Zucchelli, G., Mounssif, I.

The aim of the present article is to summarise current knowledge in terms of the aetiology, diagnosis, prognosis and surgical treatment of gingival recession. While the main aetiological factors (i.e., toothbrushing trauma and bacterial plaque) are well established, challenges still remain to be solved in the diagnostic, prognostic and classification processes of gingival recession, especially when the main reference parameter – the cemento-enamel junction – is no longer detectable on the affected tooth, or when there is a slight loss of periodontal interdental attachment. Root coverage in single type gingival recession defects is a very predictable outcome following the use of various surgical techniques. The coronally advanced flap, with or without connective tissue grafting, is the technique of choice. The adjunctive use of connective tissue grafts improves the probability of achieving complete root coverage. Surgical coverage of multiple gingival recessions is also predictable with the coronally advanced flap and the coronally advanced flap plus the connective tissue graft, but no data are available indicating which, and how many, gingival recessions should be treated adjunctively with connective tissue grafting in order to limit patient morbidity and improve the aesthetic outcome. None of the allograft materials currently available can be considered as a full substitute for the connective tissue graft, even if some recent results are encouraging. The need for future studies with patient-based outcomes (i.e., aesthetics and morbidity) as primary objectives is emphasised in this review.

Periodontology 2000; 68 (1): 333-368.