With the recent advances in modern dentistry, localized gingival recessions and root exposure represent an aesthetic problem to the discerning patient. Further, root caries, dentine hypersensitivity and persisting gingival inflammation are frequently observed. All of these situations represent an indication for periodontal plastic surgery. With this intervention being a highly elective one, treatment modalities have to focus on complete coverage of the exposed root, leaving no millimetre uncovered. Furthermore, a perfect match of colour and texture of tissues should be achieved. Coronally advanced flaps, laterally repositioned flaps, free gingival grafts, and subepithelial connective tissue grafts appeared as novel approaches to achieve improvements in recession depth, clinical attachment level and width of keratinized tissue [
6,
24,
25]. Techniques such as free gingival grafts are reported to fail frequently [
26,
27]. Connective tissue grafts, however, are described to cause excessive tissue thickness as a post surgical complication [
9‐
12]. The major drawbacks of this technique are bleeding of the donor site, sensations of pain and hyposensitivity of the palate [
9‐
12]. In multi-recession cases connective tissue grafts can be applied only with retention as the amount of donor tissue limits the treatable area. Multiple surgeries have to be performed in those cases, imposing physiological and psychological stress on the patient. On the basis of these complications, a large number of biological biomatrices have been introduced within the last decades, all of which have been reported to contribute to clinically relevant root coverage [
23,
28,
29]. These matrices were developed with the intention to reduce the major disadvantages of connective tissue grafts. When looking at the success rate, long term stability and aesthetical outcome every matrix has to face the comparison with the connective tissue graft. Due to its perfect colour match, the bilaminar blood supply and the high grade of clinical success this technique is still regarded as the gold standard. In the present study Copios
® (Zimmer, Germany), a matrix derived from bovine pericardium was used in order cover teeth with recession of Miller class I and II. The matrix was well tolerated by all of patients with no allergic reaction or other complications observed within the study period. The data of this study were able to prove that obviously, the application of the Copios
® matrix leads to a marked increase of the clinical attachment level after the observation time point of 6 month. These results are in accordance with previously published data employing a similar human dermal derived matrix [
29]. In this study no change was observed in the probing depth within the six months. The width of gingiva increased in average 0,9 mm, which is slightly less compared to the values reported for connective tissue grafts. However, when comparing those values to AlloDerm products they are slightly higher [
28]. This observation is also true for the width of keratinized gingiva and the gingival biotype.
The harmlessness of the use of Tutoplast, which is the basis of Copios
® has been previously described for application in dental surgery [
29] as well as for closing ventricular septal defects in cardiovascular surgery [
30] and dura replacement in neurosurgery [
31]. Furthermore, animal studies in rats proved a complete integration of the membrane by recipients' connective tissue. Approximately 60% of the original membrane thickness remained [
32]. The results underline that obviously, non cross linked collagen based matrices such the above mentioned material, show similar integrative capacities for soft tissue augmentation as observed for the CTG and other porcine derived matrices. The used matrix was able to be integrated within host connective and thereby augmenting the biotype by enhancing gingival thickness. However, further investigations with this material and with patients own connective tissue is necessary to critically assess the potential of this new membrane for a long-term clinical use.