Soft tissue augmentation is often required due to high expectations of a natural red-and-white esthetic but also to allow the generation of more complex tissues than with GBR alone. Since autologous grafts involve disadvantages such as the creation of a second surgical site with additional pain and morbidity and the limited availability of grafting material, resorbable collagen scaffolds were developed to offer an off-the-shelf alternative to autologous grafts.
To perform a first case series with a new regenerative collagen 3-D matrix with vertically oriented open pores
as a potential alternative to autologous connective tissue grafts.
Material and methods:
A new 3-D regenerative collagen matrix was used in this case report (Mucomaix, Matricel GmbH, Herzo-
genrath, Germany) that is CE-approved in Europe since 2013. This biodegradable 3-D matrix is composed of porcine collagen and elastin fibers and has a highly open porous structure that is intended to guide migrating cells and blood vessels into the matrix to support the soft tissue regeneration. It is not chemically crosslinked and is remodelled during the healing process. For this series the product size 15 X 20 mm with a thickness of 3 mm was used. The 3-D regenerative matrix was used for the treatment of the following clinical indications: Root coverage with coronally advanced flap technique, immediate implant placement with buccal soft tissue augmentation, and socket preservation with socket sealing. Surgical handling, soft tissue reaction during the healing process and final results will be discussed.
Due to the shape stability of the 3-D collagen matrix in the dry as well as in the wet state, the trimming and handling is very easy. The wet matrix is compressible and stretchable and due to its ‘memory-effect’ it regains its initial shape after a few seconds. After the placement of the dry matrix on the prepared recipient site the hydration of it was providing great handling properties. The primary healing phase was uneventful in all cases. During the healing, tissue inflammatory reactions were within normal limits and with no visible difference to those of autologus soft tissue grafts that would be used in these indications. The final results presented are satisfying in all cases. Since the new 3-D matrix does not provide a barrier layer, it is not indicated for open healing during e.g. socket sealing, because degradation of the exposed 3-D matrix would be too fast. However, the combination of the 3-D matrix with a slow degrading collagen membrane gave promising results also for this indication.
Conclusion and clinical implications:
The initial results obtained after clinical application of the new 3-D collagen matrix in closed-healing procedures to avoid connective tissue graft harvesting are very encouraging. However, further well designed clinical studies involving larger patient populations are needed to generate evidence-based data for validation of these early results.