Decision Tree for the Treatment of Multiple Gingival Recession Defects When Utilizing MCAT or MCAF Based on Evidence and Clinical Experience

The multiple coronally advanced flap (MCAF) and the modified coronally advanced tunnel technique (MCAT) are the most commonly used methods for treating multiple gingival recessions. However, treating multiple defects is very complex due to various biological and anatomical factors, and there is no clear guideline on the major or minor determinants that influence surgical decisions. The aim of the present commentary is to discuss a decision tree to suggest to clinicians the most relevant anatomical factors to take in to consideration when evaluating the choice between a MCAT and an MCAF. In the proposed decision-making process, the first crucial step involves the evaluation of the interdental clinical attachment loss (CAL), according to the new EFP/AAP classification. The next step is to assess the dimensions of the lateral keratinized tissue (LKT), that is the keratinized tissue located laterally to the recession defect. When LKT amount is insufficient, the size of the interdental papillae, including base, height, and coronal width, must also be evaluated.