An evidence‐based system for the classification and clinical management of non‐proximal gingival recession defects

Abstract

Gingival recession defect (GRD) may be defined as an apical migration of the gingival margin respective to the cementoenamel junction resulting in partial exposure of the root surface to the oral cavity, which may have important esthetic, functional, and periodontal health implications. A novel system for the classification and management of non-proximal GRDs is proposed in this article. This evidence-based system consists of two essential components: (1) Establishment of the GRD type based on the midbuccal/midlingual attachment level respective to the interproximal bone level, and (2) Assessment of the gingival phenotype according to the width of attached gingiva and gingival thickness. Each category of this new classification system is linked with treatment recommendations substantiated by relevant literature pertaining to the outcomes of validated root coverage procedures in specific scenarios, which can be used as a guide for clinical decision-making in daily practice.

Does the subepithelial connective tissue graft in conjunction with a coronally advanced flap remain as the gold standard therapy for the treatment of single gingival recession defects? A systematic review and network meta‐analysis

“…To the best of our knowledge, this is the first NMA specifically designed to evaluate the efficacy of SCTG + CAF versus the five most frequently reported treatment alternatives, according to an evidence-based ranking based on previous systematic reviews, [1][2][3][5][6][7] and to calculate the differences in primary clinical outcomes (e.g., CRC and MRC) according to percentage gains. Only RCTs were considered Treatments are ranked from best to worst along the leading diagonal.…”

“…Successful treatment of gingival recession defects (GRD) typically requires a trimodal approach: 1) elimination of the etiologic agent(s) related to the onset and progression of the defect; 2) meticulous assessment and characterization of the phenotypic characteristics of the recession site and adjacent areas; and 3) selection and proper execution of the most suitable treatment option. 1 In the category of corrective surgical interventions, available high-level clinical evidence indicates that autogenous subepithelial connective tissue graft (SCTG)-based bilaminar procedures (e.g., SCTG + coronally advanced flap [CAF]) typically render the best cost-benefit treatment outcomes in terms of complete root coverage (CRC), mean root coverage (MRC), keratinized tissue width (KTW) gain, and long-term stability of treatment outcomes. [2][3][4][5][6][7] For that reason, SCTG-based bilaminar procedures are generally acknowledged as the "gold standard" for the treatment of single and multiple GRD.…”

Laterally Positioned Flap with Subepithelial Connective Tissue Graft Modified One-Stage Procedure for the Treatment of Deep Isolated Gingival Recessions in Mandibular Incisors

“…The potential of the FGG (free gingival graft) for increasing the KTW has been documented and seems to explain the increase in KTW after the two-stage CAF procedures [21,22]. Among the free graft procedures, the bilaminar techniques have been reported to be more predictable [23] and to provide more esthetic results [24] than the FGG.…”

Peri‐implant marginal mucosa defects: Classification and clinical management

“…It must be acknowledged that, because of the heterogeneity of implant systems and prosthetic designs that may be encountered in clinical practice, as well as the lack of robust connective tissue attachment of the peri-implant mucosa to implant components, 18 it is not feasible to establish a classification for PMMDs based on implant-related landmarks or standard anatomical references that would be comparable to available systems for gingival recession defects. [19][20][21] Taking into account these considerations, a new, treatment-driven classification for facial PMMDs that is primarily based on the topographic characteristics of the marginal peri-implant mucosa is hereby proposed. This classification applies to single, non-molar, tooth-bound implant sites that have not been diagnosed with periimplantitis, according to the criteria established in the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.…”

“…It must be acknowledged that, because of the heterogeneity of implant systems and prosthetic designs that may be encountered in clinical practice, as well as the lack of robust connective tissue attachment of the peri‐implant mucosa to implant components, 18 it is not feasible to establish a classification for PMMDs based on implant‐related landmarks or standard anatomical references that would be comparable to available systems for gingival recession defects 19–21 …”