Root Coverage for Single Deep Gingival Recessions: Outcomes Based on a Decision-Making Algorithm

Abstract

Aim The aim of this study is to report root coverage outcomes in single deep gingival recessions (GR) following a proposed decision-making algorithm. Materials and Methods A retrospective, practice-based study included single deep (≥5 mm) Miller Class II and III defects. The step-by-step decision-making algorithm led to a choice among three different flap designs (coronally advanced flap (CAF), double papilla envelope flap (DPE) or modified lateral sliding flap (LSF)) used with a connective tissue graft. Recession depth (RD) at 6 months follow-up and the corresponding root coverage (RC) were the primary outcomes assessed. Results Sixteen GR defects were included, with baseline RD of 6.7 ± 1.8 mm. Six months postoperatively, RD was significantly reduced to 1.2 ± 0.8 mm (p < 0.05). Mean RC was 81.7 ± 13.0%, without significant differences between Miller Class II (87.1 ± 9.2%; n=9) and Class III (74.6 ± 14.5%; n=7) GRs (p=0.07). Postoperatively, keratinized tissue width increase was greater for LSF (3.5 ± 1.1) and DPE (4.2 ± 1.4 mm) than for CAF (1.9 ± 0.9 mm). Conclusions Following the proposed decision-making algorithm, root coverage outcomes for GR defects ≥5 mm were comparable to outcomes reported for shallow defects. Prospective clinical trials are needed to validate the proposed approach and techniques. Practical Implications The proposed algorithm allows the clinician to select the appropriate surgical technique for treatment of single deep gingival recessions with good predictability.

Complete root coverage in the treatment of Miller class III or RT2 gingival recessions: a systematic review and meta-analysis

“…Seventeen studies were cases series [ 39 – 41 , 43 – 56 ], nine were case reports [ 31 , 35 , 38 , 57 – 62 ], seven were clinical trials [ 6 , 7 , 14 , 42 , 63 – 65 ], and four were retrospective studies [ 36 , 66 – 68 ]. Out of these 37 studies, only two studies [ 7 , 65 ] used the classification proposed by Cairo et al [ 5 ].…”

“…Of the 16 articles focusing only on Miller class III GRs, nine of them [ 7 , 31 , 35 , 38 , 39 , 57 , 61 , 62 , 64 ] treated single GRs, six studies [ 6 , 53 , 56 , 58 – 60 ] included multiple GRs, and one study [ 67 ] included single or multiple Miller class III GRs. In the rest of articles, different kind of GRs were treated: single Miller class I, II and III GRs were treated in nine studies [ 40 , 41 , 44 , 48 , 50 , 51 , 63 , 65 , 66 ], whereas multiple Miller class I, II, III and IV GRs were treated in five articles [ 45 , 46 , 52 , 54 , 68 ], and single and multiple Miller class I, II and III GRs were treated in other seven articles [ 14 , 42 , 43 , 46 , 47 , 49 , 55 ] (Table 2 ).…”

Description of the modified vestibular incision subperiosteal tunnel access (m-VISTA) technique in the treatment of multiple Miller class III gingival recessions: a case series

“…At present, the evidence concerning the treatment of Miller class III [ 4 ] gingival recession is scarce. The evidence is mainly based on case reports [ 8 ], four retrospective studies [ 12 – 15 ], and ten clinical trials [ 16 – 25 ]. This scarcity could probably be, not because of the fact that these recessions are not being treated, but because the predictability of outcomes in the treatment of this type of lesion is low.…”

“…Until now, the evidence regarding root coverage in Miller class III recessions [ 4 ] has been limited to multiple case reports and case series [ 8 ], four retrospective studies [ 12 – 15 ], and ten randomized clinical trials (RCTs) [ 16 – 25 ]. Only three of the RTCs’ [ 17 , 24 , 25 ] multiple Miller class III gingival recessions [ 4 ] (a total of 501 recessions) were treated, with the follow-up period ranging from 6 to 36 months [ 16 – 25 ].…”

Combining Techniques to Treat Isolated Deep Recession-Type Defects: A Case Report with Long-Term Stability

“…Although the combination of these techniques presented in this report provided the complete resolution of the defect, it had a disadvantage of promoting two surgical procedures at a different time. Other available possibilities using a GTG in a single step may minimize this disadvantage [ 17 , 18 ]. However, all the alternatives have in common the use of tissues adjacent to the defect to cover the exposed root.…”