Patientsí demands for the correction of the exposure, during smiling or function, of portions of the root surface are the main indication for surgical procedures to improve root coverage. Often, the most coronal millimeters of the root exposure are the only visible part of the recession when the patient smiles; therefore, the persistence of even a shallow recession after therapy may be an esthetic problem for the patient. Thus, complete root coverage, up to the cementoenamel junction, is the goal to be achieved when a patient complains about the esthetic appearance of his or her teeth. When the cementoenamel junction is no longer visible because of the presence of cervical abrasion defects or when complete root coverage is not achievable, the shifting of the cementoenamel junction to a more coronal position may help to achieve a good esthetic outcome as well. A new classification for cervical abrasions associated with gingival recessions will be presented. Another factor to be considered is that gingival recessions most frequently affect a group of adjacent teeth. To minimize the number of surgeries and to optimize the esthetic result, all the contiguous recessions should be treated at the same surgical appointment. A new approach, the coronally advanced flap, has been used to treat multiple adjacent recession defects. This surgical technique has been demonstrated to achieve complete root coverage in all treated recessions in most patients, irrespective of the number of recessions treated. These outcomes can be maintained in the long term. Specific use of the connective tissue graft may improve the outcome by providing an increase in gingival thickness without worsening the esthetic result.
Giovanni Zucchelli, DDS, PhD, who has a doctorate in medical biotechnology, is a professor of periodontology at Bologna University in Italy. He is vice president and an active member of the Italian Society of Periodontology and the European Federation of Periodontology. Dr Zucchelli is a member of the editorial board of the European Journal of Esthetic Dentistry. The winner of several European and US scientific prizes for research on periodontology, he is the author of 100 publications in the field of periodontology and an atlas on soft tissue plastic surgery.
Approximate Running Time: 30 minutes