Root Coverage : when do you need a connective tissue graft

Aetiologigal factors of gingival recessions

Gingival recessions are associated with several aetiological factors:

• Plaque induced inflammation
• Anatomical factors: thin biotype, tooth malposition
• Traumatic toothbrushing
• Prosthetic interaction with the biological width

Any therapeutic approach must start by controlling the aetiological factors.

Surgical Treatment & goals

The most predictable and documented procedures for root coverage are coronally advanced flaps with or without a connective tissue graft (CTG). The advanced flap can be performed with specific incisions (horizontal, oblique, vertical) or with sulcular incisions only (tunnel technique).

The surgical treatment should fulfill one or more of the following goals

• Improve aesthetics
• Improve attachment level
• Improve keratinized mucosa width

Patient-centered outcomes are considered to limit treatment morbidity and improve quality of life.

Key scientific data

• Autologous connective tissue graft remains the gold standard
• Root coverage can be obtained with or without CTG
• If a gain of keratinzed tissue is expected, the use of a CTG is mandatory
• The use of CTG promote a better stability over time compared to flap alone

Clinical tips

• On a thick periodontium, root coverage is achievable with advanced flaps, without additional tissue
• On a thin biotype the use of a CTG is the best option to obtain a predictable and stable root coverage
• A CTG is also particularly indicated in the following situations:
  • Orthodontic treatment with buccal tooth movement (expansion, proclination)
  • Prosthetic project in the esthetic zone