CDEN0110

14 I I special _ root recession _Gingival recession is defined as the location or displacement of the marginal gingiva apical to the cemento-enamel junction (CEJ).1 Reces- sion is the exposure of root surface, resulting in a tooth that appears to be of longer length. From a patient’s perspective, recession means an unaesthetic appearance and is associated with ageing. The gingiva consists of free and attached gin- gival tissue, as seen macroscopically. The free marginal gingiva, located coronal to the attached gingiva (AG), surrounds the tooth and is not at- tached to the tooth surface. The AG is the kera- tinisedportionofgingivaltissue(KG)thatisdense, stippled and firmly bound to the underlying peri- odontium,toothandbone.Inidealhealth,themost coronal portion of the AG is located at the CEJ, where the most apical portion is adjacent to the muco-gingivaljunction(MGJ).TheMGJrepresents the junction between the AG (keratinised) and alveolar mucosa (non-keratinised).2 There are numerous aetiological factors that may result in recession. Generally, the aetiology can be categorised as either mechanical or as a function of periodontal disease progression. Recession usually occurs due to tooth malposi- tion,3–5 alveolar bone recession,6,7 high muscle at- tachments and frenal pull,8 and iatrogenic factors related to restorative and periodontal treatment procedures.3,9 The detrimental effects of recession include compromised aesthetics, an increase in root sen- sitivity to temperature and tactile stimuli, and an increase in root caries susceptibility due to cem- entum exposure. Thus, the main therapeutic goal of recession elimination is gingival root coverage in order to fulfil aesthetic demands and prevent root sensitivity. Miller classifies recession defects into four ca- tegories: _class I: marginal tissue recession does not extend to the MGJ; _class II: marginal tissue recession extends to the MGJ, with no loss of interdental bone; _class III: marginal tissue recession extends to or beyondtheMGJ;lossofinterdentalboneisapical to the CEJ but coronal to the apical extent of the marginal tissue recession; _class IV: marginal tissue recession extends be- yond the MGJ; interdental bone extends apical to the marginal tissue recession.10 A possible treatment modality for recession in- cludes restorative/mechanical coverage, such as cervical composite restorations. This kind of treat- ment may effectively manage root sensitivity and rootcaries.However,suchtreatmententailsalong- term compromise from an aesthetic perspective. Composite restorations stain over time, and any marginal leakage may lead to secondary caries, recurrence of sensitivity and/or local inflammatory changes. Additionally, colour matching can be dif- ficult and such restorations may involve the un- desirableremovalofvitaltoothstructureinorderto create adequate retention form. Thus, clinicians must determine whether the restorative benefits outweigh the aesthetic shortcomings and whether is it possible to employ a treatment modality with few, if any, functional and aesthetic disadvantages. Another treatment modality for recession is muco-gingival surgery. Muco-gingival surgery re- fers to periodontal surgical procedures designed to correct defects in the morphology, position and/or amountandtypeofgingivasurroundingtheteeth.11 In the early development of muco-gingival sur- gery, clinicians believed that there was a specific cosmeticdentistry 1_2010 Root recession coverage made predictable using resorbable barriers Authors_ Dr David L. Hoexter, Dr Nikisha Jodhan & Dr Jon B. Suzuki, USA