14 February 2022

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Surgical treatment of gingival recession

Lara Figini

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Gingival recession is defined as the apical displacement of the gingival margin with respect to the enamel-cement junction (CEJ), which leads to exposure of the root surface. It affects a significant portion of the adult population, 85% with a prevalence of recessions of at least 1 mm.
The etiology of gingival recession is multifactorial and includes the existence of predisposing factors, such as a thin gingival biotype, and triggering factors, such as traumatic brushing of the teeth or margins of intra-sulcular restorations, or gingival and periodontal inflammation chronic.
The presence of a non-carious cervical lesion (NCCL) can represent a complication for the covering of the teeth following a gingival recession.

Materials and methods
In a systematic review, published in the Journal of Dentistry of February 2022, the authors studied the effectiveness of periodontal plastic surgery on recessions associated with NCCL non-carious cervical lesions, with or without restorative treatment.
RCTs were included in the review, investigating the evaluation of root coverage of teeth with Miller class I and II isolated gingival recessions with non-carious cervical lesions NCCL, published through April 2020, with at least 10 patients per group and a follow-up of more than 6 months.
The research of the studies was carried out using electronic databases and specialized journals according to a pre-established search strategy.

Results
Seven articles were included in the final review. Treatment consisted systematically of a coronally advanced flap in association with partial or complete restorative treatment with at least one CTG connective tissue graft.
Meta-analyzes have shown that periodontal plastic procedures are less effective in terms of complete root coverage in cases of teeth with NCCL. The reduction in recession was on average 2.00 mm and the overall mean complete root coverage was 5%.

Conclusions
From the data of this review, which must be confirmed in other similar works, it can be concluded that the presence of an NCCL represents a complication in plastic surgery.
The use of CTG without NCCL restoration provides better results with the exception of the reduction of dental hypersensitivity for which the combined treatment (restoration + CTG) is more effective.

Clinical implications
The best treatment of recessions associated with non-carious cervical lesions is the combined approach (CAF plus CTG plus NCCL restoration) in which dentinal hypersensitivity is resolved by restoration. The combined approach (restorative treatment and root surgery) should be considered as a first choice option for the treatment of Miller class I and isolated class II gingival recessions associated with non-carious cervical lesions.

For additional information: The influence of non-carious lesions in the surgical treatment of gingival recession: A systematic review & meta-analysis