Professor Hannes Wachtel uses a coronally advanced flap in order to cover multiple recessions in the first quadrant. In this case, the surgery is combined with the application of Straumann Emdogain (an enamel matrix protein) in order to treat the recession defects. The use of enamel matrix derivatives under a coronally advanced flap is less invasive and time consuming than the use of a subepithelial graft under a coronally advanced flap which also includes the risk of wound healing problems at the donor site. Thus, patient comfort is increased.
First, the recession areas are cleaned. While preserving the interdental papillae, an intrasulcular incision is followed by the gentle preparation of a mucoperiosteal flap in the vestibular area, which merges into a split flap once the mucogingival junction is passed. This facilitates the passive mobilization of the prepared flap. The removal of the epithelium of the interdental papillae is performed thoroughly. This step is important to ensure the attachment of the new, surgically created papillae of the prepared flap to the de-epithelialized tissue of the original papillae.
Once the wound surface has been cleaned and the conditioning of the cervical tooth substance with EDTA is completed, Professor Wachtel applies Straumann Emdogain and places the prepared flap in the coronal position. Double-sling suturing supports the adaption of the flap to the interdental papillae. Using light-curing bonding material, the interproximal spaces of the affected teeth are now connected. These “bridges” serve as a hypomochlion for additional sutures that go around the connected contacts – a suturing technique that supports the stabilization of the coronally advanced flap.