OPEN

ACCESS Freely Available Online

Copyright: 2010 Mahajan A. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
doi:10.5436/j.dehy.2010.1.0009







Mahajan's Modification of the Millers Classification
for Gingival Recession

Ajay Mahajan
a








a
Department of Periodontics, Himachal
Pradesh Government Dental College
and Hospital (H.P.G.D.C.), Shimla-H.P,
India.



Correspondence to:
Department of Periodontics, Himachal
Pradesh Government Dental College
and Hospital, Showdown, Shimla-
171001.
Tel.: + 9418017029
julius05@redimail.com



Received: April 15, 2010
Accepted: June 31, 2010
Published: August 5, 2010









Abstract
Introduction: Miller has primarily based his classification of gingival
recession defects on two aspects: Extent of gingival recession de-
fects and Extent of hard and soft tissue loss in interdental areas sur-
rounding the gingival recession defects. Based on the above criteria
Miller classified the gingival recession defects into four classes and
also took prognosis into account. The prognosis decreases from
class 1 to class 4 and the treatment options are also limited from
class 1 having maximum treatment options and class 4 having mini-
mum options for treatment.
The hypothesis: At first glance classification looks comprehensive
and simple to use but close screening points out some of the inhe-
rent drawbacks associated in this classification system. Since the
ultimate goal of any classification system is to facilitate common
standardized identification of the condition under consideration, aid
in diagnosis and prognosis and thus finalizing an appropriate treat-
ment plan for the condition; the present manuscript is an attempt to
emphasize the need to modify Millers classification to make it more
comprehensive and updated according to the recent concepts.
Evaluation of the hypothesis: The hypothesis highlights some in-
herent drawbacks and necessary changes in Millers Classification
system and emphasizes the need to update it.

Key words: Millers classification, Gingival Recession, Periodontal
Diseases.
Original Hypothesis
Mahajan A Mahajan's modification of the millers classification






46 Vol 1, No 2, 2010 http://www.dentalhypotheses.com







D
e
n
t
a
l


H
y
p
o
t
h
e
s
e
s


Introduction
There have been several attempts to clas-
sify the gingival recession defects (GRD)
[1-4]. Among all the classifications the
classifications given by P.D. Miller is still
the most widely used [5]. Miller has pri-
marily based his classification of gingival
recession defects on two aspects:
a) Extent of gingival recession defects.
b) Extent of hard and soft tissue loss in in-
terdental areas surrounding the gingiv-
al recession defects.
Based on the above criteria Miller clas-
sified the gingival recession defects into
four classes and also took prognosis into
account (Table 1). Since no classification
system is complete until it is updated reg-
ularly especially in the light of recent in-
novations and advancements. The aim of
this article is to highlight some of the
drawbacks associated with the current
system of Millers classification and sug-
gest some improvements in the present
system and to device a more complete
classification system in future.

The hypothesis
At first glance the classification given by
Miller around two decades back looks
comprehensive and simple to use but
close screening points out some of the in-
herent drawbacks associated in this classi-
fication system:
In which class one would place the de-
fect if gingival recession defect doesnt
extend to mucogingival junction (MGJ)
but there is associated hard and soft tis-
sue loss in the inter dental areas adja-
cent to the defects, Class I or Class IV
(Figure1)? (As per Miler classification
class IV extends up to or beyond the
mucogingival junction, there is severe
loss of bone /soft tissue in the inter
dental area or rotated tooth.) Same is
the dilemma between Class I and Class
III .
Class III or Class IV(Subjective cri-
teria) - The difference between Clas-
sIII and IV lies only in the extent of
the severity of the gingival recession
defects. The classification system
doesnt mention any objective crite-
ria to assess the severity of bone /
soft tissue loss.
Prognosis: Characteristics of gingival
recession defects are not the sole cri-
teria for determination of prognosis,
two subjects in same class may have
different prognosis as described later
in the article.

However, in view of the above facts,
the following modifications are sug-
gested:
The emphasis on the extent of gin-
gival recession defect in relation to
mucogingival junction should be se-
parated from the criteria of bone
/soft tissue loss in interdental areas.
Objective criteria should be included
to differentiate between the severity
of bone /soft tissue loss in class III
and class IV, as used in some of the
other classifications [6].
Prognosis assessment must include
the profile of the gingiva as recent
studies have shown that gingival
thickness is an important criteria
Mahajan A Mahajan's modification of the millers classification






47 Vol 1, No 2, 2010 http://www.dentalhypotheses.com







D
e
n
t
a
l


H
y
p
o
t
h
e
s
e
s



Table 1. Millers classification of gingival recession defects.

Symptoms Treatment Success

Class I Recession that does not extend to the mucogin-
gival junction

Complete root coverage is
achievable
100%
Class II Recession that extends to or beyond the muco-
gingival junction, with no periodontal attach-
ment loss (i.e bone, soft tissue)

Complete root coverage is
achievable
100%
Class III Recession that extends to or beyond the muco-
gingival junction, with periodontal attachment
loss in the interdental area or malpositioning of
the teeth

Only partial root coverage
possible to the height of the
contour of interproximal tis-
sue
50-70%
Class IV Recession that extends to or beyond the muco-
gingival junction, with severe bone or soft-tissue
loss in the interdental area and/or severe mal-
positioning of the teeth

Root coverage is unpredicta-
ble and requires adjunctive
treatment (ie orthodontics)
<10%

affecting long term prognosis of treated
gingival recession defects(> 0.8 mm
improves the prognosis) in other words
thick gingival profile favours treatment
outcome and vice versa [7].
Nevertheless, the ultimate goal of any
classification system is to facilitate com-
mon standardized identification of the
condition under consideration, aid in di-
agnosis and prognosis and thus finalizing
an appropriate treatment plan for the
condition; the above mentioned classifica-
tion system is an attempt to emphasize the
need to modify Millers classification to
make it more comprehensive and updated
according to the recent concepts.

Mahajan's modification
An outline of classification system in-
cluding the above mentioned changes is
presented:
Class I: GRD not extending to the MGJ.
Class II: GRD extending to the
MGJ/beyond it.
Class III: GRD with bone or soft-tissue
loss in the interdental area up to cervic-
al 1/3 of the root surface and/or mal-
positioning of the teeth.
Class IV: GRD with severe bone or soft-
tissue loss in the interdental area great-
er than cervical 1/3rd of the root sur-
face and/or severe malpositioning of
the teeth.

Prognosis
BEST: ClassI and Class II with thick
gingival profile.
GOOD: ClassI and ClassII with thin
gingival profile.
FAIR: Class III with thick gingival pro-
file.
POOR: ClassIII and ClassIV with thin
gingival profile.
Thus a subject with similar Millers classi-
fication may have different prognosis de-
pending upon the gingival profile.
Mahajan A Mahajan's modification of the millers classification





48 Vol 1, No 2, 2010 http://www.dentalhypotheses.com






D
e
n
t
a
l


H
y
p
o
t
h
e
s
e
s




Figure 1. Millers class I or class IV/III? Interdental bone and soft tissue loss (a). Gingival recession not ex-
tending to the muco- gingival junction (b). Mucogingival junction (c).


Evaluation of the hypothesis
The hypothesis discusses the Millers clas-
sification and points out at some inherent
limitations associated with it. As every
classification evolves with time the hypo-
thesis stresses upon the fact that Millers
classification should also be updated, if
not completely changed, to cope up with
the advancements in the diagnosis and
treatment plan of gingival recession de-
fects. Although the author has given ideas
to evolve /modify Millers classification
for gingival recession defects, it will take
some time to shift from the widely used
Millers classification system to the one
suggested here until more studies with
proper research methodology are taken
up to support this hypothesis.
List of abbreviations
GRD: Gingival recession defects.
MGJ: Muco-gingival junction.

Conflicts of interests
Mahajan A reports no conflicts of interest
related to this study.

Acknowledgments
I would like to acknowledge the support
of Dr Ashu bhardwaj, Professor and head
of department of Periodontics, Himachal
Pradesh Government Dental College and
Hospital, Shimla, India, for her guidance
and support.


Mahajan A Mahajan's modification of the millers classification






49 Vol 1, No 2, 2010 http://www.dentalhypotheses.com







D
e
n
t
a
l


H
y
p
o
t
h
e
s
e
s


Authors' contributions
Main idea: by AM.
Literature search: by AM.
Data collection: by AM.
Data interpretation: by AM.
Manuscript preparation: by AM.
Funds Collection: N/A.


References
1. Greenwell H, Fiorellini J, Giannobile
W, Offenbacher S, Salkin L, Townsend
C, Sheridan P, Genco R; Research, Science
and Therapy Committee. Oral reconstructive and
corrective procedures used in periodontal therapy. J
Periodontol 2005;7:1588-600.
2. Mlinek A, Smukler H, Buchner A. The use of free
gingival grafts for the coverage of denuded roots. J
Periodontol 1973;44:248-54.
3. Smith RG. Gingival recession: reappraisal of an
enigmatic condition and a new index for monitor-
ing. J Clin Periodontol 1997;24:201-5.
4. Kassab M, Cohen RE .The etiology and prevalence
of gingival recession. J Am Dent As-
soc 2003;134:220-5.
5. Miller PD Jr. A classification of marginal tissue re-
cession. Int J Periodontics Restorative Dent
1985;5:8-13.
6. Nordland WP, Tarnow DP. A classification system
for loss of papillary height. J Periodontol
1998;69:1124-6.
7. Baldi C, Pini-Prato G, Pagliaro U, Nieri M, Saletta
D, Muzzi L, Cortellini P.Coronally advanced flap
procedure for root coverage. Is flap thickness a re-
levant predictor to achieve root coverage? A 19-
case series. J Periodontol 1999;70:1077-84.
































































Mahajan A Mahajan's modification of the millers classification





50 Vol 1, No 2, 2010 http://www.dentalhypotheses.com






D
e
n
t
a
l


H
y
p
o
t
h
e
s
e
s




































Make a new comment on this article via:
www.dentalhypotheses.com/index.php/dhj/comment/add/51/0



Citation: Mahajan A. Mahajan's modification of
the millers classification for gingival recession.
Dent Hypotheses 2010;1:45-50. doi:10.5436/j.dehy.
2010.1.0009.



This journal utilizes the LOCKSS system to create a
distributed archiving system among participating libra-
ries and permits those libraries to create permanent arc-
hives of the journal for purposes of preservation and
restoration.