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19perio TribuneJune 28-July 4, 2010United Kingdom Edition G ingival recession is de- fined as the location or displacement of the marginal gingiva apical to the cementoenamel junction (CEJ).1 Recession 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 aging. The gingiva consists of free and attached gingival tis- sue, as seen macroscopically. The free marginal gingiva, located coronal to the attached gingiva (AG), surrounds the tooth and is not attached to the tooth surface. The AG is the keratinised portion of gingival tissue (KG) that is dense, stippled and firmly bound to the underlying peri- odontium, tooth and bone. In ideal health, the most coro- nal portion of the AG is located at the CEJ, where the most apical portion is adjacent to the muco- gingival junction (MGJ). The MGJ represents the junction between the AG (keratinised) and alveolar mucosa (non-keratinised).2 Reasons for recession There are numerous etiologi- cal factors that may result in recession. Generally, the etiol- ogy can be categorised as either mechanical or as a function of periodontal disease progression. Recession usually occurs due to tooth malposition3–5 , alveolar bone recession 6,7 , high muscle attachments and frenal pull8 , and iatrogenic factors related to restorative and periodontal treat- ment procedures.3,9 The detrimental effects of re- cession include compromised esthetics, an increase in root sen- sitivity to temperature and tactile stimuli, and an increase in root caries susceptibility due to ce- mentum exposure. Thus, the main therapeutic goal of recession elim- ination is gingival root coverage in order to fulfill esthetic demands and prevent root sensitivity. Miller classifies recession de- fects into four categories: • Class I: marginal tissue recession does not extend to the MGJ • Class II: marginal tissue reces- sion extends to the MGJ, with no loss of interdental bone • Class III: marginal tissue reces- sion extends to or beyond the MGJ; loss of interdental bone is apical to the CEJ but coronal to the apical extent of the marginal tissue recession • Class IV: marginal tissue reces- sion extends beyond the MGJ; interdental bone extends apical to the marginal tissue recession.10 A possible treatment modality for recession includes restorative/ mechanical coverage, such as cer- vical composite restorations. This kind of treatment may effectively manage root sensitivity and root caries. However, such treatment entails a long-term compromise from an esthetic perspective. Com- posite restorations stain over time, and any marginal leakage may lead to secondary caries, recur- rence of sensitivity and/or local inflammatory changes. Additionally, colour matching can be difficult and such restora- tions may involve the undesirable removal of vital tooth structure in order to create adequate retention form. Thus, clinicians must deter- mine whether the restorative ben- efits outweigh the esthetic short- comings and whether is it possible to employ a treatment modality with few, if any, functional and es- thetic disadvantages. Muco-gingival surgery Another treatment modality for re- cession is muco-gingival surgery. Muco-gingival surgery refers to periodontal surgical procedures designed to correct defects in the morphology, position and/or amount and type of gingiva sur- rounding the teeth.11 In the early development of muco-gingival surgery, clinicians believed that there was a specific minimum apical-coronal dimen- sion of AG that was necessary to maintain periodontal health. However, subsequent clini- cal12–15 and experimental stud- ies16, 17 have demonstrated that there is no minimum numerical value necessary. However, for esthetics, a uniform colour and value of AG is desirable among adjacent teeth.18 Some of the earliest tech- niques for correcting recession involved extension of the vesti- bule.19 The subsequent healing usually resulted in an increase of AG. However, within six months, as much as a 50 per cent relapse Using resorbable barriers to make root recession coverage predictable By Drs David L Hoexter, Nikisha Jodhan and Jon B Suzuki page 20DTà Fig. 1: Pre-op labial view of anteriorteeth: recession on tooth #6; tooth #7 surround- ed by a small adequate zone of keratinised apical tissue. Fig. 2: Flaps reflected preserve the interproximal tissue, which preserves the blood supply and prevents black triangles (unesthetic interproximal spaces). Fig. 3: The GTR membrane was shaped and placed over the root surfaces of teeth #6 and #7. Fig. 4: Gingival tissue was coronally repositioned, covering the membranes and the roots of teeth #6 and #7, and sutured in place. Fig. 6: Pre-op labial view of anterior teeth.Fig. 5: Post-op view: the previously recessed roots of teeth #6 and #7 are covered with attached pink, keratinized gingival tis- sue, with no pocket depth upon probing.

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