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
1
Professor 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

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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.

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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
Figure 3: Nordland WP and Tarnow DP’s classification
[4] of interproximal attachment.

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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. Interdental
with loss of interproximal attachment. papilla recession can also be classified
The amount of interproximal attachment according to this new classification.
loss (measured from the interproximal  Class I: There is no loss of interdental
CEJ to the depth of the pocket) was bone or soft tissue. This is sub classified
higher than the buccal attachment loss into two categories:
(measured from the buccal CEJ to the  ClassIA: Gingival margin on F/L aspect
depth of the buccal pocket). [10] lies apical to CEJ, but coronal to MGJ
with attached gingiva present between
10. Rotundo et al. (2011) marginal gingiva and MGJ.
Classified gingival recession taking  Class IB: Gingival margin on F/L
into consideration both soft and hard dental aspect lies at or apical to MGJ with an
tissues. absence of attached gingiva between
For this classification, specific taxonomic marginal gingiva and MGJ. [10]
variables have been considered,
1. the amount of keratinized tissue (KT = 2 Class II: The tip of the interdental papilla is
mm); located between the interdental contact
2. the presence/absence of noncarious point and the level of the CEJ
cervical lesion (NCCL), with a midbuccally/midlingually. Interproximal
consequent unidentifiable CEJ; bone loss is visible on the radiograph.
3. and the presence/absence of This is sub-classified into three categories:
interproximal attachment loss.  Class IIA: There is no marginal tissue
Considering these variables, the following recession on F/L aspect
method of assessment is suggested:
 Class IIB: Gingival margin on F/L
1) KT ≥2 mm , NCCL – absent aspect lies apical to CEJ but coronal to
 Interproximal attachment loss – absent. MGJ with attached gingiva present
2) KT <2 mm , NCCL – present between marginal gingiva and MGJ
 Interproximal attachment loss – present  Class IIC: Gingival margin on F/L
As a consequence, the following classes aspect lies at or apical to MGJ with an
may be identified within the population: absence of attached gingiva between
 KT ≥2 mm – no NCCL – no marginal gingiva and MGJ.
interproximal attachment loss (AAA)
 KT ≥2 mm – NCCL – no interproximal Class III: The tip of the interdental
attachment loss (ABA) papilla is located at or apical to the level
 KT ≥2 mm – no NCCL – interproximal of the CEJ midbuccally/midlingually.
attachment loss (AAB) Interproximal bone loss is visible on the
 KT ≥2 mm – NCCL – interproximal radiograph.
attachment loss (ABB)

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 Rosiline James et al. Classifications for Gingival Recession: A Mini Review

This is sub-classified into two categories: The evaluation was performed on

 Class IIIA: Gingival margin on F/L both frontal and lateral views using a 4X
aspect lies apical to CEJ, but coronal to magnification lens, a periodontal probe
MGJ with attached gingiva present (PCP UNC 15), and a dental explorer.
between marginal gingiva and MGJ  Class A, identifiable CEJ on the entire
 Class IIIB: Gingival margin on F/L buccal surface
aspect lies at or apical to MGJ with an  Class B, unidentifiable CEJ totally or
absence of attached gingiva between partially.
marginal gingiva and MGJ. [11] Considering the presence of cervical
discrepancies (step), measured with a
12. Proposed Classification for palatal periodontal probe perpendicular to the long
recession axis of the:
The position of interdental papilla Class (+), presence of cervical step
always remains the basis for classifying (>0.5 mm) involving the root or the crown
gingival recession on palatal aspect. The and the root and Class (−), absence of
criteria of sub classifications have been cervical step
modified to compensate for the absence of
MGJ. CONCLUSIONS
1: Marginal tissue recession on palatal There are a variety of classifications
aspect with no loss of interdental bone or for gingival recessions. However each
soft-tissue classification has its own advantages and
 1 A: Marginal tissue recession ≤3 mm limitations. No classification is complete
from CEJ and fulfils all criteria. Further studies
 1 B: Marginal tissue recession of >3 mm continue to develop more classifications for
from CEJ the ease to classify gingival recessions.
2: The tip of the interdental papilla is
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