Received: 15 March 2020 | Revised: 9 July 2020
DOI: 10.1111/jcpe.13353
ORGINAL ARTICLE CLINICAL PERIODONTOLOGY
Epidemiology of mid-buccal gingival recessions in NHANES
according to the 2018 World Workshop Classification System
Mario Romandini1 | Maria Costanza Soldini2 | Eduardo Montero1,3 | Mariano Sanz1,3
1
Section of Graduate Periodontology,
Faculty of Odontology, University
Complutense, Madrid, Spain
2
Department of Periodontology, Universitat
Internacional de Catalunya, Barcelona, Spain
3
ETEP (Etiology and Therapy of Periodontal
and Peri-implant Diseases) Research Group,
University Complutense, Madrid, Spain
Correspondence
Mario Romandini, Universidad Complutense
de Madrid, Facultad de Odontología, Plaza
Ramón y Cajal, 3, 28040 Madrid, Spain.
Email: mario.romandini@gmail.com
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
1180 | 
wileyonlinelibrary.com/journal/jcpe
| Accepted: 27 July 2020
Abstract
Aim: There are no nationally representative epidemiological studies available report-
ing on the different recession types according to the 2018 classification system or
focusing on the aesthetic zone. The aims of this cross-sectional study were (a) to
provide estimates on the prevalence, severity and extent of mid-buccal GRs accord-
ing to the 2018 classification and (b) to identify their risk indicators in the adult U.S.
population from the NHANES database.
Materials and Methods: Data from 10,676 subjects, representative of 143.8 millions
of adults, were retrieved from the NHANES 2009–2014 database. GR prevalence
was defined as the presence of at least one mid-buccal GR ≥1 mm. GRs were catego-
rized following the 2018 World Workshop classification system (RT1, RT2, RT3) and
according to different severity cut-offs. An analysis for GR risk indicators was also
performed, selecting subjects without periodontitis.
Results: The patient-level prevalence of mid-buccal GRs (all types) was 91.6%, while
it decreased to 70.7% when considering only the aesthetic zone. When focusing on
RT1 GRs, the patient-level prevalence (whole mouth) was 12.4%, while it was 5.8%
considering only the aesthetic zone. The majority of RT1 GRs were considered as
mild (1–2 mm). The whole-mouth patient-level prevalence of RT2 and RT3 GRs was
88.8% and 55.0%, respectively. Age (35–49 years), gender (female), ethnicity (non–
Hispanic Whites), last dental visit (>6 months before), tooth type (incisors) and the
arch (mandible) resulted as risk indicators associated with the presence of RT1 GR.
Conclusions: Mid-buccal GRs affect almost the entire US population. Age, gender,
ethnicity, dental care exposure, tooth type and arch were identified as risk indicators
for RT1 GRs.
KEYWORDS
2017 World Workshop, aesthetics, classification, epidemiology, hypersensitivity,
mucogingival deformities and conditions, mucogingival surgery, National Health and Nutrition
Examination Survey, periodontal diseases and conditions, risk factors, root caries, root
coverage procedures, root sensitivity
J Clin Periodontol. 2020;47:1180–1190.

ROMANDINI et al.
1 | I NTRO D U C TI O N
Gingival recession has been recently defined in the 2018 World
Workshop classification as the apical shift of the gingival margin
caused by different conditions/pathologies, associated with clinical
attachment loss (Jepsen et al., 2018). This condition, not only can
impair patient aesthetic and comfort (e.g. root sensitivity) (Nieri
et al., 2013; Vignoletti, Di Martino, Clementini, Di Domenico, & De
Sanctis, 2020), but also can increase the risk for root caries (Bignozzi
et al., 2014; Cortellini & Bissada, 2018) and the patient fear of tooth
loss (Tugnait & Clerehugh, 2001).
This new classification system has categorized gingival reces-
sions with reference to the inter-dental clinical attachment loss, dis-
tinguishing among the three different types proposed by Cairo, Nieri,
Cincinelli, Mervelt, and Pagliaro (2011) (Cortellini & Bissada, 2018):
• Recession type 1 (RT1) with no loss of inter-proximal attachment;
• Recession type 2 (RT2) with loss of inter-proximal attachment,
being less or equal than the loss of buccal attachment (measured
from the buccal CEJ to the apical end of the buccal sulcus/pocket);
• Recession type 3 (RT3) when the amount of inter-proximal attach-
ment loss exceeds the loss of buccal attachment.
Mid-buccal gingival recessions, especially in case of RT1 gin-
gival recessions, have been associated with a traumatic aetiology
and with patient's aesthetic impairment and discomfort (Zucchelli
& Mounssif, 2015). In fact, many surgical interventions have been
designed and studied for their efficacy to reconstruct the buccal
loss of attachment and attain complete root coverage (Barootchi
et al., 2019; Cairo, Nieri, & Pagliaro, 2014; Cortellini et al., 2009;
Rasperini et al., 2011, 2018, 2020; Sanz & Simion, 2014; Tatakis
et al., 2015; Tavelli, Barootchi, Cairo, et al., 2019; Tavelli, Barootchi, Di
Gianfilippo, et al., 2019; Tavelli et al., 2018; Tonetti & Jepsen, 2014).
Gingival recessions involving inter-dental attachment loss (mainly
RT3, due to periodontitis) have however shown limited reconstruc-
tive potential using these surgical approaches (Cairo et al., 2012,
2015; Prato, Rotundo, Cortellini, Tinti, & Azzi, 2004; Zucchelli
et al., 2010).
Despite their clinical relevance, mid-buccal gingival recessions
have received scarce epidemiological attention and there are few
available population-based studies, most of them based on par-
tial-mouth periodontal examination (PMPE) protocols. Moreover,
despite the different nature of these conditions and the differ-
ent predictability of their reconstructive treatment (Tonetti &
Jepsen, 2014; Tugnait & Clerehugh, 2001),41, none of the available
studies have distinguished among the different types (i.e. RT1, RT2
and RT3) proposed by the 2018 classification system or have fo-
cused on the presence of these conditions in the aesthetic zone.
The epidemiological knowledge of gingival recession would allow
to quantify its burden and thus to guide its preventive and thera-
peutic management. It was, therefore, the aim of this study to pro-
vide estimates on the prevalence, severity and extent of mid-buccal
gingival recessions according to the 2018 classification system and,
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| 1181
Clinical Relevance
Scientific rationale for study: Despite their clinical relevance,
no nationally representative studies have analysed the
epidemiology of gingival recessions (GRs) according to the
2018 classification system or have focused on the aes-
thetic zone.
Principal findings: Mid-buccal GRs affect almost the entire
adult population, while 12.4% of the subjects have RT1
GRs. Age, gender, ethnicity, dental care exposure, tooth
type and arch were identified as risk indicators for RT1
GRs.
Practical implications: Mid-buccal GRs are an extremely
prevalent condition. An important proportion of GRs (RT1
and RT2) have root coverage potential through periodontal
plastic surgery procedures, although their indication needs
to be evaluated specifically in each case.
furthermore, to identify their systemic and local risk indicators.
With this objective, we have analysed the 2009–2014 U.S. National
Health and Nutrition Examination Survey (NHANES), since in this
database belonging to a large nationwide representative sample, gin-
gival recessions were recorded using a full-mouth periodontal exam-
ination (FMPE) protocol.
2 | M ATE R I A L S A N D M E TH O DS
2.1 | Study sample: NHANES 2009–2014
The data for this analysis were derived from the 2009–2014 sections
of the National Health and Nutrition Examination Survey (NHANES).
The NHANES is a nationwide cross-sectional survey conducted by
the Centers for Disease Control and Prevention (CDC), with each
cycle consisting of a different representative sample of the total
resident civilian non-institutionalized US population. It consists of
questionnaires administered in the home of the participants, fol-
lowed by an examination carried out in a specially equipped mobile
examination centre (MEC). Detailed information about the survey,
its contents and the sampling methods are provided elsewhere 42.
The NHANES 2009–2014 cycles were ethically approved by the
National Center for Health Statistics (NCHS) Research Ethics Review
Board (ERB), and each participant signed an informed consent form.
2.2 | Study variables
The primary variable of this investigation was the presence of mid-
buccal gingival recessions. In NHANES 2009–2014, gingival recessions
were evaluated during the periodontal examination conducted in a
MEC. All survey participants of at least 30 years old were considered
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1182 | ROMANDINI et al.

TA B L E 1 Prevalence of gingival recession (all types) at participant-level for persons aged 30 years or more in the United States
(2009–2014)

Entire mouth
Weighted
N in GR ≥ 1 mm GR ≥ 3 mm GR ≥ 5 mm
N Millions (%) SE (%) SE (%) SE GR ≥ 7 mm (%) SE

Total 10,676 143.8 91.63 0.66 39.26 1.21 7.68 0.42 1.11 0.14
Age groups
30–34 years 1,298 17.7 80.47 1.36 14.65 1.16 2.49 0.58 0.00 0.00
35–49 years 3,750 54.2 89.75 0.98 29.61 1.32 4.10 0.40 0.67 0.15
50–64 years 3,330 46.8 95.35 0.68 49.70 1.91 10.58 0.71 1.60 0.21
65 + years 2,298 25.1 96.56 0.44 57.91 1.81 13.67 0.98 1.95 0.39
Gender
Male 5,261 70.2 92.69 0.74 45.89 1.33 10.09 0.67 1.62 0.19
Female 5,415 73.6 90.55 0.80 32.94 1.32 5.38 0.41 0.63 0.14
Ethnicity
Mexican American 2,215 15.3 84.64 1.32 34.54 1.62 9.80 0.72 1.95 0.28
Non–Hispanic 4,576 98.3 92.43 0.83 39.51 1.60 7.14 0.58 1.03 0.18
White
Non–Hispanic 1,519 11.7 92.69 0.78 37.79 1.74 7.75 0.68 1.04 0.21
Black
Other ethnicity 2,366 18.5 92.46 0.71 42.82 1.55 8.77 0.91 0.90 0.25
Educational level
<High school 2,493 21.9 93.49 0.65 4,861 129 14.53 1.15 2.64 0.45
High school 2,297 29.9 91.19 1.10 4,347 165 11.04 0.85 2.30 0.36
>High school 5,873 91.8 91.33 0.78 3,561 138 4.95 0.40 0.36 0.09
Periodontal status (AAP)
No Periodontitis 5,207 82.9 88.94 0.88 23.59 1.17 0.96 0.19 0.04 0.03
Mild Periodontitis 495 6.3 80.67 2.45 22.62 2.28 1.95 0.63 0.00 0.00
Moderate 3,780 43.3 96.69 0.38 61.43 1.48 14.05 0.91 1.44 0.25
Periodontitis
Severe 1,194 11.3 98.02 0.66 78.94 1.50 36.05 1.97 8.36 1.26
Periodontitis
Smoking status
Current smoker 2,001 24.9 93.19 0.73 49.26 1.81 14.10 0.97 2.68 0.49
Former smoker 2,671 37.7 93.14 0.87 44.25 1.77 8.71 0.85 1.36 0.24
Non-smoker 6,000 81.1 90.44 0.82 33.87 1.16 5.23 0.34 0.52 0.10

Abbreviations: GR, gingival recession; SE, standard error.

TA B L E 2 Prevalence of gingival recession types at participant-level for persons aged 30 years or more in the United States (2009–2014)

Entire mouth Only 15–25 (FDI)

GR ≥ 1 mm (%) SE GR ≥ 3 mm (%) SE GR ≥ 5 mm (%) SE GR ≥ 7 mm (%) SE

RT1 GRs 12.37 0.93 1.08 0.12 0.03 0.02 0.00 0.00
RT2 GRs 88.81 0.73 36.77 1.15 6.65 0.38 0.77 0.11
RT3 GRs 54.99 1.70 12.03 0.60 2.47 0.19 0.19 0.07

Abbreviations: GR, gingival recession; SE, standard error.

eligible for the periodontal evaluation if they had at least one tooth Gingival recessions were measured at six sites/tooth (exclud-
(excluding third molars) and did not meet any of the health exclusion ing third molars) as the distance from the cemento-enamel junc-
criteria44. tion (CEJ) to the free gingival margin (FGM). Further details about
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ROMANDINI et al. | 1183

Only 15–25 (FDI)

Multiple GR ≥ 1 mm GR ≥ 3 mm GR ≥ 5 mm GR ≥ 7 mm Multiple GR
GR (≥1 mm) SE (%) SE (%) SE (%) SE (%) SE (≥1 mm) SE

71.72 1.22 70.68 1.08 20.52 1.03 2.56 0.22 0.26 0.06 40.62 1.15

51.05 1.97 46.54 1.70 6.35 0.80 0.83 036 0.00 0.00 20.66 1.43
66.97 1.61 63.95 1.40 15.10 0.96 1.23 0.21 0.05 0.03 34.78 1.51
78.96 1.64 80.55 1.29 26.65 1.64 3.52 0.37 0.45 0.14 48.03 1.47
83.00 1.11 86.16 1.80 32.45 1.85 5.20 0.59 0.59 0.24 53.91 1.99

75.85 1.17 74.12 1.19 25.45 1.21 3.79 0.36 0.50 0.12 45.24 1.34
67.78 1.40 67.38 1.26 15.80 1.07 1.38 0.22 0.03 0.02 36.25 1.25

57.52 1.84 60.31 1.91 18.62 1.32 3.81 0.41 0.56 0.12 27.05 1.42
73.79 1.58 72.73 1.42 20.63 1.38 2.38 0.28 0.20 0.08 43.25 1.50

70.01 2.11 63.70 1.79 17.13 0.84 2.54 0.38 0.20 0.09 33.49 1.33

73.54 1.12 72.57 1.35 23.64 1.18 2.51 0.40 0.35 0.15 42.55 1.70

74.64 1.32 69.48 1.47 23.54 1.31 4.33 0.60 0.52 0.16 35.83 1.34
72.15 1.72 69.81 1.60 24.13 1.39 3.87 0.58 0.62 0.25 40.43 1.67
70.87 1.38 71.20 1.28 18.69 1.14 1.76 0.21 0.09 0.03 41.86 1.39

65.26 1.51 65.03 1.38 11.17 0.82 0.39 0.11 0.00 0.00 34.56 1.27
46.47 3.02 51.87 3.51 9.92 1.63 0.73 0.50 0.00 0.00 21.61 2.45
82.63 1.11 80.10 1.12 33.94 1.80 4.04 0.49 0.14 0.05 49.39 1.39

91.43 1.11 89.28 1.23 47.48 2.27 14.58 1.40 2.84 0.78 62.38 2.11

75.99 1.29 74.56 1.07 27.07 1.48 5.43 0.70 0.55 0.22 42.19 1.78
73.45 1.76 75.57 1.52 23.75 1.58 2.79 0.43 0.41 0.16 44.92 1.58
69.61 1.30 67.39 1.29 17.18 0.94 1.63 0.21 0.11 0.05 38.09 1.30

Only 15–25 (FDI

GR ≥ 1 mm (%) SE GR ≥ 3 mm (%) SE GR ≥ 5 mm (%) SE GR ≥ 7 mm (%) SE

5.82 0.59 0.49 0.08 0.01 0.01 0.00 0.00

64.44 1.09 18.85 1.00 2.26 0.21 0.22 0.06
26.17 1.05 3.89 0.24 0.63 0.08 0.06 0.02

gingival recession assessment are reported in Appendix S1. For the The periodontal examiners were trained and calibrated prior to
present study, only mid-buccal gingival recessions were considered. the beginning of the surveys by the NHANES survey expert dentist,
When a mid-buccal gingival recession was identified, it was further and also periodically 2–3 times a year. The examiners training and
categorized as RT1, RT2 or RT3 (Cairo et al., 2011). calibration methods for the 2009–2014 cycles are described in detail
 1600051x, 2020, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13353 by Spanish Cochrane National Provision (Ministerio de Sanidad), Wiley Online Library on [26/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1184 | ROMANDINI et al.

TA B L E 3 Prevalence of gingival recession at tooth level for persons aged 30 years or more in the United States (2009–2014)

All types* RT1*

N GR ≥ 1 mm (%) GR ≥ 3 mm (%) GR ≥ 5 mm (%) GR ≥ 7 mm (%) GR ≥ 1 mm (%) GR ≥ 3 mm (%) GR ≥ 5 mm (%)

Total 242,304 33.79 6.87 0.93 0.11 0.85 0.05 0.00

Tooth type
Incisor 75,251 27.33 5.61 0.85 0.09 1.42 0.06 0.00
Canine 39,390 26.71 7.05 1.27 0.23 0.78 0.08 0.01
Premolar 68,744 45.53 9.40 1.09 0.10 0.84 0.06 0.00
Molar 58,919 33.09 5.42 0.61 0.08 0.20 0.01 0.00
Arch
Maxilla 118,010 29.44 5.99 0.72 0.08 1.05 0.05 0.00
Mandible 124,294 37.93 7.71 1.12 0.14 0.65 0.06 0.00
Arch side
Right 121,233 33.65 6.76 0.91 0.11 0.80 0.06 0.00
Left 121,071 33.94 6.99 0.95 0.12 0.91 0.05 0.00

Abbreviation: GR, gingival recession

*Percentages are not survey-adjusted; for 426 teeth, it was not possible to establish the recession type (RT) as the inter-proximal CAL was not
available.

F I G U R E 1 Prevalence of gingival
recession at tooth level according to the
tooth position and the recession type

elsewhere (Dye et al., 2014),42. Gingival recession assessment has
shown an excellent level of reliability43, with Inter-class correlation
coefficients (ICCs) ranging from 0.91 to 0.96 during the initial cali-
bration session of the 2009–2010 NHANES cycles (Dye et al., 2014).
Furthermore, the following covariates were considered to define
subpopulations and for the analytical epidemiological analysis:
• Participant level: age (30–34 years, 35–49 years, 50–64 years,
65 + years), gender (male, female), ethnicity (Mexican American,
non–Hispanic White, non–Hispanic Black, other ethnicity),
educational level (<high school, high school,>high school), mar-
ital status (married, widowed, divorced, separated, never mar-
ried, living with partner), family poverty level (FPL - <100% FPL,
100%–199% FPL, 200%–399% FPL, ≧400% FPL), periodontal sta-
tus (CDC/AAP case definition—(Eke, Page, Wei, Thornton-Evans,
& Genco, 2012)—no periodontitis, mild, moderate, severe peri-
odontitis), smoking status (current smoker, former smoker, non-
smoker), frequency of dental floss/device (0 days/wk, 1–6 days/
wk, 7 days/wk) and last dental visit (6 months or less, more than
6 months).
 1600051x, 2020, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13353 by Spanish Cochrane National Provision (Ministerio de Sanidad), Wiley Online Library on [26/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
ROMANDINI et al. | 1185

RT2* RT3*

GR ≥ 7 mm
GR ≥ 7 mm (%) GR ≥ 1 mm (%) GR ≥ 3 mm (%) GR ≥ 5 mm (%) GR ≥ 7 mm (%) GR ≥ 1 mm (%) GR ≥ 3 mm (%) GR ≥ 5 mm (%) (%)

0.00 24.49 5.23 0.65 0.07 8.25 1.53 0.26 0.04

0.00 18.02 3.74 0.51 0.05 7.55 1.71 0.32 0.04

0.00 19.62 5.53 0.92 0.14 6.13 1.39 0.32 0.09
0.00 35.15 7.88 0.88 0.08 9.37 1.42 0.19 0.02
0.00 23.56 3.85 0.38 0.05 9.25 1.53 0.22 0.04

0.00 21.59 5.83 0.50 0.09 7.13 1.32 0.21 0.03

0.00 27.24 4.60 0.79 0.05 9.31 1.73 0.31 0.05

0.00 24.61 5.17 0.64 0.06 8.04 1.59 0.27 0.04

0.00 24.37 5.30 0.66 0.07 8.46 1.48 0.26 0.04

• Tooth level: tooth type (incisor, canine, premolar, molar), arch Risk indicator analyses for GRs were performed only in subjects
(maxilla, mandible) and mouth side (right, left). without periodontitis, using two different approaches:

1. Survey-adjusted multivariate logistic regressions (subject level);

2.3 | Statistical analyses
All statistical analyses were performed with STATA version 14.2
software, using analysis for complex samples in order to allow the
generalization of the results to the entire non-institutionalized US
population. Mid-buccal gingival recession prevalence was defined as
the presence of at least one mid-buccal GR ≥1 mm, and it was re-
ported, both at subject level and at tooth level, according to differ-
ent severity cut-offs: ≥1 mm, ≥3 mm, ≥5 mm and ≥7 mm. At subject
level, it was reported separately considering the entire mouth or only
the aesthetic zone (between second upper premolars), and for both
the whole population and selected subject's characteristics (Eke,
Dye, Wei, Thornton-Evans, & Genco, 2012). At tooth level, it was re-
ported separately considering all teeth and categorized by tooth type
(Zucchelli et al., 2018, 2019), arch and side. Moreover, we reported at
both subject level and tooth level the prevalence of different reces-
sion types (RT) according to the 2018 World Workshop classification
(Jepsen et al., 2018). Finally, we reported at subject level the preva-
lence of multiple gingival recession defined as the presence of a mid-
buccal gingival recession in at least two adjacent teeth.
Mid-buccal gingival recession extent was reported as the per-
centage of teeth affected by GR (≥1 mm) in subjects with GR, and
categorized in localized (<15% of teeth) and generalized (≥15% of
teeth).
2. Multilevel multivariate logistic regressions (subject level and tooth
level).
The covariates were estimated individually and the final model
included all factors that were found significant (p < .05) (Vignoletti,
Di Domenico, Di Martino, Montero, & De Sanctis, 2019). Odds ra-
tios (ORs) with 95% confidence intervals (CI) were reported together
with two-tailed p-values derived from Wald tests.
3 | R E S U LT S
The sampling strategy resulted in the selection of 30,468 subjects
accepting to participate in NHANES 2009–2014. From this sam-
ple, 14,071 were aged 30 years or more and received the health
examination, being 2,318 excluded from the oral health assess-
ment due to medical exclusions or incomplete examinations, while
other 1,070 were identified as edentulous. The periodontal exami-
nation was then carried out in the remaining 10,683 participants,
but mid-buccal gingival recession was not assessed in 7 of them.
Consequently, the present study included a total of 10,676 partici-
pants, representing a weighted population of approximately 143.8
million civilian non-institutionalized American adults, 30 years. of
age and older.

1186 | ROMANDINI et al.
3.1 | Prevalence and severity of mid-buccal
gingival recessions
At subject level, the prevalence of mid-buccal gingival recession (all
types) was 91.6%, while it decreased to 70.7% when considering
only the aesthetic zone (Table 1). The prevalence of GR according
to the types defined in the 2018 classification system is reported in
Table 2. When focusing on RT1 gingival recessions (Table S1), the
prevalence (whole mouth) was 12.4%, while it was 5.8% consider-
ing only the aesthetic zone. The majority of RT1 gingival recessions
were mild (1–2 mm), being the prevalence of RT1 ≧3 mm 1.1%,
while very few RT1 GR ≥5 mm were identified. RT2 and RT3 GRs
affected, respectively, 88.8% and 55.0% of the population (Table S2
and S3). Multiple gingival recessions affected 71.7% of the adults
(Table 1), although the prevalence of multiple RT1 was only 3.1%
(Table S1). At tooth level (Table 3), the prevalence of mid-buccal
gingival recessions was 33.8%, most of them being RT2 (prevalence
of RT2: 24.5%). RT1 GRs affected only 0.9% of the teeth (Figure 1).
3.2 | Extent of mid-buccal gingival recession
At subject level, 77.9% of the subjects with GR had generalized GRs,
while 8.7% of the subjects with RT1 GRs had generalized RT1 GRs.
The mean percentage of teeth involved in subjects with GR was
37.4%. When focusing only on RT1, the mean percentage of teeth
involved in subjects with RT1 GRs was 7.5%.
3.3 | Risk indicators for gingival recessions
The survey-adjusted multivariate regression model for RT1 GRs is
presented in Table 4. Age, gender, ethnicity and last dental visit were
associated with the presence of RT1 GR. Indeed, RT1 GRs were
more frequent in 35- to 49-year-old subjects (versus 30–34 years:
OR = 1.61; 95% CI: 1.07–2.43; p < .05), in females (OR = 1.75; 95%
CI: 1.27–2.40; p = .001) and in people who received last dental visit
more than 6 months before (OR = 1.47; 95% CI: 1.15–1.89; p < .01).
Moreover, the following ethnicities had increased odds to have RT1
GRs than non–Hispanic Black: non–Hispanic White (OR = 3.43;
95% CI: 1.95–6.04; p < .001), Mexican American (OR = 2.34; 95%
CI: 1.06–5.15; p < .05) and other (OR = 3.28; 95% CI: 1.81–5.94;
p < .001).
The multilevel analysis (Table 5) confirmed 3 of the 4 subject-level
indicators (age was not significant anymore) and further identified two
site-specific factors associated with RT1 GR: the tooth type and the arch.
RT1 GRs were more frequent in incisors (OR = 26.32; 95% CI: 14.97–
46.29; p < .001), canines (OR = 6.33; 95% CI: 3.37–11.87; p < .001) and
premolars (OR = 11.62; 95% CI: 6.54–20.64; p < .001) than in molars,
and in the mandible (OR = 3.01; 95% CI: 2.43–3.72; p < .001).
The survey-adjusted multivariate regression model and the mul-
tilevel analyses for all types, RT2 and RT3 GRs in subjects without
periodontitis are reported in Tables S4-S9.
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4 | D I S CU S S I O N
This investigation has shown that mid-buccal gingival recessions are
widely prevalent in the general adult population in the USA (>90%).
However, when focusing on RT1 gingival recessions, the prevalence
is lower (12.4%). The decrease in prevalence of RT1 gingival reces-
sions, with increasing age, in males, in some ethnicities, in low so-
cio-economic categories and in smokers is likely to be due to the
increasing prevalence of periodontitis in such subpopulations (Eke,
Dye, et al., 2012).
Most RT1 gingival recessions are mild (1–2 mm) and have the
tendency to affect more than one tooth, although generalized RT1
gingival recessions are not a common finding. Multiple RT1 gingival
recessions affect 3.1% of the population. Age, gender, ethnicity and
dental care exposure were identified as subject-level risk indicators
of RT1 gingival recessions in subjects without periodontitis, while
tooth type and arch (mandible) were identified as tooth-level risk in-
dicators. Some of these findings could be interpreted as a possible
indirect confirmation of the role of the periodontal phenotype as
a risk indicator for GRs, as a thin periodontal phenotype has been
previously related to the female gender and to mandibular teeth
(Eger, Muller, & Heinecke, 1996; Vandana & Savitha, 2005). In regard
to RT2 and RT3 GRs in subjects without periodontitis, they were
mostly associated with the same risk indicators of periodontitis. This
is not an unexpected finding, being these gingival recessions associ-
ated with loss of attachment.
Other published population-based studies using a FMPE
protocol have reported prevalence data in agreement with the
results reported in this investigation (Rios et al., 2014; Sarfati,
Bourgeois, Katsahian, Mora, & Bouchard, 2010; Serrano, Suarez,
& Uzaheta, 2018; Susin, Haas, Oppermann, Haugejorden, &
Albandar, 2004). Sarfati et al. (2010) reported a subject-level
prevalence of mid-buccal (all types) GRs of 84.6%. Most of
the participants had more than 1 GRs (74.3%) and 76.9% had
the deepest GR between 1 and 3 mm. Serrano et al. (Serrano
et al., 2018) did not distinguish between mid-buccal and oth-
er-buccal sites, but their data are likely to be assimilable to
mid-buccal estimates for all-type GRs in this manuscript. They
reported a prevalence of buccal GRs of 69.7%, again in the ma-
jority of cases between 1–3 mm in severity. The epidemiologi-
cal surveys performed in Porto Alegre (Brazil) (Rios et al., 2014;
Susin et al., 2004) presented the most similar findings in terms of
prevalence and extent of GR to the ones reported in this investi-
gation. While Rios et al. (2014) reported a prevalence of 93.1%,
Susin et al. (2004) observed a prevalence over 95.7% among sub-
jects 30 years or older. The observed slight differences could
be easily explained due to the different sampling procedures
(e.g. age limits) and to the different geographical source of the
samples. Conversely, previous studies on representative sam-
ples of the U.S. population reported lower prevalence of gingival
recession (42%–58%), which may be the direct consequence of
the partial-mouth periodontal examination protocol employed
(Albandar & Kingman, 1999; Brown, 1994).
 1600051x, 2020, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13353 by Spanish Cochrane National Provision (Ministerio de Sanidad), Wiley Online Library on [26/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
ROMANDINI et al. | 1187

TA B L E 4 Survey-adjusted multivariate logistic regression (participant-level) for risk indicators for RT1 gingival recessions in participants
without periodontitis

Univariate models Intermediate model Final model

Variable OR 95% CI p-value OR 95% CI p-value OR 95% CI p-value

Age
30–34 Ref Ref Ref Ref Ref Ref Ref Ref Ref
35–49 1.28 0.99–1.63 .054 1.66 1.16–2.37 .007 1.61 1.07–2.43 .023
50–64 1.14 0.82–1.58 .421 1.44 0.87–2.15 .107 1.45 0.92–2.28 .101
65+ 0.68 0.47– 0.99 .043 1.37 0.71–2.64 .330 1.21 0.69–2.14 .495
Gender
Male Ref Ref Ref Ref Ref Ref Ref Ref Ref
Female 1.51 1.26–1.80 <.001 1.79 1.28–2.48 .001 1.75 1.27–2.40 .001
Ethnicity
Non–Hispanic Black Ref Ref Ref Ref Ref Ref Ref Ref Ref
Non–Hispanic White 3.37 2.40–4.72 <.001 3.20 1.79–5.50 <.001 3.43 1.95–6.04 <.001
Mexican American 2.27 1.46–3.51 <.001 2.10 0.84–5.24 .107 2.34 1.06–5.15 .035
Other Ethnicity 2.81 1.91–4.16 <.001 3.14 1.68–5.87 .001 3.28 1.81–5.94 <.001
Educational level
<High school Ref Ref Ref Ref Ref Ref
High school 0.84 0.54–1.29 .419 1.01 0.51–2.03 .946
>High school 1.23 0.95–1.61 .118 1.00 0.59–1.69 .987
Marital status
Married Ref Ref Ref Ref Ref Ref
Widowed 0.84 0.52–1.36 .481 0.87 0.29– 2.62 .806
Divorced 0.78 0.58–1.03 .087 0.78 0.49–1.24 .285
Separated 0.75 0.38–1.48 .403 0.81 0.30– 2.23 .687
Never Married 0.74 0.51–1.08 .123 1.17 0.67–2.03 .566
Living with partner 0.72 0.41–1.26 .254 1.08 0.48–2.42 .829
Family poverty level (FPL)
<100% FPL Ref Ref Ref Ref Ref Ref
100%–199% FPL 1.05 0.70–1.58 .794 0.77 0.42–1.41 .402
200%–400% FPL 1.46 1.03–2.06 .035 1.00 0.61–1.65 .979
≧400% FPL 1.60 1.15–2.22 .007 1.13 0.64–1.96 .655
Smoking status
Current smoker Ref Ref Ref
Former smoker 0.94 0.63–1.41 .770
Non-smoker 1.17 0.82–1.68 .367
Frequency of inter-proximal flossing/device
0 days/wk Ref Ref Ref
1–6 days/wk 1.60 0.90–1.49 .240
7 days/wk 1.17 0.89–1.52 .245
Last dental visit
6 months or less Ref Ref Ref Ref Ref Ref Ref Ref Ref
More than 6 months 1.58 1.23–2.02 .001 1.36 1.05–1.77 .020 1.47 1.15–1.89 .004

Note: Intermediate model included age, gender, ethnicity, educational level, marital status, family poverty level (FPL) and last dental visit. Final model
included age, gender, ethnicity and last dental visit.
Abbreviations: CI, confidence interval; OR, odds ratio; Ref., reference category.
 1600051x, 2020, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13353 by Spanish Cochrane National Provision (Ministerio de Sanidad), Wiley Online Library on [26/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1188 | ROMANDINI et al.

TA B L E 5 Multilevel multivariate
Empty model Final model
logistic regression (participant level and
Variable OR 95% CI OR 95% CI p-value tooth level) for risk indicators for RT1
gingival recessions in participants without
Fixed part periodontitis (not survey-adjusted)
Intercept 0.00 0.00–0.00 0.00 0.00–0.00 <.001
Tooth type
Molar Ref Ref Ref
Incisor 26.32 14.97–46.29 <.001
Canine 6.33 3.37–11.87 <.001
Premolar 11.62 6.54–20.64 <.001
Arch
Maxilla Ref Ref Ref
Mandible 3.01 2.43–3.72 <.001
Gender
Male Ref Ref Ref
Female 1.78 1.30–2.43 <.001
Ethnicity
Non– Ref Ref Ref
Hispanic
Black
Non– 3.84 2.26–6.57 <.001
Hispanic
White
Mexican 2.49 1.24–5.01 <.001
American
Other 4.27 2.44–7.49 <.001
Ethnicity
Last dental visit
6 months Ref Ref Ref
or less
More than 1.51 1.21–2.05 <.001
6 months
Random part
Participant 4.96 4.35–5.68 4.10 3.31–5.08
variance
AIC 14,451.45 5,065.279

Abbreviations: AIC, Akaike's information criterion; CI, confidence interval; OR, odds ratio; Ref.,
reference category.

However, in all these studies, the different recession types
(i.e. RT1, RT2 and RT3) were not identified, nor a focus on the
aesthetic zone was done, what prevents a thorough comparison
with the results reported in this investigation. The only exception
is represented by Sarfati et al. (2010) which reported that the ma-
jority of the GRs in their sample were represented by Miller class
I and class II. Despite Miller class I and class II may correspond in
some cases to RT1 GRs, a direct comparison of this finding is not
possible since RT2 GRs, which represent the majority of GRs in the
present sample, may potentially correspond with different Miller
classes.
In the aforementioned studies, no risk indicator analysis was
reported for RT1 GRs alone, with the results of the present study
showing that the risk assessment for all RTs together may hamper
the true identification of the specific risk indicators for RT1 GRs.
Indeed, merging RT1 GRs with GRs associated with attachment loss
(the majority of GRs according to our data) resulted in the present
study in the identification as risk indicators of common risk indica-
tors for periodontitis, which were not the same ones specifically as-
sociated with mid-buccal RT1 GRs.
The results of this investigation are relevant, due to the lack of
similar national representative epidemiological studies reporting the
prevalence of mid-buccal gingival recessions according to the 2018
classification system and to the power of the sample size provided
with the combination of NHANES data from 6 years. Furthermore,
these results are timely, since the advent of the new classification

ROMANDINI et al.
system (Caton et al., 2018) has allowed us to report mid-buccal GR
in the different categories (RT1, RT2, RT3) and to stratify in those
having aesthetic relevance. In addition, the large sample size allowed
us to study risk indicators of RT1 gingival recessions both at subject
level and at tooth level. This investigation, however, has some lim-
itations, mainly related to the risk indicators analyses since a high
amount of residual participant variance was detected in the final
multivariate models. This might be due to the impossibility of analys-
ing some key variables (as not collected in NHANES) that have been
identified as risk factors in the aetiology of mid-buccal RT1 GR (e.g.
trauma, periodontal phenotype, tooth malposition). Additionally,
the nature of the cross-sectional design prevents the evaluation
of a possible temporal relationship between any of the identified
risk indicators and the development/progression of RT1 gingival
recessions. Finally, our results are generalizable only to the non-in-
stitutionalized U.S. population, what limits their external validity. A
different prevalence, severity and extent, as well as different risk in-
dicators could occur in other populations characterized by different
socio-cultural features.
In conclusion, in this national representative sample of US
non-institutionalized adults, mid-buccal gingival recessions affect
almost the entire population. When focusing on mid-buccal RT1 gin-
gival recessions, its prevalence is reduced to 12.4%. These types of
recessions are usually mild (1–2 mm), and in 3.1% of the subjects,
they occur as multiple GRs on adjacent teeth. Age, gender, ethnicity,
dental care exposure, tooth types and arch were identified as risk in-
dicators for RT1 GRs, while the risk indicators of the RT2/RT3 ones
were mostly the same ones of periodontitis. The generalizability of
these results should be verified in other populations, and well-de-
signed prospective cohort studies are needed to verify the tempo-
rality of the association between the identified risk indicators and
other factors potentially associated with the onset/progression of
RT1 mid-buccal gingival recessions.
AC K N OW L E D G E M E N T S
The authors wish to kindly thank the CDC for providing the data
for this study, the CDC/AAP Periodontal Disease Surveillance
Workgroup for inspiring such detailed periodontal examination and
all the data collectors for their precious work.
C O N FL I C T O F I N T E R E S T
The authors declare no conflicts of interest related to this study.
This study was self-funded by the authors; however, the data of
the NHANES 2009–2014 have been provided from the Center for
Disease Control and Prevention (CDC).
ORCID
Mario Romandini https://orcid.org/0000-0001-5646-083X
REFERENCES
Albandar, J. M., & Kingman, A. (1999). Gingival recession, gingival bleed-
ing, and dental calculus in adults 30 years of age and older in the
1600051x, 2020, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13353 by Spanish Cochrane National Provision (Ministerio de Sanidad), Wiley Online Library on [26/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
| 1189
United States, 1988–1994. Journal of Periodontology, 70(1), 30–43.
https://doi.org/10.1902/jop.1999.70.1.30
Barootchi, S., Tavelli, L., Di Gianfilippo, R., Byun, H.-Y., Oh, T.-J., Barbato,
L., … Wang, H.-L. (2019). Long term assessment of root coverage
stability using connective tissue graft with or without an epithelial
collar for gingival recession treatment. A 12-year follow-up from a
randomized clinical trial. Journal of Clinical Periodontology, 46(11),
1124–1133. https://doi.org/10.1111/jcpe.13187
Bignozzi, I., Crea, A., Capri, D., Littarru, C., Lajolo, C., & Tatakis, D. N.
(2014). Root caries: A periodontal perspective. Journal of Periodontal
Research, 49(2), 143–163. https://doi.org/10.1111/jre.12094
Brown, L. F., Beck, J. D., & Rozier, R. G. (1994). Incidence of attachment loss
in community-dwelling older adults. Journal Periodontology, 65, 1–8.
Cairo, F., Cortellini, P., Tonetti, M., Nieri, M., Mervelt, J., Cincinelli, S.,
& Pini Prato, G. (2012). Coronally advanced flap with and without
connective tissue graft for the treatment of single maxillary gingival
recession with loss of inter-dental attachment. A randomized con-
trolled clinical trial. Journal of Clinical Periodontology, 39(8), 760–768.
https://doi.org/10.1111/j.1600-051X.2012.01903.x
Cairo, F., Cortellini, P., Tonetti, M., Nieri, M., Mervelt, J., Pagavino, G., &
Pini-Prato, G. P. (2015). Stability of root coverage outcomes at sin-
gle maxillary gingival recession with loss of interdental attachment:
3-year extension results from a randomized, controlled, clinical
trial. Journal of Clinical Periodontology, 42(6), 575–581. https://doi.
org/10.1111/jcpe.12412
Cairo, F., Nieri, M., Cincinelli, S., Mervelt, J., & Pagliaro, U. (2011). The
interproximal clinical attachment level to classify gingival recessions
and predict root coverage outcomes: An explorative and reliability
study. Journal of Clinical Periodontology, 38(7), 661–666. https://doi.
org/10.1111/j.1600-051X.2011.01732.x
Cairo, F., Nieri, M., & Pagliaro, U. (2014). Efficacy of periodontal plas-
tic surgery procedures in the treatment of localized facial gingival
recessions. A Systematic Review, 41(Suppl 15), S44–S62. https://doi.
org/10.1111/jcpe.12182
Caton, J. G., Armitage, G., Berglundh, T., Chapple, I. L. C., Jepsen,
S., Kornman, K. S., … Tonetti, M. S. (2018). A new classification
scheme for periodontal and peri-implant diseases and conditions -
Introduction and key changes from the 1999 classification. Journal of
Clinical Periodontology, 45(Suppl 20), S1–S8. https://doi.org/10.1111/
jcpe.12935
Cortellini, P., & Bissada, N. F. (2018). Mucogingival conditions in the
natural dentition: Narrative review, case definitions, and diagnostic
considerations. Journal of Periodontology, 89(Suppl 1), S204–S213.
https://doi.org/10.1002/JPER.16-0671
Cortellini, P., Tonetti, M., Baldi, C., Francetti, L., Rasperini, G.,
Rotundo, R., … Pini Prato, G. (2009). Does placement of a con-
nective tissue graft improve the outcomes of coronally ad-
vanced flap for coverage of single gingival recessions in upper
anterior teeth? A multi-centre, randomized, double-blind, clinical
trial. Journal of Clinical Periodontology, 36(1), 68–79. https://doi.
org/10.1111/j.1600-051X.2008.01346.x
Dye, B. A., Li, X., Lewis, B. G., Iafolla, T., Beltran-Aguilar, E. D., & Eke, P.
I. (2014). Overview and quality assurance for the oral health com-
ponent of the National Health and Nutrition Examination Survey
(NHANES), 2009–2010. Journal of Public Health Dentistry, 74(3), 248–
256. https://doi.org/10.1111/jphd.12056
Eger, T., Muller, H. P., & Heinecke, A. (1996). Ultrasonic determination of
gingival thickness. Subject variation and influence of tooth type and
clinical features. Journal of Clinical Periodontology, 23(9), 839–845.
https://doi.org/10.1111/j.1600-051x.1996.tb006​21.x
Eke, P. I., Dye, B. A., Wei, L., Thornton-Evans, G. O., & Genco, R. J. (2012).
Prevalence of periodontitis in adults in the United States: 2009
and 2010. Journal of Dental Research, 91(10), 914–920. https://doi.
org/10.1177/00220​3 4512​457373

1190 | ROMANDINI et al.
Eke, P. I., Page, R. C., Wei, L., Thornton-Evans, G., & Genco, R. J. (2012).
Update of the case definitions for population-based surveillance of
periodontitis. Journal of Periodontology, 83(12), 1449–1454. https://
doi.org/10.1902/jop.2012.110664
Jepsen, S., Caton, J. G., Albandar, J. M., Bissada, N. F., Bouchard, P.,
Cortellini, P., … Yamazaki, K. (2018). Periodontal manifestations
of systemic diseases and developmental and acquired conditions:
Consensus report of workgroup 3 of the 2017 World Workshop
on the Classification of Periodontal and Peri-Implant Diseases and
Conditions. Journal of Clinical Periodontology, 45(Suppl 20), S219–S229.
https://doi.org/10.1111/jcpe.12951
Nieri, M., Pini Prato, G. P., Giani, M., Magnani, N., Pagliaro, U., & Rotundo,
R. (2013). Patient perceptions of buccal gingival recessions and re-
quests for treatment. Journal of Clinical Periodontology, 40(7), 707–
712. https://doi.org/10.1111/jcpe.12114
Prato, G. P. P., Rotundo, R., Cortellini, P., Tinti, C., & Azzi, R. (2004).
Interdental papilla management: A review and classification of the
therapeutic approaches. The Journal of Prosthetic Dentistry, 24(3),
246–255. https://doi.org/10.1016/j.prosd​ent.2004.07.002
Rasperini, G., Acunzo, R., Pellegrini, G., Pagni, G., Tonetti, M., Pini Prato,
G. P., & Cortellini, P. (2018). Predictor factors for long-term outcomes
stability of coronally advanced flap with or without connective tissue
graft in the treatment of single maxillary gingival recessions: 9 years
results of a randomized controlled clinical trial. Journal of Clinical
Periodontology, 45(9), 1107–1117. https://doi.org/10.1111/jcpe.12932
Rasperini, G., Codari, M., Paroni, L., Aslan, S., Limiroli, E., Solís-Moreno,
C., … Acunzo, R. (2020). The influence of gingival phenotype on the
outcomes of coronally advanced flap: A prospective multicenter
study. The International Journal of Periodontics & Restorative Dentistry,
40(1), e27–e34. https://doi.org/10.11607/​prd.4272
Rasperini, G., Roccuzzo, M., Francetti, L., Acunzo, R., Consonni, D., &
Silvestri, M. (2011). Subepithelial connective tissue graft for treat-
ment of gingival recessions with and without enamel matrix derivative:
A multicenter, randomized controlled clinical trial. The International
Journal of Periodontics & Restorative Dentistry, 31(2), 133–139.
Rios, F. S., Costa, R. S. A., Moura, M. S., Jardim, J. J., Maltz, M., & Haas,
A. N. (2014). Estimates and multivariable risk assessment of gingi-
val recession in the population of adults from Porto Alegre, Brazil.
Journal of Clinical Periodontology, 41(11), 1098–1107. https://doi.
org/10.1111/jcpe.12303
Sanz, M., & Simion, M. (2014). Surgical techniques on periodontal plastic sur-
gery and soft tissue regeneration: Consensus report of Group 3 of the 10th
European Workshop on Periodontology. Journal of Clinical Periodontology,
41(Suppl 15), S92–S97. https://doi.org/10.1111/jcpe.12215
Sarfati, A., Bourgeois, D., Katsahian, S., Mora, F., & Bouchard, P. (2010).
Risk assessment for buccal gingival recession defects in an adult
population. Journal of Periodontology, 81(10), 1419–1425. https://doi.
org/10.1902/jop.2010.100102
Serrano, C., Suarez, E., & Uzaheta, A. (2018). Prevalence and extent of
gingival recession in a national sample of colombian adults. Journal of
the International Academy of Periodontology, 20(3), 94–101.
Susin, C., Haas, A. N., Oppermann, R. V., Haugejorden, O., & Albandar, J.
M. (2004). Gingival recession: Epidemiology and risk indicators in a
representative urban Brazilian population. Journal of Periodontology,
75(10), 1377–1386. https://doi.org/10.1902/jop.2004.75.10.1377
Tatakis, D. N., Chambrone, L., Allen, E. P., Langer, B., McGuire, M. K.,
Richardson, C. R., … Zadeh, H. H. (2015). Periodontal soft tis-
sue root coverage procedures: A consensus report from the AAP
Regeneration Workshop. Journal of Periodontology, 86(2 Suppl), S52–
S55. https://doi.org/10.1902/jop.2015.140376
Tavelli, L., Barootchi, S., Cairo, F., Rasperini, G., Shedden, K., & Wang, H.
L. (2019a). The effect of time on root coverage outcomes: A network
meta-analysis. Journal of Dental Research, 98(11), 1195–1203. https://
doi.org/10.1177/00220​3 4519​867071
1600051x, 2020, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13353 by Spanish Cochrane National Provision (Ministerio de Sanidad), Wiley Online Library on [26/02/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Tavelli, L., Barootchi, S., Di Gianfilippo, R., Modarressi, M., Cairo, F.,
Rasperini, G., & Wang, H.-L. (2019b). Acellular dermal matrix and cor-
onally advanced flap or tunnel technique in the treatment of multiple
adjacent gingival recessions. A 12-year follow-up from a randomized
clinical trial. Journal of Clinical Periodontology, 46(9), 937–948. https://
doi.org/10.1111/jcpe.13163
Tavelli, L., Barootchi, S., Nguyen, T. V. N., Tattan, M., Ravidà, A., & Wang,
H.-L. (2018). Efficacy of tunnel technique in the treatment of local-
ized and multiple gingival recessions: A systematic review and me-
ta-analysis. Journal of Periodontology, 89(9), 1075–1090. https://doi.
org/10.1002/JPER.18-0066
Tonetti, M. S., & Jepsen, S. (2014). Clinical efficacy of periodontal
plastic surgery procedures: Consensus report of Group 2 of the
10th European Workshop on Periodontology. Journal of Clinical
Periodontology, 41(Suppl 15), S36–S43. https://doi.org/10.1111/
jcpe.12219
Tugnait, A., & Clerehugh, V. (2001). Gingival recession-its significance
and management. Journal of Dentistry, 29(6), 381–394. https://doi.
org/10.1016/s0300-5712(01)00035-5
Vandana, K. L., & Savitha, B. (2005). Thickness of gingiva in association with
age, gender and dental arch location. Journal of Clinical Periodontology,
32(7), 828–830. https://doi.org/10.1111/j.1600-051X.2005.00757.x
Vignoletti, F., Di Domenico, G. L., Di Martino, M., Montero, E., & De
Sanctis, M. (2019). Prevalence and risk indicators of peri-implantitis
in a sample of university-based dental patients in Italy: A cross-sec-
tional study. Journal of Clinical Periodontology, 46(5), 597–605. https://
doi.org/10.1111/jcpe.13111
Vignoletti, F., Di Martino, M., Clementini, M., Di Domenico, G. L., & De
Sanctis, M. (2020). Prevalence and risk indicators of gingival reces-
sions in an Italian school of dentistry and dental hygiene: A cross-sec-
tional study. Clinical Oral Investigations, 24(2), 991–1000. https://doi.
org/10.1007/s00784-019-02996-9
Zucchelli, G., Mele, M., Stefanini, M., Mazzotti, C., Mounssif, I., Marzadori,
M., & Montebugnoli, L. (2010). Predetermination of root coverage.
Journal of Periodontology, 81(7), 1019–1026. https://doi.org/10.1902/
jop.2010.090701
Zucchelli, G., & Mounssif, I. (2015). Periodontal plastic surgery.
Periodontology 2000, 68(1), 333–368. https://doi.org/10.1111/
prd.12059
Zucchelli, G., Tavelli, L., Barootchi, S., Stefanini, M., Rasperini, G., Valles, C.,
… Wang, H.-L. (2019). The influence of tooth location on the outcomes
of multiple adjacent gingival recessions treated with coronally ad-
vanced flap: A multicenter re-analysis study. Journal of Periodontology,
90(11), 1244–1251. https://doi.org/10.1002/JPER.18-0732
Zucchelli, G., Tavelli, L., Ravidà, A., Stefanini, M., Suárez-López Del Amo,
F., & Wang, H.-L. (2018). Influence of tooth location on coronally ad-
vanced flap procedures for root coverage. Journal of Periodontology,
89(12), 1428–1441. https://doi.org/10.1002/JPER.18-0201
S U P P O R T I N G I N FO R M AT I O N
Additional supporting information may be found online in the
Supporting Information section.
How to cite this article: Romandini M, Soldini MC, Montero
E, Sanz M. Epidemiology of mid-buccal gingival recessions in
NHANES according to the 2018 World Workshop
Classification System. J Clin Periodontol. 2020;47:1180–1190.
https://doi.org/10.1111/jcpe.13353