Dear Doctor.

Your true that recession occur after pdl surgery and it depends on the amount of bone loss underneath.

Revered sir,

I think a connective tissue graft or a guided tissue regeneration procedure should be advised. however it also depends on the exact clinical status of the patient, that is, sometimes as simple a procedure like a coronally positioned flap might suffice and it also is more importantly based on your experience and expertise.

Thank you.

Thank you Dr. Mallikarjun for your response, I think connective tissue graft is the most predictable surgical technique for covering recession but the problem here is the amount of donor tissue required for generalized recession. Recently while i was searching data bases for most recent and novel approaches i found 2 new techniques for root covering and they are pinhole technique and bridge flap and i will attach the link, i wonder how efficient these two techniques for covering generalised gingival recession 

http://www.ncbi.nlm.nih.gov/pubmed/22754900

and

http://www.ncbi.nlm.nih.gov/pubmed/23633786

Respected Sir's, i think the initial concern was recession and formation of black holes after surgical or non-surgical periodontal therapy. The use of connective tissue graft with coronally repositioned flap or the newer pin-hole and bridge flaps are ways to cover radicular recession, but it wont help to close the embrassure spaces. Infact, if the papilla are not filling the embrassure spaces, one cannot achieve 100% root coverage on the roots.

I feel prevention of black hole occurence is the best we can do to achieve predictable esthetic outcome for the patient. One technique using CTG itself, is to place strips of CTG along the alveolar crest before suturing the flaps. This will prevent the collapse of the flap and hence no open embrassure spaces.

Can you please define what you mean by "moderate" gingival recession? This is necessary because gingival recession is popularly classified using Miller's..... and by generalized, do you mean that more than 30% of teeth are involved? If it is truly generalized like that, what's the age of the age? What are his brushing habits? Is the recession purely periodontal or is it complication by brushing-induced trauma? 

If you can please clarify the above concerns in DETAIL, then it will be easy for members to provide answers to your query.

Cheers!!

N/B-- I'm a senior lecturer/consultant periodontist.

Dear Dr. Nwhator, thank you for your intervention, I meant by moderate gingival recession  mainly Class II and few Class III recession according to miller, yes more 30% of the teeth affected by recession which was purely due to periodontitis and the patient's age 48 years, the patient was instructed for Modified Stillmans brushing technique

Great. You've done most of the work already!  With respect to what techniques to use, I think much of it depends on your clinical judgment and expertise. I believe the sub-epithelial connective tissue graft combined with the coronally-advanced  flap will do the trick for multiple sites with gingival recession. 

Other techniques have been reported including using the so-called "periosteal pedicle graft" -- "Mahajan A. Treatment of multiple gingival recession defects using periosteal pedicle graft: a case series. J Periodontol. 2010 Oct;81(10):1426-31. doi:10.1902/jop.2010. 

You may also be interested in the following reference--Amberkar SC, Deshmukh V, Acharya A, Jhaveri HM. Management of multiple and isolated gingival recession sites with periodontal plastic surgical procedures--a case report. Quintessence Int. 2010 Oct;41(9):739-48. 

We had suggested a non-surgical approach in cases where surgery is either in-practicable or in-advisable for several reasons.-- Please look at the reference here-- "http://www.ajol.info/index.php/nqjhm/article/view/12783" 

Finally, please rule out underlying systemic causes in this individual. Being just 48 with such a periodontal profile doesn't sound good. A full blood count and differentials, HBaC and FBS to rule out DM and a specialist periodontal consultation will be nice. 

Also, there is a need to rule out exaggerated periodontal destruction due to a hyper-inflammatory profile..... this again will need an expert periodontal assessment.

Hope this helps.

Cheers!!!

Thank you for your detailed answer am glad for that, I think some times we have to go to the prosthesis, I  searched the link u sent about the prosthesis, I understood that it is a  gingival mask or what is called party gum because the link only shows the abstract and no much details about the prosthesis,  if it is a gingival mask? have you practiced that? if yes could you please tell me how the impression is taken, i mean the technique and the material used for taking the impression of the embrasures area and thank you

In our own case we took the impr