Dentistry in Practice: A Guide to Materials and Instruments for Gingival Recession Treatment
Complete step-by-step clinical guide — diagnosis, planning, surgery, suturing, post-operative care, and periodontal maintenance.
PART 1 – Procedure Overview, Indications, and Preparation
What you will learn in this guide
By the end of this guide you will be able to understand:
| You will learn |
Practical application |
| When to indicate treatment |
Identify cases that genuinely require intervention |
| When to opt for a conservative approach |
Avoid unnecessary surgical procedures |
| When to indicate periodontal plastic surgery |
Correctly select surgical cases |
| Materials used |
Organize consumables for each step |
| Necessary instruments |
Prepare the appropriate clinical arsenal |
| Support equipment |
Improve ergonomics and predictability |
| Biomaterials |
Know when they can be employed |
| Critical care |
Reduce failures and complications |
| Related products |
Quickly identify catalog categories |
⚠️ Important — How to interpret the flowcharts in this guide
|
The flowcharts presented in this guide are for didactic, educational, and clinical planning support purposes. Their objective is to represent, in an organized manner, the sequence of steps typically involved in the treatment of gingival recession, facilitating the understanding of the procedure and the identification of the main materials, instruments, biomaterials, and supplies used in each phase.
There is no single protocol applicable to all patients. The presented sequences should be interpreted as general reference models, which may undergo adaptations according to the diagnosis, selected surgical technique, professional experience, and clinical particularities of each case.
The definition of the therapeutic conduct must be preceded by a complete anamnesis, thorough clinical examination, periodontal evaluation, complementary examinations when indicated, classification of gingival recession, prognosis analysis, and the development of an individualized treatment plan.
Among the factors that may modify the sequence or indication of steps are:
- Systemic conditions (diabetes mellitus, osteoporosis, cardiovascular diseases, immunosuppression, among others);
- Smoking and other risk habits;
- Continuous use of medications, such as anticoagulants, antiplatelet agents, bisphosphonates, immunosuppressants, and corticosteroids;
- Periodontal phenotype (thick or thin);
- Amount of keratinized tissue available;
- Presence of active periodontal disease;
- Non-carious cervical lesions (NCCLs);
- Previous or planned orthodontic movements;
- Extent of recession, interproximal clinical attachment level, and prognosis of root coverage.
Similarly, the materials, instruments, biomaterials, suture threads, and other supplies presented in this guide represent the resources most frequently used in the literature and clinical practice, and may vary according to the chosen technique, product availability, professional preferences, and the Instructions for Use (IFU) of each manufacturer.
This guide does not replace the clinical judgment of the dental surgeon. Every therapeutic decision must be based on the best available scientific evidence, recommendations from scientific societies, manufacturers' Instructions for Use, current health legislation, and ethical principles established by the Federal Council of Dentistry.
|
Procedure Overview
The treatment of gingival recession follows an organized clinical sequence. Before any surgical intervention, it is essential to identify the etiology, control causative factors, and confirm the actual need for surgery.
Clinical flow of treatment
| Step |
Objective |
| Clinical evaluation |
Diagnose recession |
| Etiology identification |
Discover the cause |
| Control of etiologic factors |
Eliminate risk factors |
| Definition of surgical need |
Choose conservative or surgical treatment |
| Planning |
Select technique and materials |
| Surgery |
Execute the procedure |
| Post-operative |
Promote healing |
| Maintenance |
Preserve results |
Operational Flowchart
Patient
│
▼
Clinical Evaluation
│
▼
Diagnosis
│
▼
Etiological Control
│
▼
Is there a surgical indication?
├── No → Conservative treatment
└── Yes → Surgical planning
│
▼
Clinical setup preparation
│
▼
Material selection
│
▼
Surgical execution
│
▼
Suturing
│
▼
Post-operative care
│
▼
Periodontal maintenance
When is this procedure indicated?
Instead of memorizing isolated indications, use the following decision matrix.
Clinical Indication Matrix
| Clinical situation |
Treatment usually indicated |
| Persistent hypersensitivity |
Periodontal evaluation and conservative treatment |
| Aesthetic compromise |
Evaluation for periodontal plastic surgery |
| Recession progression |
Etiological control + planning |
| Root exposure |
Individual evaluation |
| Non-carious cervical lesion |
Associated restorative dentistry |
| Difficulty in oral hygiene |
Periodontal control |
| Insufficient keratinized tissue |
Graft evaluation |
| Restorative planning |
Previous periodontal correction |
| Implant planning |
Mucogingival evaluation |
| Aesthetic request |
Complete clinical evaluation |
When is surgery usually NOT necessary?
| Situation |
Initial approach |
| Inflamed gingiva |
Inflammation control |
| Traumatic brushing |
Technique correction |
| Persistent biofilm |
Prophylaxis and guidance |
| Discrete recession |
Monitoring |
| No aesthetic compromise |
Conservative treatment |
| Temporary contraindication |
Postpone surgery |
Preparation for the Appointment
Good preparation reduces clinical time, improves ergonomics, and prevents interruptions during the procedure.
Clinical Tray Organization
Instrument Organization Matrix
| Group |
Instruments |
| Diagnosis |
Clinical mirror • Clinical tweezers • Explorer • Periodontal probe • Periodontal ruler |
| Periodontics |
Gracey curettes • Universal curettes • Periodontal tips • Ultrasound |
| Surgery |
Scalpel handle nº 3 • Blades 15/15C • Periosteal elevators • Microsurgery scissors • Delicate forceps |
| Sutures |
Castroviejo needle holder • Mayo-Hegar needle holder • Suture scissors • Microsurgical forceps |
Equipment normally used
| Equipment |
When to use |
| Dental ultrasound |
Periodontal therapy |
| Light-curing unit |
Restorative procedures |
| Micromotor |
Finishing |
| Contra-angle handpiece |
Finishing |
| Surgical aspirator |
Surgery |
| Intraoral scanner |
Documentation |
| Radiographic sensor |
Diagnosis |
| Clinical camera |
Photographic record |
| Surgical loupes |
Magnification |
| LED illumination |
Field visualization |
Materials normally used — Materials Matrix
| Category |
Materials |
| Consumables |
Gauze • Compresses • Cotton |
| Irrigation |
Saline solution |
| Isolation |
Surgical drapes |
| Aspiration |
Aspirators |
| Antisepsis |
Chlorhexidine |
| Anesthesia |
Cartridge • Needles • Anesthetic tubes |
Biosafety — Personal Protective Equipment
| PPE |
Use |
| Gloves |
Hand protection |
| Mask |
Respiratory protection |
| Glasses |
Eye protection |
| Face Shield |
Procedures with splash risk |
| Apron |
Body protection |
| Cap |
Contamination control |
Clinical Environment Verification
Before the patient's arrival, confirm:
| Item |
Verification |
| Instruments |
Sterilized |
| Materials |
Within expiration date |
| Equipment |
Functioning |
| Biomaterials |
Available |
| Sutures |
Separated |
| Anesthetics |
Available |
| Documentation |
Complete |
Best Practices for the Step — Preparation
| Do |
Avoid |
Confirm |
| Organize instruments in clinical sequence |
Opening sterile materials prematurely |
Revised planning |
| Check packaging |
Working with untested equipment |
Biomaterials separated |
| Photograph the case |
Forgetting suture threads |
Drapes organized |
| Review the planning |
Operating without controlling the etiology |
Signed consent |
PART 2 – Clinical Evaluation, Control of Etiological Factors, and Conservative Treatments
Step 1 – Clinical Evaluation and Diagnosis
Objective of the step
Every clinical decision related to the treatment of gingival recession must be preceded by a systematic evaluation. In this phase, the etiology of the recession, risk factors, prognosis, and the need — or not — for surgical intervention are identified.
When to perform?
| Clinical Moment |
Objective |
| First consultation |
Establish initial diagnosis |
| Before restorative treatment |
Plan integration with restorative dentistry |
| Before periodontal therapy |
Define clinical approach |
| Before surgery |
Confirm surgical indication |
| Periodic re-evaluations |
Monitor evolution |
| Recession progression |
Update treatment plan |
Clinical Evaluation Sequence — Operational Matrix
| Step |
What to do |
Objective |
| 1. Anamnesis |
Update medical and dental history |
Identify systemic factors |
| 2. Clinical Examination |
Evaluate periodontal tissues |
Characterize recession |
| 3. Periodontal Examination |
Perform complete probing |
Determine clinical attachment |
| 4. Classification |
Apply Miller and Cairo |
Estimate prognosis |
| 5. Complementary Examinations |
Request when necessary |
Refine planning |
Anamnesis Matrix
| Check |
Clinical Importance |
| Systemic diseases |
Influence healing |
| Allergies |
Treatment safety |
| Continuous medications |
Clinical interferences |
| Smoking |
Periodontal prognosis |
| Previous periodontal treatments |
Clinical history |
| Orthodontic treatments |
Possible etiological factor |
| Chief complaint |
Definition of treatment objectives |
Clinical Examination Matrix
| Evaluation |
Purpose |
| Extent of recession |
Quantify the defect |
| Number of teeth involved |
Define scope |
| Depth |
Planning |
| Width |
Planning |
| Root exposure |
Prognosis |
| Hypersensitivity |
Define treatment |
| Esthetic compromise |
Evaluate surgical need |
| Band of keratinized tissue |
Technique choice |
| Periodontal phenotype |
Prognosis |
| Muscle attachments and frenula |
Identify anatomical factors |
| Tooth mobility |
Evaluate periodontal support |
| Inflammation |
Need for prior therapy |
Periodontal Evaluation
| Parameter |
Application |
| Probing depth |
Periodontal diagnosis |
| Clinical attachment level |
Recession classification |
| Bleeding on probing |
Inflammatory activity |
| Plaque index |
Etiological control |
| Periodontal pockets |
Therapeutic definition |
| Furcation (when applicable) |
Advanced periodontal evaluation |
Recession Classification
| System |
Clinical Application |
| Miller |
Estimation of root coverage potential |
| Cairo (RT1, RT2, and RT3) |
Currently the most used classification for prognostic definition |
Complementary Examinations
| Examination |
When to use |
| Periapical radiograph |
Root evaluation |
| Bitewing radiograph |
Bone evaluation |
| CBCT |
Complex cases |
| Clinical photographs |
Documentation |
| Digital models |
Planning |
| Intraoral scanning |
Digital workflow |
Operational Flowchart — Clinical Evaluation
Reception
│
▼
Anamnesis
│
▼
Clinical Examination
│
▼
Periodontal Examination
│
▼
Classification
│
▼
Complementary Examinations
│
▼
Prognosis
│
▼
Treatment Plan
Resources Used in Step 1
| Category |
Resources |
Catalog |
| Materials |
Gauze • Cotton • Suction tips • Retractors • Photographic contrasts |
Disposable materials |
| Instruments |
Mirror • Forceps • Explorer • Periodontal probe • Periodontal ruler • Nabers probe |
Mirrors • Forceps • Explorers • Probes |
| Equipment |
Radiographic sensor • Intraoral scanner • Clinical camera • Negatoscope |
Sensors • Photographic equipment |
Best Practices for Step 1
| Do |
Avoid |
Confirm |
| Photograph the case |
Plan surgery without diagnosis |
Periodontal exam performed |
| Record all measurements |
Ignore systemic diseases |
Recession classified |
| Evaluate the phenotype |
Do not request exams when necessary |
Prognosis defined |
| Identify the etiology |
Disregard aesthetic expectations |
Treatment plan completed |
Step 2 – Control of Etiological Factors
Step Objective
Eliminate or control the factors responsible for the onset and progression of gingival recession before any restorative or surgical procedure.
When to perform?
| Before... |
Reason |
| Restorative procedures |
Stabilize tissues |
| Periodontal surgery |
Reduce risk of recurrence |
| Periodontal regeneration |
Improve prognosis |
| Grafts |
Ensure stability |
| Maintenance program |
Preserve results |
Etiological Control Matrix
| Factor |
Conduct |
| Biofilm |
Disclosure, scaling, prophylaxis, and guidance |
| Traumatic brushing |
Correction of technique |
| Occlusal trauma |
Evaluation and adjustment when indicated |
| Orthodontic movement |
Orthodontic evaluation |
| Inadequate restorations |
Correction of excesses and overcontours |
Operational Flowchart — Etiological Control
Identify cause
│
▼
Control biofilm
│
▼
Guide hygiene
│
▼
Correct brushing
│
▼
Evaluate occlusion
│
▼
Evaluate orthodontics
│
▼
Correct restorations
│
▼
Reevaluate
Resources Used in Step 2
| Category |
Resources |
Catalog |
| Materials |
Prophylactic paste • Chlorhexidine • Antiseptics • Plaque disclosing agents • Fluoride |
Prophylactic pastes • Antiseptics |
| Instruments |
Gracey curettes • Universal curettes • Periodontal tips • Rubber cup • Robinson brush |
Curettes • Ultrasonic tips • Brushes |
| Equipment |
Ultrasonic scaler • Bicarbonate jet (when indicated) • Micromotor |
Periodontal equipment |
Best Practices for Step 2
| Do |
Avoid |
Confirm |
| Control biofilm |
Operate inflamed gingiva |
Adequate hygiene |
| Guide brushing |
Ignore occlusal trauma |
Biofilm controlled |
| Reevaluate the patient |
Maintain inadequate restorations |
Periodontal stability |
| Eliminate causal factors |
Indicate surgery prematurely |
Case stabilized |
Step 3 – Conservative Treatments
Step Objective
Stabilize periodontal tissues, control symptoms, and preserve dental structures before indicating surgical procedures.
When to indicate?
| Clinical Situation |
Conduct |
| Hypersensitivity |
Desensitization |
| LCNC |
Restorative evaluation |
| Small recession |
Follow-up |
| No aesthetic demand |
Conservative treatment |
| Temporary contraindication |
Postpone surgery |
| Pre-surgical preparation |
Periodontal stabilization |
Therapeutic Matrix
| Situation |
Materials |
Instruments |
Equipment |
| Hypersensitivity |
Varnishes • Desensitizing agents • Oxalates • Arginine |
Microbrush • Mirror • Forceps |
— |
| LCNC |
Adhesive • Acid • Resin • Ionomer |
Spatulas • Applicators • Microbrush |
Light-curing unit |
| Finishing |
Diamond paste • Discs • Rubber polishers |
Polishing instruments |
Contra-angle • Micromotor |
Operational Flowchart — Conservative Treatments
Clinical evaluation
│
▼
Control of hypersensitivity
│
▼
Treatment of LCNC
│
▼
Finishing and polishing
│
▼
Reevaluation
│
▼
Define surgical need
Resources Used in Step 3
| Category |
Resources |
Catalog |
| Materials |
Adhesive systems • Acid etchants • Composite resins • Ionomers • Desensitizing varnishes |
Adhesive systems • Resins • Ionomers |
| Instruments |
Microbrushes • Spatulas • Applicators • Abrasive discs • Polishing rubber cups |
Microbrushes • Discs • Rubber polishers |
| Equipment |
Light-curing units • Contra-angle • Micromotor |
Light-curing units |
Best Practices for Step 3
| Do |
Avoid |
Confirm |
| Evaluate restorative need |
Restore unnecessarily |
Hypersensitivity controlled |
| Plan according to future gingival margin |
Restore beyond the planned margin |
LCNC treated |
| Perform careful finishing |
Omit polishing |
Case reevaluated |
| Integrate Restorative Dentistry and Periodontics |
Indicate surgery prematurely |
Surgical indication confirmed |
PART 3 – Surgical Planning, Clinical Setup, and Periodontal Plastic Surgery
Step 4 – Surgical Planning
Step Objective
After controlling etiological factors and achieving periodontal stability, surgical planning begins. In this phase, the operative technique, materials, biomaterials, instruments, and clinical sequence necessary to achieve predictable root coverage are defined.
When to start planning?
| Criterion |
Objective |
| Periodontium without inflammation |
Favor healing |
| Satisfactory oral hygiene |
Reduce risk of recurrence |
| Controlled etiology |
Avoid treatment failures |
| Completed examinations |
Precise planning |
| Defined prognosis |
Choice of surgical technique |
Technique Selection Matrix
| Clinical Situation |
Frequently indicated technique* |
| Single recession with good keratinized tissue |
Coronally advanced flap |
| Recession with tissue deficiency |
Connective tissue graft + flap |
| Multiple recessions |
Coronally advanced flap associated or other techniques as indicated |
| Thin periodontal phenotype |
Connective tissue graft |
| High aesthetic demand |
Microsurgical technique |
*The definitive choice depends on individual clinical evaluation, professional experience, and anatomical characteristics of the case.
Resource Planning — Planning Matrix
| Group |
What to define before surgery |
| Surgical technique |
Operative sequence |
| Anesthesia |
Type and quantity |
| Instruments |
Complete sterilized kit |
| Biomaterials |
Availability and indication |
| Sutures |
Material and thickness |
| Team |
Distribution of functions |
| Clinical photography |
Initial record |
Biomaterial Selection
| Biomaterial |
Application |
| Autogenous connective tissue graft |
Increase in tissue thickness |
| Collagen matrix |
Alternative in selected cases |
| Membranes |
Specific regenerative procedures |
| Enamel matrix derivatives |
Cases indicated by planning |
| Absorbable hemostatics |
Bleeding control when necessary |
Planning Flowchart
Diagnosis completed
│
▼
Etiological control
│
▼
Prognosis definition
│
▼
Technique selection
│
▼
Material selection
│
▼
Table organization
│
▼
Team confirmation
│
▼
Surgery start
Resources Used in Step 4
| Category |
Resources |
Catalog |
| Materials |
Surgical drapes • Gauze • Sponges • Saline solution |
Disposable materials • Surgical drapes |
| Instruments |
Periodontal ruler • Periodontal kit • Microsurgical kit |
Surgical instruments |
| Equipment |
Clinical photography • Loupes • LED illumination |
Biomaterials • Clinical equipment |
Good Practices for Step 4
| Do |
Avoid |
Confirm |
| Plan the entire sequence |
Improvising during surgery |
Materials checked |
| Organize the tray beforehand |
Opening unnecessary materials |
Biomaterials available |
| Review exams |
Starting without planning |
Technique defined |
| Confirm all resources |
Working with an incomplete kit |
Team aligned |
Step 5 – Surgical Tray Preparation
Objective
Make all materials available in a logical sequence of use, reducing interruptions during the procedure.
Organization by Clinical Sequence
| Moment |
Resources usually used |
| Anesthesia |
Carpule • Needles • Anesthetic cartridges |
| Incision |
Scalpel handle • 15C blade |
| Reflection |
Periosteal elevators |
| Root preparation |
Curettes • Ultrasound |
| Graft |
Scissors • Delicate forceps |
| Suture |
Needle holders • Forceps • Scissors |
| Irrigation |
Saline solution • Syringes |
| Finalization |
Gauze • Compresses |
Tray Organization — Instruments
| Group |
Instruments |
| Incision |
No. 3 handle • 15 and 15C blade |
| Reflection |
Molt • Prichard • Allen periosteal elevators |
| Periodontics |
Gracey curettes • Universal curettes |
| Microsurgery |
Delicate forceps • Micro scissors |
| Suture |
Castroviejo • Mayo-Hegar needle holders |
Tray Organization — Materials
| Category |
Materials |
| Irrigation |
Saline solution |
| Aspiration |
Surgical aspirators |
| Hemostasis |
Compresses • Gauze |
| Antisepsis |
Chlorhexidine |
| Isolation |
Sterile surgical drapes |
Tray Organization — Equipment
| Equipment |
Purpose |
| Ultrasound |
Root instrumentation |
| Surgical aspirator |
Aspiration |
| Clinical photography |
Documentation |
| Surgical loupes |
Magnification |
| LED reflector |
Illumination |
Step 6 – Periodontal Plastic Surgery
Objective
Perform the planned technique, preserving tissues, ensuring flap stability, and promoting root coverage.
Operating Sequence
| Order |
Procedure |
| 1 |
Anesthesia |
| 2 |
Incision marking |
| 3 |
Incision |
| 4 |
Flap reflection |
| 5 |
Root preparation |
| 6 |
Graft positioning (if indicated) |
| 7 |
Flap positioning |
| 8 |
Sutures |
| 9 |
Final check |
Operational Flowchart — Surgery
Anesthesia
│
▼
Incision
│
▼
Reflection
│
▼
Root Preparation
│
▼
Graft (if indicated)
│
▼
Flap Repositioning
│
▼
Suture
│
▼
Final Check
Resources per Surgical Step
| Step |
Materials |
Instruments |
Equipment |
| Anesthesia |
Anesthetic cartridges |
Carpule |
— |
| Incision |
Gauze |
Handle and blade |
Illumination |
| Reflection |
Saline |
Periosteal elevators |
Loupes |
| Root preparation |
Saline |
Curettes |
Ultrasound |
| Graft |
Biomaterial |
Forceps and scissors |
Loupes |
| Suture |
Suture thread |
Needle holders |
Illumination |
Critical Points
| Attention |
Clinical Impact |
| Precise incisions |
Better flap adaptation |
| Delicate reflection |
Vascular preservation |
| Clean root surface |
Better healing |
| Absence of tension |
Higher predictability |
| Graft stability |
Lower risk of displacement |
| Stable suture |
Clot protection |
Most Frequent Errors
| Error |
Possible consequence |
| Flap under tension |
Wound dehiscence |
| Insufficient reflection |
Inadequate coverage |
| Deficient root instrumentation |
Compromised healing |
| Excessive manipulation |
Tissue trauma |
| Unstable suture |
Flap displacement |
Good Surgical Practices
| Do |
Avoid |
Confirm |
| Handle tissues delicately |
Excessive traction |
Stable flap |
| Irrigate constantly |
Dry surgical field |
Adequate hemostasis |
| Maintain good visibility |
Blind instrumentation |
Adapted graft |
| Respect the plan |
Changing technique unnecessarily |
Satisfactory root coverage |
PART 4 – Sutures, Post-operative Care, Maintenance, Related Products, FAQ, Conclusion, and Technical Basis
Step 7 – Surgical Suture
Objective of the step
The purpose of suturing is to stabilize the flap, keep the graft in position (when used), protect the clot, and promote healing by primary intention.
More than just closing the wound, it should provide tissue immobility, passive adaptation, and minimal tension.
When to perform?
| Clinical Situation |
Conduct |
| Coronally displaced flap |
Stabilizing suture |
| Connective tissue graft |
Graft and flap fixation |
| Regenerative techniques |
Careful stabilization |
| Microsurgical procedures |
Delicate and precise sutures |
Suture Thread Selection Matrix
| Thread type |
Characteristics |
Frequent applications |
| Monofilament |
Lower bacterial retention |
Periodontal plastic surgeries |
| Multifilament |
Greater flexibility |
Selected cases |
| Absorbable |
No removal required |
As clinically indicated |
| Non-absorbable |
Excellent stability |
Widely used in root coverage |
Suturing Instruments
| Category |
Instruments |
| Needle holders |
Castroviejo • Mayo-Hegar |
| Forceps |
Adson • Microsurgical |
| Scissors |
Iris • Micro scissors |
| Support |
Gauze • Compresses |
Operational Sequence — Suture
| Order |
Procedure |
| 1 |
Check flap positioning |
| 2 |
Select appropriate thread |
| 3 |
Perform planned stitches |
| 4 |
Adjust tension |
| 5 |
Confirm stability |
| 6 |
Review hemostasis |
Flowchart — Suture
Adapted flap
│
▼
Thread selection
│
▼
First stitch
│
▼
Remaining stitches
│
▼
Tension control
│
▼
Hemostasis
│
▼
Finalization
Good Practices — Suture
| Do |
Avoid |
Confirm |
| Use minimal tension |
Over-tightening the thread |
Immobile flap |
| Preserve irrigation |
Strangulating tissues |
Protected clot |
| Maintain symmetry |
Irregular stitches |
Adapted margins |
| Review all stitches |
Ending without inspection |
Hemostasis achieved |
Step 8 – Post-operative Care
Objective
Promote predictable healing and reduce the risk of complications.
Patient Instructions — First 24 hours
| Instruction |
Purpose |
| Do not brush the operated area |
Preserve the flap |
| Do not manipulate the stitches |
Avoid displacement |
| Avoid hot foods |
Reduce bleeding |
| Prefer soft foods |
Minimize trauma |
| Apply cold compress if indicated |
Edema control |
Patient Instructions — First Week
| Instruction |
Objective |
| Hygiene as directed by the professional |
Biofilm control |
| Correct use of prescribed medications |
Pain and inflammation control |
| Avoid strenuous exercise |
Reduced risk of hemorrhage |
| Attend follow-up appointments |
Healing monitoring |
Medications (as prescribed by the dental surgeon)
| Class |
Objective |
| Analgesics |
Pain control |
| Anti-inflammatories |
Inflammatory control |
| Antimicrobials |
When clinically indicated |
| Oral antiseptics |
Aid in chemical biofilm control |
Important: the choice of medication, dose, route of administration, and duration of treatment must be defined exclusively by the dental surgeon, according to the clinical assessment of each patient.
Possible Intercurrences
| Situation |
Initial action |
| Mild edema |
Expected in the first hours |
| Sensitivity |
Clinical follow-up |
| Minor bleeding |
Local compression |
| Persistent pain |
Clinical reevaluation |
| Suture dehiscence |
Immediate evaluation |
| Signs of infection |
Immediate treatment |
Post-operative Flowchart
Patient discharge
│
▼
Instructions
│
▼
Medication management
│
▼
Clinical review
│
▼
Suture removal
│
▼
Periodontal maintenance
Step 9 – Periodontal Maintenance
Objective
Preserve the results obtained with the treatment and reduce the possibility of recurrence of gingival recession.
Maintenance Program
| Interval |
Objective |
| First review |
Assess healing |
| Initial return |
Suture removal (when applicable) |
| Periodic reviews |
Periodontal control |
| Preventive maintenance |
Prevent recurrence |
Periodic Evaluations
| Evaluation |
Check |
| Biofilm |
Hygiene control |
| Inflammation |
Gingival health |
| Recession |
Stability |
| Hypersensitivity |
Clinical evolution |
| Clinical attachment |
Prognosis |
| Aesthetics |
Patient satisfaction |
Best Practices — Maintenance
| Do |
Avoid |
Confirm |
| Reinforce hygiene |
Abandon follow-ups |
Controlled biofilm |
| Re-evaluate periodically |
Ignore small signs |
Tissue stability |
| Photograph evolution |
Lack of documentation |
Maintained result |
| Provide continuous guidance |
Suspend follow-up |
Motivated patient |
Consolidated Checklist — All Phases
| Phase |
Item |
Status |
| Pre-treatment |
Updated medical history |
□ |
| Pre-treatment |
Evaluated exams |
□ |
| Pre-treatment |
Clinical photographs |
□ |
| Pre-treatment |
Radiographs available |
□ |
| Pre-treatment |
Defined diagnosis |
□ |
| Pre-treatment |
Planned technique |
□ |
| Pre-treatment |
Sterilized instruments |
□ |
| Pre-treatment |
Separated biomaterials |
□ |
| Pre-treatment |
Suture materials |
□ |
| Pre-treatment |
Organized tray |
□ |
| Pre-treatment |
Tested equipment |
□ |
| Pre-treatment |
Consent obtained |
□ |
| Pre-surgical |
Confirmed diagnosis |
□ |
| Pre-surgical |
Signed consent |
□ |
| Pre-surgical |
Exams available |
□ |
| Pre-surgical |
Sterilized instruments |
□ |
| Pre-surgical |
Separated biomaterials |
□ |
| Pre-surgical |
Sutures available |
□ |
| Pre-surgical |
Anesthetics prepared |
□ |
| Pre-surgical |
Equipment functioning |
□ |
| Post-procedure |
Diagnosis performed |
□ |
| Post-procedure |
Etiology controlled |
□ |
| Post-procedure |
Planning completed |
□ |
| Post-procedure |
Surgery executed |
□ |
| Post-procedure |
Stable suture |
□ |
| Post-procedure |
Instructions provided |
□ |
| Post-procedure |
Review scheduled |
□ |
| Post-procedure |
Maintenance plan defined |
□ |
Related Products — Master Table by Phase
| Phase |
Catalog Category |
Application |
| Diagnosis / Preparation |
Periodontal instruments |
Diagnosis |
| Diagnosis / Preparation |
Surgical instruments |
Planning |
| Diagnosis / Preparation |
Suturing instruments |
Preparation |
| Diagnosis / Preparation |
Disposable materials |
Treatment |
| Diagnosis / Preparation |
Biosafety products |
Protection |
| Diagnosis / Preparation |
Anesthetics |
Anesthesia |
| Diagnosis / Preparation |
Dental needles |
Anesthesia |
| Diagnosis / Preparation |
Surgical drapes |
Isolation |
| Diagnosis / Preparation |
Gauze and compresses |
Clinical support |
| Diagnosis / Preparation |
Antiseptic solutions |
Antisepsis |
| Diagnosis / Preparation |
Saline solution |
Irrigation |
| Diagnosis / Preparation |
Clinical equipment |
Procedure support |
| Conservative |
Adhesive systems |
Cervical restoration |
| Conservative |
Acid etchants |
Adhesion |
| Conservative |
Composite resins |
Reconstruction |
| Conservative |
Glass ionomers |
Restoration |
| Conservative |
Desensitizing varnishes |
Sensitivity control |
| Conservative |
Microbrushes |
Application |
| Conservative |
Abrasive discs |
Finishing |
| Conservative |
Polishing cups |
Polishing |
| Conservative |
Light-curing units |
Light curing |
| Surgery |
Scalpel handles |
Incisions |
| Surgery |
Surgical blades |
Incisions |
| Surgery |
Periodontal elevators |
Flap |
| Surgery |
Periodontal curettes |
Root instrumentation |
| Surgery |
Microsurgical instruments |
Periodontal plastic surgery |
| Surgery |
Needle holders |
Suture |
| Surgery |
Delicate forceps |
Tissue manipulation |
| Surgery |
Surgical scissors |
Trimming and suturing |
| Surgery |
Biomaterials |
Grafts |
| Surgery |
Suture threads |
Flap stabilization |
| Surgery |
Surgical drapes |
Isolation |
| Surgery |
Gauze and compresses |
Hemostasis |
| Maintenance |
Gauze and compresses |
Hemostasis |
| Maintenance |
Surgical drapes |
Isolation |
| Maintenance |
Saline solution |
Irrigation |
| Maintenance |
Antiseptics |
Chemical biofilm control |
| Maintenance |
Periodontal curettes |
Instrumentation |
| Maintenance |
Needle holders |
Sutures |
| Maintenance |
Delicate forceps |
Tissue manipulation |
| Maintenance |
Scissors |
Suture cutting |
| Maintenance |
Autogenous grafts |
Tissue augmentation |
| Maintenance |
Collagen matrices |
Alternative to autogenous graft |
| Maintenance |
Membranes |
Regenerative cases |
| Maintenance |
Hemostatics |
Bleeding control |
| Maintenance |
Ultrasound |
Periodontal therapy |
| Maintenance |
Surgical loupes |
Magnification |
| Maintenance |
Radiographic sensor |
Diagnosis |
| Maintenance |
Intraoral scanner |
Digital follow-up |
Frequently Asked Questions (FAQ)
| Question |
Answer |
| Does all gingival recession require surgery? |
No. Many cases are initially treated with etiological control and a conservative approach. |
| Which classification is currently most used? |
The Cairo classification is widely adopted to define the prognosis of root coverage. |
| Is grafting always necessary? |
No. The indication depends on the amount of keratinized tissue, the periodontal phenotype, and the chosen technique. |
| How long does healing take? |
The answer varies depending on the procedure and the patient's clinical conditions. |
| Does treatment definitively eliminate recession? |
Success depends on the technique used, control of etiological factors, and periodontal maintenance. |
| Is it possible to prevent new recessions? |
Yes. Adequate hygiene, biofilm control, correct brushing technique, and periodic follow-up significantly reduce the risk of recurrence. |
Conclusion
The treatment of gingival recession requires a systematic approach that integrates accurate diagnosis, elimination of etiological factors, individualized planning, and careful execution of periodontal techniques. Clinical predictability depends not only on the surgical procedure but also on the correct selection of materials, instruments, biomaterials, and equipment, as well as the patient's commitment to postoperative care and the periodontal maintenance program.
Organizing care in stages promotes greater clinical safety, standardization of processes, and better functional and aesthetic results.
Technical Basis
This guide was prepared based on consolidated scientific literature and widely accepted recommendations for Periodontics and Periodontal Plastic Surgery, covering:
- Periodontal diagnosis and classification of gingival recessions.
- Non-surgical periodontal therapies.
- Root coverage surgeries.
- Gingival grafts and biomaterials.
- Biosafety in dental procedures.
- Best practices for surgical tray organization.
- Postoperative care and maintenance protocols.
References
| Author / Document |
Topic |
| Cairo et al. |
Classification of gingival recessions (RT1, RT2, and RT3) |
| Miller |
Classic classification of gingival recessions |
| Zucchelli & De Sanctis |
Periodontal plastic surgery and root coverage |
| Langer & Langer |
Connective tissue graft |
| Cortellini & Tonetti |
Periodontal regeneration |
| Lindhe, Lang & Karring |
Clinical Periodontology |
| Carranza's Clinical Periodontology |
Clinical fundamentals of Periodontology |
| Jepsen et al. |
Guidelines for periodontal treatment |
| Papapanou et al. |
Classification of periodontal diseases |
Applicable Legislation and Standards
| Standard |
Application |
| RDC ANVISA nº 15/2012 |
Good practices for processing health products |
| Code of Dental Ethics (CFO) |
Professional practice |
| Current biosafety standards |
Infection control |
| IFU (Instructions for Use) from manufacturers |
Correct use of materials, biomaterials, instruments, and equipment |
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