EC Dental Science

Review Article Volume 22 Issue 9 - 2023

Why Classify Further? When the Extension of Miller Classification of Gingival Recession is an Answer to Most Clinical Question Related to Diagnosis and Prognosis of Gingival Recession

Bindiya Kumari Pahuja1* and Yasser Khaled2

1All India Institute of Medical Sciences (AIIMS), New Delhi, India
2Assistant Professor, Oral Medicine, TMD/Orofacial Pain School of Dentistry, Marquette University, USA

*Corresponding Author: Bindiya Kumari Pahuja, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Received: January 02, 2023; Published: August 11, 2023



Many attempts have been made in the past to classify gingival recession defects. Classification of gingival recession is one such condition where there is no clear-cut grouping of the gingival defects. The miller’s classification is the most accepted classification of gingival recession so far. However, many classifications of gingival structural defects are popular in the literature but are of no significant clinical use. Too many classifications rather confuses the clinician about the diagnosis, treatment guidelines and prognosis of the gingival defect which may takes the attention of the clinician away into the classification terminology rather than the actual insight into the defect. The contribution of various authors in providing the classification is well appreciated and acknowledged, but it is not seemingly possible to understand the shortcomings and applications of all the classification system since no classification is complete, rather it would be better for the clinician to apply simple permutation and combinations of basic biological principals to achieve the favorable outcome. No two gingival recessions are similar in the mouth. A combination of Multiple factors is playing a role in defining the complex nature of gingival recession. Here in this paper an attempt has been made to acknowledge and simplify all clinical possibilities of gingival recession in terms of diagnosis and predetermining the prognosis.

Keywords: Miller Classification; Gingival Recession; Prognosis; Gingival Defect

  1. Guttiganur N., et al. “Classification systems for gingival recession and suggestion of a new classification system”. Indian Journal of Dental Research2 (2018): 233.
  2. Jain S., et al. “Classification systems of gingival recession: An update”. Indian Journal of Dental Sciences1 (2017): 52.
  3. Kumar A and Masamatti S. “A new classification system for gingival and palatal recession”. Journal of Indian Society of Periodontology2 (2013): 175.
  4. Ravipudi S., et al. “Gingival Recession: Short Literature Review on Etiology, Classifications and Various Treatment Options”. Journal of Pharmaceutical Sciences 9 (2017): 6.
  5. Hall WB. “Pure mucogingival problems: etiology, treatment, and prevention”. Quintessence Publishing Company (1984).
  6. Van Palanstein Helderman WH., et al. “Gingival recession and its association with calculus in subjects deprived of prophylactic dental care”. Journal of Clinical Periodontology 25 (1998): 106-111.
  7. Baker DL and Seymour DJ. “The possible pathogenesis of gingival recession. A histological study of induced recession in the rat”. Journal of Clinical Periodontology 3 (1976): 208-219.
  8. Waerhaug J. “The gingival pocket. Anatomy, pathology, deepening and elimination”. Odontologisk Tidskrift 60 (1952).
  9. Zucchelli G. “Mucogingival Esthetic Surgery”. Quintessenza Edizioni (2013).
  10. Tomlinson RE and Silva MJ. “Skeletal Blood Flow in Bone Repair and Maintenance”. Bone Research4 (2013): 311-322.
  11. Brandi ML and Collin-Osdoby P. “Vascular biology and the skeleton”. Journal of Bone and Mineral Research 21 (2006): 183-192.
  12. McCarthy I. “The physiology of bone blood flow: a review”. Journal of Bone and Joint Surgery American3 (2006): 4-9.
  13. Maes C., et al. “Hypoxia-driven pathways in bone development, regeneration and disease”. Nature Reviews Rheumatology 8 (2012): 358-366.
  14. Burkhardt R., et al. “Changes in trabe- cular bone, hematopoiesis and bone marrow vessels in aplastic anemia, primary osteoporosis, and old age: a comparative histo- morphometric study”. Bone 8 (1987): 157-164.
  15. Reeve J., et al. “Skeletal blood flow, iliac histomorphometry, and strontium kinetics in osteoporosis: a relationship between blood flow and corrected apposition rate”. The Journal of Clinical Endocrinology and Metabolism 66 (1988): 1124-1131.
  16. Flanagan D. “Important arterial supply of the mandible, control of an arterial hemorrhage, and report of a hemorrhagic incident”. The Journal of Oral Implantology4 (2003): 165-173.
  17. Brookes M. “Approaches to non-invasive blood flow measurement in bone”. Biomedical Engineering 9 (1974): 342-347.
  18. Trias A and Fery A. “Cortical circulation of long bones”. Journal of Bone and Joint Surgery American 61 (1979): 1052-1059.
  19. Shenk R. “Biology of fracture repair. In: Brown BD, Jupiter JB, Levine AM et al (editions) Skeletal trauma: fractures, dislocations, ligamentous bone injuries, 2nd edition”. W. B. Saunders, Philadelphia (1998).
  20. Filipowska J., et al. “The role of vasculature in bone development, regeneration and proper systemic functioning”. Angiogenesis3 (2017): 291-302.
  21. Pannarale L., et al. “SEM corrosion-casts study of the microcirculation of the flat bones in the rat”. The Anatomical Record4 (1997): 462-471.
  22. Swaminathan DY and Thomas DJT. What makes cementum a unique structure? 4.12 (2013): 18.
  23. Provenza DV. “The Blood Vascular Supply of the Dental Pulp with Emphasis on Capillary Circulation”. Circulation Research2 (1958): 213-218.
  24. Polson Alan M., et al. “Trauma and progression of marginal periodontitis in squirrel monkeys. IV Reversibility of bone loss due to trauma alone and trauma superimposed upon periodontitis”. Journal of Periodontal Research5 (1976): 290-298.
  25. Zoellner H., et al. “Microvasculature in gingivitis and chronic periodontitis: Disruption of vascular networks with protracted inflammation”. Microscopy Research and Technique1 (2002): 15-31.
  26. Shkreta M., et al. “Exploring the Gingival Recession Surgical Treatment Modalities: A Literature Review”. Open Access Macedonian Journal of Medical Sciences4 (2018).
  27. Gerstenfeld LC., et al. “Fracture healing as a post-natal developmental process: molecular, spatial, and temporal aspects of its regulation”. Journal of Cellular Biochemistry 88 (2003): 873-884.
  28. Steinbrech DS., et al. “Hypoxia increases insulinlike growth factor gene expression in rat osteoblasts”. Annals of Plastic Surgery 44 (2000): 529-534.
  29. Siebert J and Lindhe J. “Tetbook of Clinical Periodontology and Implant dentistry”. 2nd Copenhangen: Munksgaard (1989).
  30. Van Der Donk S., et al. “Rinsing morsellized allografts improves bone and tissue ingrowth”. Clinical Orthopaedics 408 (2003): 302-310.
  31. Stoner JE and Mazdyansna S. “Gingival recession in the lower incisor region of 15 year old subjects”. The Journal of Periodontology 51 (1980): 74-76.
  32. Lang NP and Loe H. “The relationship between the width of keratinized Gingiva and gingival health”. The Journal of Periodontology 43 (1972): 623-627.
  33. Steiner GG., et al. “Changes of the marginal periodontium as a result of labial tooth movement in monkeys”. The Journal of Periodontology 52 (1981): 314-320.
  34. Batenhorst KF., et al. “Tissue changes resulting from facial tipping and extrusion of incisors in monkeys”. The Journal of Periodontology 45 (1974): 660-668.
  35. Kundapur PP., et al. “Association of Trauma from Occlusion with Localized Gingival Recession in Mandibular Anterior Teeth”. DRJ2 (2009): 71-74.
  36. Miller PD Jr. “A classification of marginal tissue recession”. International Journal of Periodontics and Restorative Dentistry2 (1985): 8-13.
  37. Pini-Prato G. “The Miller classification of gingival recession: limits and drawbacks: Classification of recessions”. Journal of Clinical Periodontology3 (2011): 243-245.
  38. Zucchelli G., et al. “Clinical and Anatomical Factors Limiting Treatment Outcomes of Gingival Recession: A New Method to Predetermine the Line of Root Coverage”. The Journal of Periodontology4 (2006): 714-721.
  39. Wennstrom JL. “Mucogingival therapy”. Annals of Periodontology1 (1996): 671-701.
  40. Tackas VJ. “Root coverage techniques: a review”. Journal of the Western Society of Periodontology1 (1995): 5-14.
  41. Hattler AB. “Mucogingival surgery - utilization of interdental gingiva as attached gingiva by surgical displacement”. Periodontics 5 (1967): 126-131.
  42. Pfeifer JS and Heller R. “Histologic evaluation of full and partial thickness lateral repositioned flaps. A pilot study”. Journal of Periodontology6 (1971): 331-333.
  43. Huang LH., et al. “Factors affecting the outcomes of coronally advanced flap root coverage procedure”. Journal of Periodontology10 (2005): 1729-1734.
  44. Goldstein M., et al. “A critical evaluation of methods for root coverage”. Critical Reviews in Oral Biology and Medicine1 (1996): 87-98.
  45. Bernimoulin JP., et al. “Coronally repositioned periodontal flap. Clinical evaluation after one year”. Journal of Clinical Periodontology 2 (1975): 1-13.
  46. Zucchelli G and De Sanctis M. “Treatment of multiple recession type defects in patients with aesthetic demands”. Journal of Periodontology 71 (2000): 1506-1514.
  47. Pagliaro U., et al. “Evidence-based mucogingival therapy. Part 1: A critical review of the literature on root coverage procedures”. Journal of Periodontology5 (2003): 709-740.
  48. Allen AL. “Use of the supraperiosteal envelope in soft tissue grafting for root coverage. I. Rationale and technique”. International Journal of Periodontics and Restorative Dentistry3 (1994): 216-227.
  49. Santarelli GA., et al. “Connective tissue grafting employing the tunnel technique: a case report of complete root coverage in the anterior maxilla”. International Journal of Periodontics and Restorative Dentistry1 (2001): 77-83.
  50. Homayoun H Zadeh. “Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet-derived growth factor BB”. International Journal of Periodontics and Restorative Dentistry6 (2011): 653-660.
  51. Shantipriya Reddy., et al. “Vestibular incision subperiosteal tunnel access (VISTA) with platelet rich fibrin (PRF) and connective tissue graft (CTG) in the management of multiple gingival recession- A case series”. International Journal of Applied Dental Sciences4 (2016): 34-37.

Bindiya Kumari Pahuja and Yasser Khaled. "Why Classify Further? When the Extension of Miller Classification of Gingival Recession is an Answer to Most Clinical Question Related to Diagnosis and Prognosis of Gingival Recession". EC Dental Science 22.9 (2023): 01-17.