The RES system may be a useful tool to assess the esthetic outcome following root-coverage procedures.

Both treatments were effective in providing a significant reduction of the baseline recession and dentine hypersensitivity, with only limited intra-operative and post-operative morbidity and side effects. Adjunctive application of a CTG under a CAF increased the probability of achieving CRC in maxillary Miller Class I and II defects.

Pini-Prato GP, Cairo F, Nieri M, Franceschi D, Rotundo R, Cortellini P. Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up. J Clin Periodontol 2010; 37: 644-650. doi: 10.1111/j.1600-051X.2010.01559.x Abstract Aim: The aim of this long-term study was to compare the clinical outcomes of coronally advanced flap (CAF) alone versus coronally advanced flap plus connective tissue graft (CAF1CTG) in the treatment of multiple gingival recessions using a splitmouth design over 5 years of follow-up. Materials and Methods: A total of 13 patients (mean age 31.4 years) showing multiple bilateral gingival recessions were treated. On one side, CAF1CTG was used, while in the contra-lateral side, a CAF alone was applied. Clinical outcomes were evaluated at the 6-month, 1-year and 5-year follow-ups. Results: A total of 93 Miller class I, II and III gingival recessions were treated. In the CAF1CTG-treated sites, the baseline gingival recession was 3.6 AE 1.3 mm, while in the CAF-treated sites, it was 2.9 AE 1.3 mm (p 5 0.0034). No difference in terms of the number of sites with complete root coverage (CRC) was reported (OR 5 0.49, p 5 0.1772) at the 6-month follow-up. At the 5-year follow-up, CAF1CTG-treated sites showed a higher percentage of sites with CRC (52%) than CAF-treated sites (35%) (OR 5 3.94; p 5 0.0239). An apical relapse of the gingival margin in CAFtreated sites was observed while a coronal improvement of the margin was noted in CAF1CTG-treated sites between the 6-month and the 5-year follow-ups. Conclusions: CAF1CTG provided better CRC than CAF alone in the treatment of multiple gingival recessions at the 5-year follow-up.

Root coverage procedures for treating localised and multiple recession-type defects.

The location of the gingival margin relative to the cemento-enamel junction following CAF procedure seems to affect CRC.

Background: A clinical classification of surface defects in gingival recession area is proposed.Methods: Two factors were evaluated to set up a classification system: presence (A) or absence (B) of cemento-enamel junction (CEJ) and presence (+) or absence (-) of dental surface discrepancy caused by abrasion (step). Four classes (A+, A-, B+, and B-) were identified on the basis of these variables. To validate the classification three different calibrated examiners applied the proposed classification system to 46 gingival recessions and k statistics were performed. The classification was used on 1,010 gingival recessions from 353 patients to examine the distribution of the four classes.Results: The k statistics for intrarater agreement ranged from 0.74 to 0.95 (almost perfect agreement), whereas interrater agreement ranged from 0.26 to 0.59 (moderate agreement). Out of 1,010 exposed root surfaces associated with gingival recession, 144 showed an identifiable CEJ associated with a root surface defect (Class A+, 14%); 469 an identifiable CEJ without any associated step (Class A-, 46%); 244 an unidentifiable CEJ with a step (Class B+, 24%); and 153 an unidentifiable CEJ without any associated step (Class B-, 15%).Conclusion: The proposed classification describes the dental surface defects that are of paramount importance in diagnosing gingival recession areas. J Periodontol 2010;81: 885-890.

Background This updated Cochrane systematic review (SR) evaluated the efficacy of different root coverage (RC) procedures in the treatment of single and multiple gingival recessions (GR). Methods We included randomized controlled trials (RCTs) only of at least 6 months’ duration evaluating Miller's Class I or II GR (≥3 mm) treated by means of RC procedures. Five databases were searched up to January 16, 2018. Random effects meta‐analyses were conducted thoroughly. Results We included 48 RCTs in the SR. The results indicated a greater GR reduction for subepithelial connective tissue grafts (SCTG) + coronally advanced flap (CAF) compared to guided tissue regeneration with resorbable membranes (GTR rm) + CAF (mean difference [MD]: −0.37 mm). There was insufficient evidence of a difference in GR reduction between acellular dermal matrix grafts (ADMG) + CAF and SCTG + CAF or between enamel matrix derivative (EMD) + CAF and SCTG + CAF. Greater gains in the keratinized tissue width (KTW) were found for SCTG + CAF when compared to EMD + CAF (MD: −1.06 mm), and SCTG + CAF when compared to GTR rm + CAF (MD: −1.77 mm). There was insufficient evidence of a difference in KTW gain between ADMG + CAF and SCTG + CAF. Conclusions SCTG, CAF alone or associated with another biomaterial may be used for treating single or multiple GR. There is also some evidence suggesting that ADMG appear as the soft tissue substitute that may provide the most similar outcomes to those achieved by SCTG.

The sites treated with gingival-augmentation surgery showed a tendency for coronal displacement of the gingival margin with a reduction in recession. The contralateral untreated sites showed a tendency for apical displacement of the gingival margin with an increase in the existing recessions.