Article

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: Several classification systems have been proposed in the literature, but none of them has been validated by means of an appropriate statistical analysis and, therefore, it is unknown whether these systems work in the same manner among different clinicians. The aim of the present study is to investigate the intra- and inter-rater agreement of a new system to classify gingival recession defects and to evaluate its agreement among different clinicians. A new classification system was proposed and tested considering the following three factors: the amount of keratinised tissue ( <2 or ≥2 mm), the presence / absence of non carious cervical lesions and the presence/ absence of interproximal attachment loss. Kappa-statistics were performed to analyse the intra-rater and inter-rater agreement among three blinded examiners. A total of 120 gingival recessions were evaluated using the new classification system. The intra-rater agreement ranged from 0.74 to 0.96 for the variable keratinised tissue, from 0.67 to 0.94 for the variable non-carious cervical lesions and from 0.70 to 0.92 for the variable interproximal attachment loss. The inter-rater agreement values ranged from 0.70 to 0.85 for keratinised tissue, from 0.54 to 0.59 for non-carious cervical lesions and from 0.54 to 0.77 for the interproximal attachment loss. Based on the results of this study, the proposed new classification system showed moderate to substantial agreement among investigators when used in the present study population and was therefore able to diagnose the severity of gingival recession defects.
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