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Classifications for Gingival Recession: a Mini Review Galore International Journal of Health Sciences and Research Vol.3; Issue: 1; Jan.-March 2018 Website: www.gijhsr.com Review Article P-ISSN: 2456-9321 Classifications for Gingival Recession: A Mini Review Dr Amit Mani1, Dr. Rosiline James2 1Professor and HOD, Dept. of Periodontics, 2Post graduate student, Pravara Institute of Medical Sciences, Loni, India Corresponding Author: Rosiline James _____________________________________________________________________________________________________ ABSTRACT the treatment. The following are the classifications for gingival recession. Gingival Recession is a common problem 1. Sullivan and Atkins (1968) associated with or without Periodontitis. It can The basis for the classification was depth be associated with many etiological factors. The and width of the defect. one of the common factor is faulty tooth The four categories were: brushing trauma. There are other factors too which contribute to the gingival recession. Not Deep wide only Gingival Recession causes an esthetic Shallow wide problem but also causes hypersensitivity and Deep narrow associated caries. This paper reviews the various Shallow narrow. classifications for gingival recession which can This classification though simple is be useful for the proper diagnosis and treatment. subjected to open interpretation of the examiner and inter examiner variability and Keywords: Gingival Recession, Classification is therefore not reproducible. [3] for Gingival Recession, Palatal recession INTRODUCTION Gingival recession is defined as an apical shift of the gingival margin (GM) from its position 1 mm coronal to or at the level of the cemento-enamel junction (CEJ) with exposure of the root surface to the oral environment. [1] The displacement of marginal tissue apical to the cemento- enamel junction (CEJ). [2] The term “marginal tissue recession” has been considered to be more accurate than “gingival recession,” since the marginal Figure 1: Sullivan & Atkins Classification tissue may have been what is known as alveolar mucosa. The classification of any [Swathi Ravipudi et al. Gingival Recession: disease helps in the favorable Short Literature Review on Etiology, communication with a fellow professional. Classifications and Various Treatment It also helps in a great deal to diagnose and Options. J. Pharm. Sci. & Res. Vol. 9(2), come up with the correct treatment plan and 2017, 215-220] [4] knowing the prognosis for the same. There have been many cases of gingival recession 2. Mlinek et al. (1973) been treated successfully whereas some Shallow narrow: Recession <3 mm with not much success. Diagnosing at the Deep wide: Recession >3 mm. earliest can save the time and complexity of This modification reduced subjective variation, but it does not specify the Galore International Journal of Health Sciences and Research (www.gijhsr.com) 33 Vol.3; Issue: 1; January-March 2018 Rosiline James et al. Classifications for Gingival Recession: A Mini Review landmark for horizontal measurement as Class IV: the interproximal periodontal variable measurement may be present at attachment loss is so severe that no root variable distances. coverage is feasible. He has primarily based his 3. Liu and Solt (1980) classification of gingival recession defects Based on marginal tissue recession on following aspects: Visual: Measured from CEJ to soft A. Extent of gingival recession defects tissue margin Extent of hard and soft tissue loss in Hidden: Loss of attachment within the interdental areas surrounding the gingival pocket that is apical to tissue margin. recession defects. [6] This classification being not informative, does not classify visible 6. Smith (1990) recession, the focus being more on He proposed index of recession that consists attachment loss than visible recession. of two digits separated by a dash. The first digit denotes the horizontal and the second 4. Bengue et al. (1983) digit denotes the vertical component of a Classified the recessions according to the site of recession. coverage prognosis: Score 0 - No clinical evidence of root U-type - poor prognosis exposure. V-type - fair prognosis Score 1 - No clinical evidence of root I-type - good prognosis. [5] exposure and there is also a subjective awareness of dentinal hypersensitivity in response to air blast is reported, and/or there is clinically detectable exposure of the CEJ for up to 10% of the estimated mid-mesial to mid-distal distance. Score 2 - Horizontal exposure of the CEJ more than 10% but not exceeding 25% of the estimated mid-mesial to mid- Figure 2: Bengue classification distal distance . [Swathi Ravipudi et al Gingival Recession: Score 3 - Exposure of the CEJ more Short Literature Review on Etiology, than 25% of the mid-mesial to mid- Classifications and Various Treatment distal distance but not exceeding 50% Options. J. Pharm. Sci. & Res. Vol. 9(2), Score 4 - Exposure of the CEJ more 2017, 215-220] [4] than 50% of the mid-mesial to mid- distal distance but not exceeding 75% 5. Miller (1985) Score 5 - Exposure of the CEJ more Useful in predicting the final amount of root than 75% of the mid-mesial to mid- coverage following a free gingival graft distal distance up to 100%. procedure. Class I and II gingival recessions, show VERTICAL EXTENT OF RECESSION no loss of inter-proximal periodontal Score 0 - No clinical evidence of root attachment loss and bone loss and exposure. complete root coverage can be achieved. Score 1 - No clinical exposure of root Class III: the interdental periodontal exposure and there is also a subjective support loss is mild to moderate, and awareness of dentinal hypersensitivity is partial root coverage can be reported and/or there is clinically accomplished. detectable exposure of the CEJ not extending more than 1 mm vertically to the gingival margin. Galore International Journal of Health Sciences and Research (www.gijhsr.com) 34 Vol.3; Issue: 1; January-March 2018 Rosiline James et al. Classifications for Gingival Recession: A Mini Review Score 2–8 - Root exposure is seen 2–8 1. The interdental contact point mm extending vertically from the CEJ to 2. The apical extent of the facial CEJ the base of the soft tissue defect. 3. The coronal extent of the proximal CEJ Score 9 - Root exposure seen more than [Swathi Ravipudi et al. Gingival Recession: 8 mm from the CEJ to the base of the Short Literature Review on Etiology, soft tissue defect. Classifications and Various Treatment Score * - An asterisk is present next to Options. J. Pharm. Sci. & Res. Vol. 9(2), the second digit whenever the vertical 2017, 215-220] component of the soft tissue defect encroaches into the MGJ or extends 8. Mahajan (2010) beyond it into alveolar mucosa; the A modified classification of gingival absence of an asterisk implies either recession absence of MGJ involvement at the Class I: Gingival recession defect not indexed site or its non involvement in extending to the MGJ . the soft tissue defect. [7] Class II: Gingival recession defect extending to the MGJ/ beyond it . 7. Nordland WP and Tarnow DP (1998) Class III: Gingival recession defect A classification system for loss of with bone or soft tissue loss in the papillary height. The system utilizes three interdental area up to cervical 1/3 of the identifiable landmarks: root surface and/or malpositioning of the 1. Interdental contact point teeth. 2. Facial apical extent of the CEJ Class IV: Gingival recession defect with 3. Interproximal coronal extent of the CEJ severe bone or soft tissue loss in the interdental area greater than cervical 1/3 Normal: Interdental papilla fills embrasure of the root surface and/or severe space to the apical extent of the interdental malpositioning of the teeth. contact point/area Prognosis as per Mahajan’s classification: Class I: The tip of the interdental 1) Best: Class I and Class II with thick papilla lies between the inter-dental gingival profile contact point and the most coronal 2) Good: Class I and Class II with thin extent of the inter-proximal cemento gingival profile enamel junction (CEJ) 3) Fair: Class III with thick gingival Class II: The tip of the inter-dental profile papilla lies at or apical to the inter- 4) Poor: Class III and Class IV with thin proximal cemento enamel junction CEJ gingival profile. but coronal to the apical extent of the This modification still does not facial CEJ accommodate all clinical conditions. For Class III: The tip of the papilla lies example, a tooth with gingival recession not level with or apical to the facial CEJ. [8] extending up to MGJ but with interdental soft and hard tissue loss can neither be placed in Class I nor in Class III since there is no mention of involvement of MGJ in Class II. [9] 9. Cairo et al. (2011) Gingival recession based on the assessment of CAL at both buccal and interproximal sites. Type 1: Gingival recession with no loss [4] Figure 3: Nordland WP and Tarnow DP’s classification of interproximal attachment. Galore International Journal of Health Sciences and Research (www.gijhsr.com) 35 Vol.3; Issue: 1; January-March 2018 Rosiline James et al. Classifications for Gingival Recession: A Mini Review Interproximal CEJ was clinically not KT <2 mm – no NCCL – no detectable at both mesial and distal interproximal attachment loss (BAA) aspects of the tooth. KT <2 mm – NCCL – no interproximal Type 2: Gingival recession associated attachment loss (BBA) with loss of interproximal attachment. KT <2 mm – no NCCL – interproximal The amount of interproximal attachment attachment loss (BAB) loss (measured from the interproximal KT <2 mm – NCCL – interproximal CEJ to the depth of the interproximal attachment loss (BBB) pocket) was less than or equal to the buccal attachment loss (measured from 11. Kumar and Masamatti (2013) the buccal CEJ to the depth of the buccal It can be applied for facial surfaces pocket) of maxillary teeth and facial and lingual Type 3: Gingival recession associated surfaces of mandibular teeth.
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