Improper Classification of Marginal Tissue Recession- the first step in predicting the degree of root coverage is to classify the recession
Inadequate Root Planing- Flattening the root in the area of the CEJ so the margin of the graft can be butted against the CEJ. To reduce the convexity of the root and concomitantly minimize the mesiodistal dimension of the root.
Failure to Treat the Planed Root with Citric Acid- The necessity of burnishing or rubbing the roots with citric acid in naturally occurring periodontal disease is graphically demonstrated. It is important to complete citric acid conditioning before preparing the recipient site, since citric acid causes coagulation of blood.
Improper Preparation of the Recipient Site- the horizontal incision must be made at the level of the CEJ. Care should be taken to create a butt-joint margin in the papilla with a horizontal incision rather than with a beveled margin. Vertical incision are at the line angles of the adjacent teeth to provide a complete interdental papilla for suturing. The recipient site should be prepared a minimum of 3 mm apical to the recession. If the papilla are small, the ratio of vascular to avascular surface can be increased by extending the graft more apical.
Inadequate Size of Interdental Papillae- Conversely, thin, narrow papilla offer less blood supply and make suturing difficult.
Improper Prepared Donor Tissue- The underlying of the graft should be flat and smooth with the graft having the same type of butt-joint margins as those created in the papilla.
Inadequate Graft Size- In areas of multiple recessions or on prominent roots(canines) it is best to take additional length M-D for in suturing the root adaptation.
Inadequate Graft Thickness- An adequate graft thickness is best obtained by leaving a very thin layer of submucosa on the underside of the graft where possible.
Dehydration of Grafts- It is not necessary to leave the graft out of the mouth for more than 2 minutes. The graft should be placed immediately on the moderately bleeding recipient site.
Inadequate Adaptation of Graft to Root and Remaining Periosteal Bed- recommend individual sutures into each papilla to approximate the butt-joint margin. and two apical sutures into the periosteum that were angled distally rather than apical.
Failure to Stabilize the Graft- adequate suturing is the primary importance.
Excess or Prolonged Pressure in Coaptation of Sutured Graft- the pressure applied may compromise the necessary blood flow to the graft. a moderate bleeding surface may actually enhance circulation.
Reduction of Inflammation Prior to Grafting- to reduce inflammation is not suggested in root coverage.
Trauma to the graft-, loose dressing, incising food, a blow to the lips, stretching or manipulating of the lips, excessive edema. dressing for 2 weeks.
Excessive Smoking- of 10 cigarettes/day, refrain for 2 weeks
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