CONTEMPORARY PERIODONTAL PLASTIC SURGERY FOR GINGIVAL RECESSION: A NARRATIVE REVIEW OF EVIDENCE AND LONG-TERM CLINICAL OUTCOMES

Background: Gingival recession is a prevalent mucogingival condition characterized by the apical displacement of the gingival margin beyond the cementoenamel junction (CEJ), resulting in root surface exposure. This condition is associated with esthetic concerns, dentin hypersensitivity, root caries, and increased plaque retention. Advances in periodontal plastic surgery, microsurgical techniques, and regenerative biomaterials have significantly enhanced the predictability and outcomes of root coverage procedures. Although many consider gingival recession to be a cosmetic problem, there is a critically important factor to consider. The connective tissue to which the gingiva is attached is the only tissue that prevents bacterial infiltration and therefore plays a crucial role in maintaining periodontal support. Objective:This narrative review aims to critically summarize current evidence on the etiology, classification, and contemporary surgical management of gingival recession, with particular emphasis on periodontal plastic surgical techniques and regenerative approaches. Methods:A literature review was conducted using PubMed, Scopus, Web of Science, and Google Scholar. Articles published between 2000 and 2025 were included if they evaluated surgical management of gingival recession. The review incorporated randomized controlled trials, systematic reviews, and key landmark studies. Results:Coronally advanced flap (CAF) combined with subepithelial connective tissue graft (SCTG) remains the most predictable approach for root coverage, demonstrating high success rates and long-term stability. Tunnel techniques offer excellent esthetic outcomes with reduced surgical morbidity and minimal scarring. Biomaterials such as collagen matrices and acellular dermal matrices represent viable alternatives in selected cases, primarily by eliminating donor-site morbidity, although their predictability remains lower compared with autogenous grafting techniques. Conclusion:Contemporary periodontal plastic surgery provides reliable and predictable treatment options for gingival recession, particularly in Miller Class I and II defects. Treatment success depends on accurate diagnosis, appropriate case selection, gingival phenotype, vascular supply, and meticulous surgical technique. Future advances in tissue engineering, biologically active materials, and minimally invasive surgical techniques may further improve clinical outcomes while reducing patient morbidity