Collagen Matrix With and Without Enamel Matrix Derivative

• enamel matrix derivative (Biological), also known as Emdogain®: Enamel matrix derivative (EMD), sold under the brand name Emdogain®, is an amelogenin derivative of embryonal porcine enamel and is FDA approved for application to root surfaces to treat recession defects. Amelogenins comprise the majority of the proteins in EMD while others such as tuftelin, ameloblastin and amelin make up the remainder. EMD is thought to mimic the role of proteins crucial to cementogenesis and root development, which may promote new gingival attachment to exposed roots. The properties of EMD may favor early healing of the soft tissue and stimulate angiogenesis.
• Porcine collagen matrix (Device), also known as Mucograft®: Mucograft® is a bi-layered grafting material composed of Type I and III collagen. It is derived from veterinary certified pigs, sterilized by gamma irradiation and has a low antigenicity in conjunction with good biocompatibility. The material is approximately 2.5-5mm thick and is indicated for root coverage, increasing keratinized tissue, covering of implants placed immediately and alveolar ridge reconstruction. A compact outer layer contributes to protection, structure and allows for better control during suturing; while the inner layer is thick, porous and spongy in nature, providing a suitable environment for early vascularization and promotion of cellular in-growth.

Primary outcomes

• Change in gingival recession using conventional measurements [Baseline to 6 months]: Change in gingival recession measurements from baseline to 6 months
• Change in root coverage using digital analysis [Baseline to 6 months]: Assessment of surgical outcome by optically scanning stone models captured at baseline to 6 months post-surgery. The digital files will be aligned using global registration and GR recorded by measuring the distance from cemento-enamel junction to the height of the marginal gingiva using computer software. % RC will be calculated by comparing GR at the various times.
• Change in Probing Depths [Baseline to 6 months]: Change in Probing Depthmeasurements from baseline to 6 months
• Change in Clinical Attachment Levels [Baseline to 6 months]: Change in Clinical Attachment Levels measurements from baseline to 6 months
• Change in Keratinized Tissue [Baseline to 6 months]: Change in Keratinized Tissue measurements from baseline to 6 months

Secondary outcomes

• Comparison of digital vs. conventional measurement [Baseline to 6 months]: Compare conventional and digital change in gingival recession to assess the two modalities treatment outcomes

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Age 18 years or over
* Patient will remain in the Capital region for at least 6 months following the surgical procedure for follow up appointments
* Patient must be otherwise periodontally healthy
* Patient must be systemically healthy (ASA class I or II)
* Patient must have no contraindications to periodontal surgery
* Patient must have demonstrated good oral hygiene (plaque index <1 according to Silness and Löe)
* Paired Miller Class I, II or predictable III recession defects
* Bilateral, facial defects on single-rooted teeth

Exclusion Criteria:

* Self-reported history of smoking within previous 6 months
* Does not meet any of the preceding criteria
* Female patients who are pregnant or nursing
* Antibiotic medications taken within the last 6 months
* History of mucogingival surgery at the sites of interest
* Poor plaque control (>25% of sites)
* Those with clinically significant systemic disease, which may affect healing (i.e. uncontrolled diabetes or bone metabolic disease)
* Allergy to chlorhexidine gluconate (Peridex)
* Does not sign study consent or HIPAA forms
* Bleeding complications (e.g. hemophilia)
* Warfarin therapy
* History of osteoporosis or taking bisphosphonate medications
* History of radiation therapy in the head and neck area
* Mobile teeth beyond physiologic mobility
* Facial restorations at the site to be treated
* Recession defects that will require more than one 15x20mm Mucograft (per side)