A Multifactorial Periodontal Recession Classification (MPRC) System
Creators: name: Blake, Jonathan
Publisher: name: Zenodo
Year: 2024
Subjects: subject: Periodontics

description: This project introduces a novel multifactorial classification system for gingival recession, designed to enhance clinical predictability and treatment outcomes in periodontal therapy. Traditional classification systems, such as those by Miller and Cairo, have limitations in addressing contemporary clinical needs, particularly concerning tissue phenotype, keratinized tissue width, and esthetic results.

Our classification system evaluates gingival recession using four primary factors:



Recession Type (RT): Categorizes the extent of gingival and interproximal attachment loss into three types (RT1, RT2, RT3).

Tissue Phenotype (TP): Measures gingival thickness to distinguish between thin and thick phenotypes, which impacts root coverage success.

Keratinized Tissue Width (KTW): Assesses the width of keratinized tissue, a critical factor for long-term stability post-treatment.

Papilla Status (PS): Evaluates the integrity of the interdental papilla, which is essential for both structural support and esthetic outcomes.


The classification system is supplemented by modifying factors such as smoking status, patient age, oral hygiene, occlusal trauma, systemic health conditions (e.g., diabetes), history of periodontal treatment, and patient compliance. These modifiers are retained separately from the base classification to maintain simplicity and usability, while allowing for a tailored approach to individual cases.

The following table illustrates the proposed core classification categories, with estimated root coverage success rates based on tissue phenotype, keratinized tissue width, and papilla status, along with relevant clinical insights.

MPRC Table




RECESSION TYPY (RT)
Tissue Phenotype (Thickness)
Keratinized Tissue Width (KTW)
Papilla Status
Estimated Root Coverage Success (%)
Clinical Comments


RT1 (No interproximal attachment loss)
Thick (>1.1 mm)
>2 mm
Intact
90-100
Excellent prognosis; high predictability with grafting or flap techniques


RT1
Thin (<1mm)
<2mm
Partial Loss
70-80
Reduced predictability; connective tissue grafting recommended to increase thickness before coverage.


RT2 (Interproximal attachment loss ≤ buccal attachment loss)
Thick
> 2 mm
Intact
70-85
Good prognosis with multilayered flap and grafting techniques; interproximal support aids in stability.


RT2
Thin
<2 mm
Partial Loss
50-60
Limited success; phenotype modification and additional grafting may be required. Consider esthetic goals.


RT3 (Interproximal attachment loss > buccal attachment loss)
Thick
>2 mm
Partial Loss
40-60
Fair prognosis; root coverage often partial. Increased risk of recession recurrence


RT3
Thin
<2 mm
Complete Loss
<30
Poor prognosis; treatment focuses on stability rather than root coverage. Educate patient on expectations




 



Recession Type (RT): Defines the extent of gingival and interproximal attachment loss based on Cairo classification.

Tissue Phenotype (Thickness): Differentiates between thin (<1 mm) and thick (>1.1 mm) gingival phenotypes, influencing coverage predictability.

Keratinized Tissue Width (KTW): Width of keratinized tissue, with >2 mm generally associated with improved stability.

Papilla Status: Measures papilla integrity, with intact or partial loss determining both structural and esthetic outcomes.


Guidelines for success rate adjustment based on modifiers are as follows













Modifier Impact Table




Modifier
Adjustment to Success Rate
Notes




Smoking
Decrease by 20-30%
Impairs healing, increases risk of recession recurrence


Poor Oral Hygiene
Decrease by 15-20%
Reduces predictability due to plaque-related inflammation


Systemic Health (Diabetes)
Decrease by 15-25%
Especially in uncontrolled cases, delays healing


Age (>65)
Decrease by 10-15%
Reduced regenerative capacity in older patients


Previous Periodontal Treatment
Decrease by 10-20%
History of attachment loss can lower treatment predictability










To further assist clinicians and researchers, an online tool is in development, designed to facilitate data collection, standardize classification assessments, and provide clinicians with a real-time prediction model. This tool will streamline the input of classification criteria and modifiers, offering an immediate assessment of estimated root coverage success and treatment guidance.

The aim is to provide clinicians with a reliable tool for assessing gingival recession, setting realistic patient expectations, and optimizing treatment strategies based on a detailed understanding of each case’s unique characteristics. Further research will focus on evaluating long-term stability and the system's applicability across diverse clinical settings.