A digital index for positioning and cyanoacrylate stabilization of an acellular dermal matrix in root coverage surgery: A technical proof of concept

OBJECTIVE: To describe a technical proof-of-concept workflow using a patient-specific digital index as a physical intraoperative reference for positioning a porcine acellular dermal matrix and limited peripheral application of an n-butyl-2-cyanoacrylate-methacryloxy sulfolane surgical adhesive (Glubran 2; GEM Srl, Viareggio, Italy) to maintain the clinically selected matrix position during root coverage surgery. MATERIALS AND METHODS: Standardized photographs and an intraoral scan were used for virtual planning. A tooth-supported matrix-positioning index was designed and fabricated by vat photopolymerization and used as a physical reference for extraoral matrix trimming and intraoperative positioning. The fully hydrated matrix was adapted within the indexed boundaries and stabilized with discrete peripheral adhesive microdroplets while the central matrix-to-bed interface was kept free of adhesive. RESULTS: The index seated passively and provided a physical reference for the planned matrix boundaries. The matrix remained clinically stable during index removal, flap advancement, and suturing. Baseline and 1-year clinical measurements are reported for descriptive context; no quantitative index-transfer accuracy assessment was performed. CONCLUSIONS: This single-patient technical proof of concept showed that a patient-specific index could be used as an intraoperative reference for matrix positioning, with limited peripheral cyanoacrylate stabilization before flap closure. CLINICAL SIGNIFICANCE: A patient-specific index may provide a physical reference for planned matrix positioning, while limited peripheral cyanoacrylate may help maintain matrix stability before flap closure.