Casey M. Herrera, D.D.S.: Periodontist

Cervical Lesions and Gingival Recession: The Role of Periodontal, Restorative, and Combination Therapy
Traditional treatment of shallow root decay and non carious cervical lesions (“NCCLs”) accompanied by recession has been the placement of a restoration. Restoration of NCCLs is done by the dentist to: correct the perceived need to minimize further progression of the lesion, restore the exposed root surface, minimize sensitivity, or to improve esthetics (root color). If recession has occurred the proper treatment is to re-establish gingival height with soft tissue grafting. New and innovative techniques show that NCCLs with recession can be treated more effectively with connective tissue grafting (“CTG”) alone or CTG followed by restorative treatment. I have found that in most NCCLs with recession defects and most shallow root caries lesions, root coverage grafting (on its own) can be superior to placing a restoration in these sites provided that bone levels are adequate and papilla are intact. When bone level is compromised or NCCLs are deeper, combination therapy (CTG followed by a restoration) will offer more favorable results.

Case 1
Before		After

Recurrent Decay #28, Decay #29 Miller Class I, 3mm Recession #28 & 29, NAG #28 & 29		CTG #28 & 29, and Monitor, Full Coverage, 3 year follow up

Case 2
Before		After

NCCLs #29 & 30 Miller Class II, 4mm Recession #29 & 30, NAG #29 & 30		CTGs #29 & 30, and Monitor, Full Coverage, 1 year follow up

Case 3
Before		After

NCCLs #3 & 4 Miller Class III, 5mm Recession #3, 4mm Recession #4, NAG #3 & 4		CTGs #3 & 4, Partial Coverage, Ortho, PFMs #3 & 4, 2 year follow up

Case 4
Before		After

NCCLs #4-12 Miller Class III, 5mm NAG #3, 6mm NAG #6 3mm NAG #7, 4mm NAG #8		CTGs #3 & #5-8, Partial Coverage #3 & 5, Full Coverage #4, 6, 7, & 8, 8 month follow up

Case 5
Before		After

Failing Restoration #8 Miller Class III, 3mm Recession #8, 2mm Recession #9		CTGs #8 & 9, Partial Coverage, Restoration #9, 6 year follow up

Benefits of Root Coverage		Miller Classification		Treatment		Address Etiology
Predictability Biocompatibility Esthetics Reduces caries risk Low morbidity Easier to maintain in the aging population May reduce progression of NCCLs Regeneration of lost of gingival architecture		Narrow localized recession not to MG line. Papilla fill interprox. space: full coverage expected Narrow or wide recession. Papilla fillinterproximal, recession beyond the MG line: full coverage expected Broad recessions beyond MG line, lost interdental papilla: partial coverage expected Loss of bone and gingival tissue around tooth: no root coverage expected		Miller Cl. I,II; with little or no loss of cervical enamel or CEJ: root coverage only Miller Cl. III; with little or no loss of cervical enamel or CEJ: root coverage and reassess for restoration Miller Cl. I,II, II; with mod.-severe enamel and CEJ loss: consider restoring the cervical enamel and CEJ first, then graft		Occlusion Suboptimal Oral hygiene Faulty brushing Parafunctional habits Intrinsic and extrinsic acid Type of toothbrush Amount of toothpaste

Cervical Lesions and Gingival Recession:The Role of Periodontal, Restorative, and Combination Therapy

Cervical Lesions and Gingival Recession:
The Role of Periodontal, Restorative, and Combination Therapy