Mahajan's Modification of the Miller’s Classification for Gingival Recession

Dental Hypotheses 08/2010; DOI: 10.5436/j.dehy.2010.1.0009
Source: DOAJ

ABSTRACT Introduction: Miller has primar-ily based his classification of gingival recession defects on two aspects: Extent of gingival recession defects and Extent of hard and soft tissue loss in interdental areas surrounding the gingival recession defects. Based on the above criteria Miller classified the gingival re-cession defects into four classes and also took prognosis into account. The prognosis decreases from class 1 to class 4 and the treatment options are also limited from class 1 having maximum treatment options and class 4 having minimum options for treatment. The hypothesis: At first glance classification looks comprehensive and simple to use but close screening points out some of the inherent drawbacks associated in this classification system. Since the ultimate goal of any classification system is to facilitate common standardized identification of the condition under consideration, aid in di-agnosis and prognosis and thus finalizing an appropriate treat-ment plan for the condition; the present manuscript is an attempt to emphasize the need to modify Miller’s classification to make it more comprehensive and updated according to the recent concepts.Evaluation of the hypothesis: The hypothesis highlights some inherent drawbacks and necessary changes in Miller’s Classification system and emphasizes the need to update it.

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    ABSTRACT: Background: The aim of this study was to evaluate the reliability of the avascular exposed root surface area (AERSA) as a prognostic test for gingival recessions and to compare the predictive value of the avascular root surface area calculation and Miller classification on the final root coverage outcomes. Methods: Ninety one patients with 91 isolated single gingival recessions (32 Miller Class I, 29 Miller Class II, 30 Miller Class III defects) located at the upper and lower incisors and canines were treated with a laterally positioned flap. Clinical parameters were recorded and correlated with the achievement of CRC after 6 months. Results: From all used clinical parameters AERSA showed the highest sensitivity and specitivity for predicting CRC. Receiver operating characteristics curve (ROC) analyses revealed 3 acceptable cut-off points based on baseline AERSA for achieving complete root coverage with higher sensitivity and specificity values compared to recession depth, recession width and gingival thickness. Both univariate and multiple linear regression analyses reported that the models could explain the 86% of the mean root coverage with AERSA. Conclusions: This prospective longitudinal study indicates that AERSA may be used to classify gingival recession defects. The newly developed prognostic model may be used to predict the final root coverage outcomes.
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    ABSTRACT: Purpose: The purpose of this clinical guidelines project was to determine the most appropriate surgical techniques, in terms of efficacy, complications, and patient opinions, for the treatment of buccal single gingival recessions without loss of interproximal soft and hard tissues. Methods: Literature searches were performed (electronically and manually) for entries up to 28 February, 2013 concerning the surgical approaches for the treatment of gingival recessions. Systematic reviews (SRs) of randomised controlled trials (RCTs) and individual RCTs that reported at least 6 months of follow-up of surgical treatment of single gingival recessions were included. The full texts of the selected SRs and RCTs were analysed using checklists for qualitative evaluation according to the Scottish Intercollegiate Guidelines Network (SIGN) method. The following variables were evaluated: Complete Root Coverage (CRC); Recession Reduction (RecRed); complications; functional and aesthetic satisfaction of the patients; and costs of therapies. Results: Out of 30 systematic reviews, 3 SRs and 16 out of 313 RCTs were judged to have a low risk for bias (SIGN code: 1+). At a short-term evaluation, the coronally advanced flap plus connective tissue graft method (CAF+CTG) resulted in the best treatment in terms of CRC and/or RecRed; in case of cervical abrasion and presence of root sensitivity CAF + CTG + Restoration caused less sensitivity than CAF+CTG. CAF produced less postoperative discomfort for patients. Limited information is available regarding postoperative dental hypersensitivity and aesthetic satisfaction of the patients. Conclusion: In presence of aesthetic demands or tooth hypersensitivity, the best way to surgically treat single gingival recessions without loss of interproximal tissues is achieved using the CAF procedure associated with CTG. Considering postoperative discomfort, the CAF procedure is the less painful surgical approach, while the level of aesthetic satisfaction resulted higher after CAF either alone or with CTG. It is unclear how much tooth hypersensitivity is reduced by surgically covering buccal recessions. It is important to note that the present recommendations are based on short-term data (less than 1 year).
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    ABSTRACT: Miller's is the most commonly used classification of gingival tissue recessions, defined as the displacement of the soft tissue margin apical to the cemento-enamel junction. However, data on the reliability of this classification are missing so far, although reliability, which reflects the consistency of repeated measurements, is regarded as a prerequisite for judging the utility of a classification. The aim of the present study was to evaluate inter- and intra-observer agreement on Miller's classification of gingival tissue recessions. Two hundred photographs (50 of each region: maxillary/mandibular anterior/posterior teeth) of gingival tissue recessions were evaluated twice by four observers with different degrees of experience in Miller's classification, gingival phenotype, tooth shape, and identifiability of the cemento-enamel junction. The following inter- and intra-observer agreements were found: Miller's classification, 0.72 and 0.73-0.95; gingival phenotype, 0.29 and 0.45-0.58; tooth shape, 0.39 and 0.44-0.59; and identifiability of the cemento-enamel junction, 0.21 and 0.30-0.59. A higher agreement was detected for anterior teeth. Further, gingival phenotype (thin-high scalloping) significantly correlated with tooth shape (long-narrow) (ρ = 0.662, p < 0.001). Miller's classification of gingival tissue recessions was evaluated by four examiners using 200 clinical photographs and yielded substantial to almost perfect agreement, with higher agreement for anterior teeth. Although limited to photographic assessment, the present study offers the so far missing proof on the sufficient inter- and intra-observer agreement of this classification.
    Odontology 10/2014; DOI:10.1007/s10266-014-0179-9 · 1.35 Impact Factor

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