Root Coverage Procedures in the Treatment of Gingival Recession Hend AL-Harbi*,BDS , Nadir Babay**, DDS,MS, DESM *Postgraduate Student ** Professor & Postgraduate Program Director. Division of Periodontics. Department. of Preventive Dental Sciences, College of Dentistry, King Saud University Riyadh, Saudi Arabia. Case No.1: Free Autogenous Gingival Graft: Introduction: Gingival recession is defined by Miller et al, as an exposition of the radicular surface of the tooth due to destruction of the marginal gingiva and of the epithelial attachment that will be reestablished at a more apical position. Buccal recessions are most common and more advanced at single-rooted teeth. Aesthetic concerns are usually the reason to perform many surgical techniques to correct labial gingival recession defects. Indications for Root Coverage: Class I & II gingival recession. Multiple gingival recessions. Inadequate donor site for laterally pedicle flap. Fig. 1a: Pre-operative view recipient site (teeth# 43). Fig. 2a: Recipient site preparation. Fig. 3a: Recipient bed demonstrating a smooth surface and adequate hemostasis for graft placement. Class I Marginal tissue recession which does not extend to the mucogingival junction. No periodontal bone loss in the interdental area. 100 % Root Coverage Contraindications: Class IV gingival recession. Poor oral hygiene. Thin attached gingiva. Fig. 4a: Well adapted sutures to ensure good stability of the graft Fig. 6a: absence of bleeding on probing Fig. 5a: ? Weeks postoperative view. Class IV Marginal tissue recession which extends to or beyond the mucogingival junction. Severe bone or soft tissue loss in the interdental area and/or malpositioning of teeth. Classification of Marginal Tissue Recession by P. D. Miller (1985) Case No.2 Subepithelial Connective Tissue Graft: (proposed by Langer and Langer in 1985. Class II Marginal tissue recession which extends to or beyond the mucogingival junction. No periodontal bone loss in the interdental area. Criteria for successful root coverage: Gingival margin is on the CEJ. Depth of gingival sulcus is within 2 mm. No bleeding on probing No hypersensitivity Esthetically harmonious color match with adjacent tissue Class III Fig. 1b: Pre-operative view recipient site (tooth# 15 & 14). Fig. 2b: Recipient site preparation with vertical incisions. Fig. 3b: Recipient site Prepration. Contraindicated for root coverage Marginal tissue recession which extends to or beyond the mucogingival junction. Partial Root Coverage Bone or soft tissue loss in the interdental area or malpositioning of the teeth. Fig. 4b: Connective tissue graft sutured in position to cover the denuded root surface. Fig. 5b: overlying partial thickness flap is then replaced over the donor tissue & interrupted sutures are placed. Fig 6b: 2 months post-operative view. Etiology: Uneven atrophy of the gingival margin. Calculus deposits. Trauma caused by vigorous tooth brushing. Gingival lesions associated with plaque. Direct trauma (accident, fingernails). Predisposing Factors: Inadequate attached gingiva. Malpositioning of the teeth. Orthodontic Movements. Discussion and Conclusion: The factor most influencing the result is the blood supply to the grafted tissue. The pedicle soft tissue graft technique allows for possible root coverage in retaining good apical blood supply. The free gingival graft procedure ensures thickness and keratinization which provides a suitable housing for the gingival margin of a tooth or crown. The subepithelial connective tissue graft combines the features of the pedicle and the free gingival graft.