Root coverage techniques: a review.

Gingival recession with the exposure of root surfaces is a significant treatment problem facing the clinician. Controversy relative to treatment continues and centers primarily around the need for gingival width augmentation. In 1972, Lang and Löe advanced the concept that a true minimal width of keratinized gingival tissue was necessary for health. They showed that all surfaces with less than 2 mm of keratinized gingiva exhibited clinical inflammation and varying amounts of gingival exudate. In contrast, 80% of the surfaces with more than 2 mm of keratinized gingiva were clinically healthy, and 76% of these same surfaces failed to show gingival exudate. Since 1972, the majority of studies have found that minimizing inflammation is sufficient to maintain attachment levels, even in the absence of "adequate" widths of keratinized and attached gingiva. Certain situations may enhance recession, such as subgingival restorations and toothbrushing trauma, but if inflammation is controlled and the etiology eliminated, minimal amounts of keratinized gingiva can be maintained in a state of health without further recession. Such findings have led to the current concept that deemphasizes a need for gingival augmentation surgery when there is no accompanying need for root coverage. A requirement for root surface coverage arises when gingival recession has esthetic implications, where exposure has resulted in root sensitivity, or where recession complicates routine home care procedures. While agreement exists relative to the indications for root coverage, there are a variety of surgical techniques that can accomplish this end. The purpose of this paper is to review these techniques and to examine the indications for choosing one procedure over another.