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 biologic and anatomical factors, and there is no clear guideline on the major or minor determinants that influence surgical decisions. The aim of the present article is to discuss a decision tree to suggest to clinicians the most relevant anatomical factors to consider when evaluating the choice between an MCAT and an MCAF. In the proposed decision-making process, the first crucial step involves the evaluation of the interdental clinical attachment loss 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 the amount of LKT is insufficient, the interdental papillae size, including base, height, and coronal width, must also be evaluated.