Gingival recession defects are defined as the apical displacement of the marginal soft tissues that manifest in the exposure of the root surface. The most commonly used taxonomy for gingival recession defects is the classification proposed by Miller in 1985, which considers the dimensions of the soft tissue loss as well as the interproximal bony situation.
Types of defects
Recession defects with healthy interdental tissues have a good prognosis in terms of complete root coverage, regardless if the recession reaches or goes beyond the mucogingival junction (Miller class I and II gingival recessions). Determined by the extend of the interproximal bone loss and the level of the papilla height, complete root coverage becomes less predictable with severity of the tissue loss (Miller class III gingival recessions).
Techniques for root coverage
A variety of recession coverage procedures have been proposed with the coronally advanced flap (CAF) and modifications thereof being the most commonly used technique. Performed in conjunction with an autologous connective tissue graft (CTG) the stability of the clinical outcome can be increased as demonstrated by comparative clinical studies. For the treatment of multiple adjacent recessions the modified coronally advanced tunnel (MCAT) technique has become an attractive minimal invasive approach.
Soft tissue substitutes and enamel matrix derivative
CTGs are commonly harvested from the patient’s palate creating a second surgical site. This may result in increased post-operative pain as well as a higher risk of infections and complications. Alternatives to autologous soft tissue transplants are xenogeneic soft tissue substitutes (e.g. mucoderm®). They offer a safe alternative in situations where autologous transplants cannot be harvested in sufficient amount or quality (e.g. in thin biotypes with shallow palate or for covering multiple recessions). Enamel matrix derivative (Straumann® Emdogain®) used in recession defects has been shown to offer a potential for regeneration of the attachment.