Management of Gingival Recession After Restoration of Non-Carious Cervical Lesions
The recommended approach is to perform partial restoration of the cervical lesion (restoring only the coronal portion plus 1mm) followed by coronally advanced flap with connective tissue graft, as this combined restorative-surgical protocol achieves approximately 70-92% root coverage while maintaining long-term gingival margin stability. 1, 2, 3
Restorative Protocol
Timing and Extent of Restoration
- Restore only the coronal zone plus 1mm of the non-carious cervical lesion before periodontal surgery, leaving the apical portion exposed for soft tissue attachment 1, 3
- This partial restoration approach allows for better clinical attachment on the root surface compared to complete restoration 2
Material Selection
- Use resin-modified glass ionomer or resin composite for the partial restoration 1, 4, 5
- Both nanofilled and microhybrid composites with either total-etch or universal adhesive systems show satisfactory 2-year outcomes 3
- The presence of restorative material does not interfere with subsequent root coverage procedures 5
Surgical Protocol
Root Coverage Technique
- Perform coronally advanced flap (CAF) with connective tissue graft (CTG) as the gold standard approach 6, 1, 4, 5
- The connective tissue graft is critical because gingival thickness of at least 1.46mm at 6 months is the main determinant of long-term gingival margin stability 6, 7
- Sites require at least 1.5mm of keratinized tissue width to prevent recession recurrence 6, 7
Alternative Approaches
- L-PRF membranes (3-4 layers) can be used with CAF as an alternative to CTG, avoiding palatal harvesting 6
- rhPDGF-BB with beta-tricalcium phosphate or soft tissue matrices may be considered, though long-term data shows significant reduction in coverage from 89.85% at 6 months to 74.10% at 5 years 6
- Autogenous CTG demonstrates superior long-term stability (89.35% coverage at 5 years) compared to growth factor approaches 6
Expected Outcomes
Root Coverage Results
- Combined defect coverage ranges from 70-92% with the partial restoration plus CAF/CTG approach 1, 2, 3
- Complete root coverage achieved in approximately 71% of cases 2
- Clinical attachment gain of 1.98-2.0mm can be expected 2, 5
Long-Term Stability Considerations
- Thin soft tissue (<1.46mm) is prone to recession regardless of underlying bone level, making phenotype modification essential 6, 7
- Without adequate gingival thickness, previously covered areas may become exposed over time 7
- The modification of soft tissue phenotype through CTG is more important than bone regeneration alone for preventing long-term relapse 6
Post-Operative Management
- Restrict to soft food intake with no biting/chewing in treated area for 1 week 6
- No mechanical cleaning of treated area for 1 week 6
- Rinse with 0.12% chlorhexidine twice daily for at least 3 weeks (starting day 3) 6
- Prescribe analgesics as needed 6
Critical Pitfalls to Avoid
- Do not perform complete restoration of the cervical lesion before surgery - this prevents proper soft tissue attachment and compromises outcomes 1, 2
- Do not rely solely on growth factor approaches without addressing soft tissue thickness - this leads to significant recession recurrence over 5 years 6
- Do not proceed with CAF alone in thin phenotype cases - inadequate tissue thickness (<1.46mm) will result in long-term recession 6