Periodontal Soft Tissue Root Coverage Procedures: Practical Applications From the AAP Regeneration Workshop.

Abstract

Focused Clinical Question: How should gingival recession (GR) defects be managed based on current evidence? Summary: The purpose of this practical application is to illustrate the management of GR defects with a primary outcome goal of complete root coverage. The consensus in dental literature and among expert clinicians is that root coverage may be attained through the application of different procedures and that outcomes are generally measured by reduced defect depth, gain in clinical attachment, and an increase in keratinized tissue (KT). These procedures may include the use of: 1) subepithelial connective tissue graft (SCTG); 2) coronally advanced flap; 3) free gingival graft; and 4) soft tissue graft substitutes (acellular dermal matrix and xenogeneic collagen matrix materials) and biologics (recombinant human platelet-derived growth factor and enamel matrix derivative). The variability in these techniques revolves around the inclusion or avoidance of a palatal donor graft. The decision as to how to approach a specific clinical GR-type defect should be a combination of considerations relative to the clinician's surgical goals and the patient's understanding of the anticipated outcome. The associated systematic review (Chambrone and Tatakis, J Periodontol 2015;86(Suppl.):S8-S51) provides clear evidence that SCTG-based procedures provide the best outcome for mean and complete root coverage, as well as an increase in KT. Patient-reported outcomes, a topic that needs additional research, should be considered in the decision-making process. Conclusion: Based on the available evidence and the illustrated cases included in this practical application, root coverage can be predictably achieved and a successful clinical outcome can be maintained long term.