Which procedure is considered the gold standard for treating root surface exposure?

The sub-epithelial tissue graft is recognized as the gold standard for treating root surface exposure because it effectively enhances the coverage of exposed root surfaces while promoting soft tissue quality and resilience. This procedure involves harvesting a graft from the palate's connective tissue, which is placed underneath a flap of tissue at the site of recession. The benefits of this approach include improved aesthetics, greater retention of the graft, and the potential for better integration with the surrounding tissues.

Additionally, it contributes to the preservation of papillary height and volume, which can significantly enhance the overall appearance of the gum line and reduce sensitivity associated with root exposure. This technique is particularly effective in cases where the patient desires both functional and cosmetic improvements.

While other options like the free gingival graft can be used for root coverage, they may not provide the same aesthetic outcomes or tissue quality as the sub-epithelial tissue graft. The split thickness flap and apically positioned flap are surgical techniques that may assist in the overall management of periodontal conditions but do not specifically address root surface exposure in terms of graft quality and cosmetic results.