The Connective Tissue Graft Wall Technique and Enamel Matrix Derivative to Improve Root Coverage and Clinical Attachment Levels in Miller Class IV Gingival Recession

The case reports in this article describe a surgical approach for improving root coverage and clinical attachment levels in Miller Class IV gingival recessions. Two gingival recessions affecting maxillary and mandibular lateral incisors associated with severe interdental hard and soft tissue loss were treated. The surgical technique consisted of a connective tissue graft (CTG) that was placed below a coronally advanced envelope flap and acted as a buccal soft tissue wall of the bony defect treated with enamel matrix derivative (EMD). No palatal/lingual flap was elevated. In the first clinical case, 6 months after surgery a ceramic veneer was placed to correct tooth extrusion and improve the overall esthetic appearance. One year after the surgery in both cases, clinically significant root coverage, increase in buccal keratinized tissue height and thickness, improvement in the position of the interdental papilla, and clinical attachment level gain were achieved. The radiographs demonstrate bone fill of the intrabony components of the defects. This report encourages a novel application of CTG plus EMD to improve both root coverage and regenerative parameters in Miller Class IV gingival recessions.