Receding gums, and what can honestly be put back

The recession on the front of the tooth is what brings people in, but it is the tissue between the teeth that sets the ceiling on what can be achieved. Cairo and colleagues built a classification on exactly that: RT1 is recession with no interproximal attachment loss, RT2 has interproximal loss no greater than the loss on the outer surface, and RT3 has interproximal loss that exceeds it. Two examiners applied it blind to each other's readings with almost perfect agreement, and across 109 treated recessions the type predicted the final reduction at six months.^[1]

This is why an honest answer to "can it be covered" is given after a chart, not after a photograph. The same visible recession sits in different types depending on what the probe finds between the teeth, and the type is what changes the expected result.

Recession has several routes and they need different answers. Inflammation from biofilm is one, and it is treated first because operating into an inflamed field is a poor plan. A tooth positioned outside the bony arch with thin overlying tissue is another, and moving the tooth back into the arch sometimes does more than any graft would. Occlusal overload and a habit of clenching sit behind a share of cases and are worth examining for. Brushing technique is on the list, though the evidence for it is less settled than the advice usually implies.^[3]

Where the cause is not addressed, coverage tends to be temporary, and a second operation on the same site is harder than the first. That is the main reason the cause is named in writing before any surgical option is discussed.

The workhorse procedure for multiple adjacent recessions is a modified coronally advanced flap, with or without something added underneath it. A 2025 systematic review and meta-analysis of 17 randomised trials compared the flap plus a connective tissue graft against the flap plus collagen matrix, xenogeneic acellular dermal matrix, platelet-rich fibrin or enamel matrix derivative. Complete root coverage favoured the connective tissue graft with an odds ratio of 1.70, and the gain in keratinised tissue width also favoured it.^[2]

Two honest qualifications belong with that number. Aesthetic scores did not differ significantly between the techniques, so the case for the graft rests on coverage and tissue thickness rather than on appearance. And the review itself notes that long-term evidence is lacking, with only one randomised trial reporting stable long-term root coverage. What is being described is a short to medium-term comparison, which is what exists.

Not every exposed root is a surgical problem. Where the root surface has worn into a notch, the tissue can be brought down over a hollow only to leave the hollow underneath it. In those cases the surface is restored first, conservatively, and the recession is reviewed afterwards against what is left. This is ordinary adhesive work and Dr. Khalid Aletaibi does it himself, which keeps the decision about surgery separate from the decision about the notch.