Clinical Management of Gingival Recessions with or Without Cervical Lesions: A Decisional Scheme Proposal

Background: Treatment of gingival recessions starts from an accurate diagnosis considering both periodontal tissue status and adjacent exposed dental tissues. Based on current scientific evidence and the authors’ clinical experience, a decisional scheme has been proposed for the management of gingival recession defects, with or without non-carious cervical lesions, taking into account gingival thickness and interproximal attachment levels. To illustrate its practical application, a series of representative clinical cases is presented, documenting the rationale and outcomes of the therapeutic decisions. Methods: According to the 2017 World Workshop Classification of Periodontal and Peri-Implant Diseases and Conditions, the gingival recession defect classifications have been used to build up a decision-making therapeutic process. Combined periodontal and restorative treatments in presence or absence of dental lesions have been performed. Results: In case of an identifiable cemento-enamel junction (CEJ) with or without non-carious cervical lesions (class A+ and class A−, respectively) and absence of interproximal attachment loss (RT1), flap approaches alone or in combination with connective tissue graft (CTG) were suggested. In case of an unidentifiable CEJ without cervical lesion (class B−), flap approaches alone were proposed in presence of adequate residual keratinized tissue (KT) and absence of interproximal attachment loss (RT1); if KT is extremely reduced, flap approaches + CTG may be performed. If the unidentifiable CEJ is associated with cervical lesions involving both root and crown surfaces (class B+), the combined restorative–periodontal treatment results as the most indicated approach. The adjunctive use of CTG should be also considered in presence of interproximal attachment loss (RT2 and RT3) and reduced gingival thickness (<1 mm). Conclusions: The proposed decisional scheme could be useful to address the clinicians during the decision-making process in the treatment of gingival recessions.