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PeriodonticsIntermediate

Gingival recession: Miller and Cairo classifications

Recession is when the gingival margin drops below the cementoenamel junction (the line where the enamel ends) and leaves the root exposed.
Gingival recession on upper incisors: the gingiva receded and left the root exposed.
Gingival recession on upper incisors: the gingiva receded and left the root exposed.Photo: Damdent · CC BY-SA 3.0, Wikimedia Commons

What you need to know

  • Main causes: plaque-induced inflammation and traumatic (too hard) brushing.
  • Predisposing factors: thin gingiva, little keratinized gingiva (less than 2 mm), high frenum, orthodontic movement, restorations below the gumline and smoking.
  • Miller expected surgery to cover the whole root in Classes I and II, only part of it in Class III and none of it in Class IV.
  • Cairo (2011), used in the 2017 World Workshop classification: RT1 no attachment loss between the teeth; RT2 loss between the teeth less than or equal to the buccal loss; RT3 loss between the teeth greater than the buccal loss.

Miller classification (1985)

ClassReaches the mucogingival junction?Loss between the teeth
INoNo
IIYes, or goes past itNo
IIIYes, or goes past itYes (bone or gingiva), or malpositioned tooth
IVYes, or goes past itSevere, or severe malposition

Terms in plain words

Cementoenamel junctionThe line where the enamel ends and the cementum begins.
Mucogingival junctionThe boundary between the firm (keratinized) gingiva and the movable mucosa.
Keratinized gingivaFirm gingiva, attached to the bone, that protects the root.

For the exam

Recession that goes past the mucogingival junction, with no loss of bone or gingiva between the teeth. Which Miller class is it?

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Class II.

Sources

  1. Fageeh HI, et al. Assessing the Reliability of Miller's Classification and Cairo's Classification in Classifying Gingival Recession Defects. Medicina (Kaunas). 2024;60(2):205. View source
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