Directions for Use

Soft tissue regeneration procedures in the oral cavity are demanding and technique sensitive. Predictable and optimal results depend on many factors including a number of patient variables, surgical technique and the selection and appropriate utilization of a graft material.

Based on data from clinical studies^1,2,3, discussions with surgeons, and the consensus of eleven Round Table Conferences (2009-2011), the following technical guidelines should be considered to optimize clinical success with Mucograft^®.

Patient Selection

Mucograft^® is an effective alternative to autogenous grafts in the appropriate cases.¹ As with any soft tissue grafting procedure, patient selection, surgical requirements and patient compliance with post-surgical instructions should be carefully considered.
In order to increase keratinized tissue (KT) with Mucograft^®, select cases that have at least 1 mm of KT already present. Mucograft^® has demonstrated comparable gains in KT when compared to autogenous grafts in these types of cases.² The small band of keratinized tissue provides the cellular information necessary to signal regeneration of the desired tissue type.
Patient goals and expectations in terms of esthetic and clinical outcomes should be considered and managed.

Product Handling

Mucograft^® is ready to use without any time consuming preparatory steps. Mucograft^® can be applied directly from the package to the surgical site. No washing or soaking of the matrix is necessary.
Mucograft^® should be trimmed to size and applied dry. To avoid unnecessary wetting, the use of a template is recommended to achieve the proper size and shape.

When applied to the defect in its dry state to the defect, the matrix will rapidly moisten with blood. The soaked Mucograft^® will adapt spontaneously to the defect contours and adhere well to the defect. Once saturated with blood, care should be taken to avoid unneccessary manipulation of the matrix which may lead to separation of the collagen fibers.

The compact structure should face outwards and the spongy structure should face towards the bone and/or periosteum.
Avoid compression of the matrix as much as possible. Creation of a tension free flap is critical when using Mucograft^®. If possible, wider than normal flaps are recommended. Avoid post-surgical compression of the wound.
Mucograft^® should be immobilized when implanted to stabilize the blood clot

Mucograft^® can be easily sutured to the defect and handles similarly to autologous tissue.

Procedures to Gain Keratinized Tissue

The maximum width of the band of keratinized tissue that can be obtained is genetically predetermined.
A minimum vestibular depth should be available in posterior sites to allow surgery and tension free healing of the treated site.
When using a split-thickness flap, Mucograft^® should be sutured to the intact periosteal bed.
When utilizing Mucograft^® in an onlay technique (open healing), the mucosal portion of the split thickness flap may be excised or left without sutures at its base. If desired, you may also suture the mucosal flap apically.
When placed on an intact periosteal bed, Mucograft^® may be left exposed or covered with a wound dressing (i.e., Perio Pack) or a surgical stent.

Root Coverage Procedures

In general, treatment of Miller Class I and II defects shows much higher predictability and success rates than Miller Class III and IV defects.
Generally, root coverage procedures in the maxilla often show better results than in the mandible due to reducd muscular tension and adequate vestibular depth of the maxilla.³
Mucograft^® should remain completely submerged under the flap.
When using Mucograft^® in root coverage, clinical outcomes often improve for at least 6 months postoperative secondary to creeping attachment.
The application of Mucograft^® can be used with a traditional coronally advanced flap (CAF). Mucograft^® may also be used in a tunnel technique which coronally advances the gingival margin.
In addition to the guidelines above, the following should be considered when employing the coronally advanced tunnel technique:
- Trim Mucograft^® in its dry state so that it is narrower than the tunnel. This should help reduce friction while moving it through the tunnel.
- When advancing Mucograft^® through the tunnel, care must be taken to avoid separation of the collagen fibers.
- It is recommended that Mucograft^® be either guided through the tunnel with a hemostat instrument that grips the entire length of the matrix or pulled through the tunnel with a horizontal mattress suture. Do not push it through with a periosteal elevator or other instruments.

Post-Operative Care

As with any regenerative site, caution must be exercised in post-operative care and during oral hygiene practices at or near the surgical site. For the first 4 weeks, no brushing or flossing at the gingival margin and no chewing of hard foods. For the first 6 months, do not probe or allow scaling and root planing of the surgical sites.

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