Digital workflow to assess healing after acellular dermal matrix exposure in root coverage: A case report

This case report describes 18-month clinical and digital outcomes after bilateral treatment of multiple gingival recessions using coronally advanced flap plus acellular dermal matrix (ADM).

A 46-year-old woman with multiple maxillary recessions received bilateral surgery. Outcomes at baseline (BL), 6 months (6M), 12 months (12M), and 18 months (18M) included recession depth, recession width, keratinized tissue width, and gingival thickness. Intraoral scans were taken at all visits. Standard Tessellation Language (STL) models were superimposed per hemiarch using baseline-referenced and remodeling-interval analyses. Digital metrics included root mean square (RMS) and average positive and negative deviations for each interval.

At 6M, the left side achieved complete root coverage, with partial recurrence at teeth #13 and #14 at 12 and 18M. On the right, teeth #6 and #3 improved and remained stable. At tooth #4, limited dehiscence with partial ADM exposure occurred at 1 week without infection. Loose sutures were removed, and 0.12% chlorhexidine gauze cleansing without rinsing was prescribed until epithelial closure. Conservative care led to progressive re-epithelialization and complete closure by 1 month, with stable integration at 18M. Digital analysis showed higher RMS values on the right in baseline-referenced comparisons (BL - 6M, BL - 12M, and BL - 18M) and remodeling intervals (6M-12M, 12M-18M, and 6M-18M), indicating greater surface deviation on the right side during follow-up.

Both sides showed favorable evolution but different healing trajectories. Serial STL superimposition documented tissue remodeling and post-exposure healing, supporting its use as a complementary tool for mucogingival follow-up. In this case, the site with early ADM exposure showed gradual healing after conservative management.

Early acellular dermal matrix exposure may heal when there are no signs of infection and follow-up is strict. Serial superimposition of intraoral scans adds side-specific information that complements routine clinical assessment.

This report presents a patient with bilateral maxillary gingival recessions, treated with the same surgical technique and a soft-tissue substitute. One side healed uneventfully. On the other side, there was an early wound opening with partial matrix exposure; the area closed progressively and was fully covered by 1 month, with stability at 18 months. Clinical measurements and serial 3D intraoral scans showed improvement on both sides. However, the two sides showed different remodeling patterns over time. The patient was satisfied with the outcome, although cervical restoration was required in the tooth with exposure. The exposed matrix area closed progressively without the need for additional surgery.