Soft Tissue Augmentation Is the Gold Standard for Managing Gingival Recession

Mucogingival defects represent significant clinical challenges characterized by alterations in the normal anatomy between the gingival margin and mucogingival junction. Commonly diagnosed conditions such as gingival recession and insufficient attached gingiva can have far-reaching consequences if left untreated. These defects not only affect oral aesthetics but also contribute to functional complications, including dentinal hypersensitivity, root caries, and periodontal inflammation. Understanding the factors contributing to these defects and implementing effective management strategies is vital for maintaining periodontal health and preventing further tissue damage.

Gingival recession and lack of attached gingiva can coexist; therefore, it is important to treat these defects to prevent further tissue and tooth loss. Soft tissue augmentation has been commonly used for managing mucogingival defects. The techniques for treating gingival recession have evolved from traditional procedures, such as the semilunar technique, coronally advanced flap, lateral pedicle flap, and double papilla flap, to more minimally invasive methods, such as tunneling and vestibular incision subperiosteal tunnel access techniques. These approaches can often be used in combination with an autograft, allograft or xenograft.

Autogenous grafts, such as free gingival grafts, are traditionally used for the purpose of gaining attached gingiva, while subepithelial connective tissue grafts (SCTG) are considered the gold standard for root coverage procedures.^1-3 This could be attributed to SCTG’s properties, predictability in clinical attachment and keratinized tissue gain, and long-term result.^4,5 Autogenous grafts are harvested from either the palate (between the canine and premolar region) or maxillary tuberosity (Figure 1), requiring the need for an additional surgical site.⁵ Additionally, the quality and quantity of tissue obtained can vary depending on palatal thickness, thereby potentially compromising the surgical outcome and limiting the number of teeth that can be treated in a single surgical procedure.⁶

Addressing mucogingival defects through soft tissue augmentation is a cornerstone of periodontal therapy. Advancements in surgical techniques, including the use of autografts and minimally invasive procedures, have enhanced the predictability of clinical outcomes. By focusing on preserving biologic width, ensuring adequate attached gingiva, and utilizing innovative methods for gingival restoration, clinicians can significantly improve both the function and aesthetics of the periodontium. Comprehensive management of mucogingival conditions is essential for preventing progression, maintaining oral health, and improving patient quality of life.

References

1. Nabers JM. Free gingival grafts. Periodontics. 1966;4:243–245.
2. Langer B, Langer L. Subepithelial connective tissue graft technique for root coverage. J Periodontol. 1985;56:715–720.
3. Chambrone L, Chambrone D, Pustiglioni FE, Chambrone LA, Lima LA. Can subepithelial connective tissue grafts be considered the gold standard procedure in the treatment of Miller Class I and II recession-type defects? J Dent. 2008;36:659–671.
4. Tatakis DN, Chambrone L, Allen EP, et al. Periodontal soft tissue root coverage procedures: a consensus report from the AAP Regeneration Workshop. J Periodontol. 2015;86(Suppl 2):S52–S55.
5. Studer SP, Allen EP, Rees TC, Kouba A. The thickness of masticatory mucosa in the human hard palate and tuberosity as potential donor sites for ridge augmentation procedures. J Periodontol. 1997;68:145–151.
6. Aichelmann-Reidy ME, Yukna RA, Evans GH, Nasr HF, Mayer ET. Clinical evaluation of acellular allograft dermis for the treatment of human gingival recession. J Periodontol. 2001;72:998–1005.

This information originally appeared in Shaikh S, Regahi P. Soft tissue graft alternatives for treating mucogingival defects. Decisions in Dentistry. 2023;9(1):26-29.