic surgery around teeth and implants in the esthetic zone with one of the leading plastic surgeons Prof. Giovanni Zucchelli. In this course, you will learn about Prof. Zucchelli’s techniques [6,7] to help you achieve complete root and implant coverage.
Cannot make it to the course?
Watch the recording of Prof. Zucchelli’s one-hour webinar free of charge at
How to achieve complete coverage – insights from the literature
Recent systematic reviews and consensus reports on root coverage procedures [1,2] concluded that the addition of autologous connective tissue graft (CTG) or Emdogain® (EMD) under a Coronally Advanced Flap (CAF) are the procedures of choice to achieve complete root coverage as they both have extensive evidence showing that they significantly improve root coverage compared with CAF alone.
A split mouth, randomized clinical trial , has shown that treatment of gingival recession defects with either CAF+CTG or CAF+ EMD appears stable, clinically effective, and similar to each other on all measured parameters, even after 10 years. Because the CAF+EMD procedure avoids the need for a CTG harvesting procedure, it is the preferred treatment of most patients.
A randomized clinical study  has shown that the addition of EMD to CAF procedures not only enhances root coverage but also increases the formation of keratinized gingiva, which together may contribute to improved esthetics of the clinical results.
A split mouth, randomized clinical trial  which compared the treatment of gingival recession defects with either CAF+CTG or CAF + a xenogenic collagen matrix (CAF + CMX) after 6 months and 5 years concludes that CMX+CAF appears to present a viable and long-term alternative to traditional CTG+CAF therapy.
Prof. Zucchelli’s technique for the treatment of single and multiple recession defects affecting adjacent teeth in patients with esthetic demands has been shown to achieve complete root coverage in most patients, irrespective of the number of recessions treated in each intervention. You will have the opportunity to practice this technique on pig jaws, watch two live surgeries and are invited to bring your own cases for an open discussion with the expert. In this course, Prof. Zucchelli will also present his approach for soft tissue dehiscence coverage around single implants which has proven successful in fully correcting severe vertical and horizontal peri-implant soft tissue defects and achieving high patient satisfaction [8,9].
(Click on the picture for a larger resolution) Stages of treatment with Straumann® Emdogain® under a Coronally Advanced Flap (CAF): Before treatment (5 mm recession defect) – 8 months after treatment – 7 years after treatment: root is completely covered. With courtesy of Prof. Zucchelli.
Straumann® Emdogain® is a unique gel containing enamel matrix derivative of porcine origin. The main component is amelogenin, which has demonstrated the ability to stimulate certain cells types involved in the healing process of soft and hard tissues towards a regenerative pattern, thus leading to true periodontal regeneration and accelerated oral wound healing.
botiss mucoderm® provides a true alternative in certain indications to the patient’s own connective tissue. This stable 3-dimensional collagen soft tissue replacement, made of porcine dermis, supports fast revascularization and soft tissue integration, including color and texture. mucoderm® can help you increase patient acceptance.
Professor in Periodontology at the University of Bologna/Italy. PhD in Medical Biotechnology applied to Dentistry. Active member of the European Academy of Esthetic Dentistry, Italian Society of Periodontology, Italian Society of Osseointegration, the European Federation of Periodontology and the American Academy of Periodontology. Associate editor and member of the editorial board of the International Journal of Esthetic Dentistry and member of the Editorial Board of the International Journal of Periodontics and Restorative Dentistry. Winner of scientific prizes for research in periodontology in Italy, USA and Europe. Author of more than 100 scientific publications in the field of periodontology. Co-author of two illustrated textbooks on periodontal plastic surgery (Ed. Martina) and of the chapter “Mucogingival Therapy-Periodontal Plastic Surgery” in Jan Lindhe’s textbook on “Clinical Periodontology and Implant Dentistry” (Ed. Wiley-Blackwell). Author of the book “Mucogingival esthetic surgery” (Ed. Quintessence)
1 Tonetti MS, Jepsen S; 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. 2014 Apr;41 Suppl 15:S36-43 2 Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol. 2014 Apr;41 Suppl 15:S44-62. 3 McGuire MK, Scheyer ET, Nunn M. Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue: comparison of clinical parameters at 10 years. J Periodontol. 2012 Nov;83(11):1353-62 4 Pilloni A, Paolantonio M, Camargo PM. Root coverage with a coronally positioned flap used in combination with enamel matrix derivative: 18-month clinical evaluation. J Periodontol. 2006 Dec;77(12):2031-9. 5 McGuire MK, Scheyer ET. Long-Term Results Comparing Xenogeneic Collagen Matrix and Autogenous Connective Tissue Grafts With Coronally Advanced Flaps for Treatment of Dehiscence-Type Recession Defects. J Periodontol. 2015 Oct 15:1-12. 6 Zucchelli G, De Sanctis M. Treatment of multiple recession-type defects in patients with esthetic demands.J Periodontol. 2000 Sep;71(9):1506-14. 7 Zucchelli G, De Sanctis M. Long-term outcome following treatment of multiple Miller class I and II recession defects in esthetic areas of the mouth. J Periodontol. 2005 Dec;76(12):2286-92. 8 Zucchelli G, Mazzotti C, Mounssif I, Marzadori M, Stefanini M. Esthetic treatment of peri-implant soft tissue defects: a case report of a modified surgical-prosthetic approach. Int J Periodontics Restorative Dent. 2013 May-Jun;33(3):327-35. 9 Zucchelli G, Mazzotti C, Mounssif I, Mele M, Stefanini M, Montebugnoli L. A novel surgical-prosthetic approach for soft tissue dehiscence coverage around single implant. Clin Oral Implants Res. 2013 Sep;24(9):957-62.