Localized gingival recession and root exposure may cause an esthetic problem, root dentin hypersensitivity, root caries, and difficulties in plaque control. To solve the problems, root coverage procedures have been developed since 1950s. These surgical procedures are classified as pedicle soft tissue graft procedures, free soft tissue graft procedures, and regenerative procedures. Pedicle soft tissue graft procedures include the laterally repositioned flap procedure, the double papilla flap, the oblique rotational flap, the coronally advanced flap procedure, and a semi-lunar coronally repositioned flap procedure. Free soft tissue graft procedures contain the free gingival graft and the connective tissue graft. Regenerative procedures are the modifications of coronally advanced flap utilizing barrier membranes or enamel matrix derivatives.
Histological observations of the human root surface treated with soft tissue graft showed that new connective tissue attachment was formed in some areas, and epithelial attachment was found in other areas. Based on the literatures, the connective tissue graft results in superior root coverage comparing with other procedures. Similarly, complete root coverage was expected in highest predictability in the connective tissue graft, especially in class I or II recession defects. The color match of the grafted area to the adjacent gingiva is esthetically more favorable with the connective tissue graft than that of a free gingival graft. However, only partial coverage may be expected in class III or IV recession defects
