Gingival Recession Overview

Gingival Recession

• Gingival recession is the displacement of the gingival margin apically to the cemento-enamel junction, exposing the root surface.
• The aim of the study is to provide a comprehensive understanding of the etiology, treatment, and management of patients experiencing gingival recession.
• Intended learning outcomes include explaining the various etiological factors, recognizing the impact on the dental patient, identifying measurement and monitoring techniques, and recognizing treatment modalities.
• The GDC Learning Outcomes for this topic are 1.1.2, 1.1.4, 1.1.8, 1.7.7, 1.10.1, 1.10.2, 1.10.3, 1.10.4, and 1.10.6.

Definition

• Gingival recession is the apical displacement of the gingival margin relative to the cemento-enamel junction (CEJ), leading to root exposure.

Healthy Gingival Tissues

• A healthy mouth features alveolar mucosa, mucogingival junction, attached gingiva, free gingiva, interdental papilla, and stippling.
• Free gingiva combined with attached gingiva form the keratinized tissue (KT).

Clinical Appearance

• Gingival recession can be localized or generalized.
• Localized recession typically affects a single surface of a tooth, often the labial/buccal aspect.
• Generalized recession affects multiple teeth.

Recession (Causes)

• Recession is often confined to a single tooth surface, typically the labial/buccal aspect.
• Recession itself does not usually damage the periodontal support of the tooth.
• The underlying cause of recession needs to be considered.
• Causes are broadly classified as mechanical and inflammatory.

Mechanical Factors

• Toothbrush trauma
• Traumatic incisor relationship
• Trauma from foreign bodies, such as lower lip studs and tongue studs
• Abnormal frenal attachment
• Iatrogenic damage

Toothbrush Trauma

• Prolonged aggressive toothbrushing techniques, often with improper oral hygiene aids, and high pressure are potential causes of recession.
• Examples include inappropriate toothbrush bristles and excessive pressure.

Trauma from Foreign Bodies

• Lower lip studs and tongue studs can lead to trauma and, potentially, recession.

Traumatic Incisal Relationship

• A malocclusion where the lower incisors bite too far palatally onto the upper incisors.

Abnormal Frenal Attachments

• A marked frenal attachment can pull on the gingival tissues apically, and make oral hygiene difficult leading to localized periodontal issues and recession.

Iatrogenic Damage

• Power-driven scalers used in periodontal treatment can cause recession as an unwanted side effect.
• This is a recognised risk so patients need to be informed about this before these procedures.

Inflammatory Factors

• Gingival biotype
• Periodontal disease
• Smoking
• Poor marginal fit of restorations
• Orthodontic tooth movement

Gingival Biotype

• Gingival tissue tends to be delicate and almost translucent in appearance.
• The tissue can appear friable and has a minimal zone of attached gingiva.
• Understanding the different gingival biotypes is important, as thin biotypes are more prone to recession.
• Clinical considerations on root coverage of gingival recession are relevant to the topic.

Periodontal Disease

• Apical migration of the gingival margin is indicative of established periodontal disease.

Smoking

• Smoking significantly impacts periodontal status.
• Smokers are more susceptible to periodontal disease.

Poor Marginal Fit of Restorations

• A poorly fitting restoration can cause low-grade irritation, encroach on the biologic width, and increase the potential for plaque stagnation.
• This can contribute to recession in susceptible patients.

Orthodontic Movement

• Orthodontic tooth movement can result in gingival recession, particularly in patients with thin biotypes.
• This effect is often more pronounced in rapid orthodontic movements in adults.

Impact of Gingival Recession on the Patient

• Dentine hypersensitivity
• Aesthetic concerns
• Root caries
• Food trap/plaque stagnation
• Confidence issues
• Difficulties with speaking
• Comfort concerns (e.g. food trapping), and difficulty eating.

Dentine Hypersensitivity

• Recession exposes the dentine root surface, leading to hypersensitivity.
• Hyperaemia of the pulp can also occur due to root exposure.

Aesthetic Considerations

• Recession can cause poor aesthetics, creating an appearance frequently described as black triangles. (The part of the tooth that is exposed by the receding gum.)

Root Caries

• Exposed root surfaces are less mineralised than enamel and thus more susceptible to root caries.
• The critical pH for enamel is 5.5-6.
• If caries occurs, destruction happens much faster.

Plaque Stagnation and food trapping

• Food and plaque stagnation, especially in the "black triangles" area, can occur due to receding gumline.
• Appropriate oral hygiene advice and aids should be recommended.

Measuring & Monitoring Recession

• Recession is measured from the cemento-enamel junction (CEJ) to the gingival margin.
• A probe, held parallel to the tooth’s long axis and with clear markings, is essential for precise measurements.

Loss of Attachment (LOA)

• LOA is a combined measure of recession and probing depth.
• It may also be known as clinical loss of attachment (CLOA) or clinical attachment loss (CAL)

Recession Management

• Patient education (vital for compliance)
• Monitoring
• Treatment as needed
• Reduction of habitual factors.

Miller's Classification of Recession

• Miller's classification categorizes recession into four classes (I to IV), based on the extent of recession and bone loss.

Treatment Modalities

• Periodontal treatment
• Desensitizing agents
• Gingival veneers
• Composite restorations
• Referral for surgical interventions

Gingival Veneers

• Removable acrylic facings to improve aesthetics in patients with advanced generalized recession.

Restorations

• Composite restorations can cover sensitive, caries-prone exposed dentine, especially in the cervical region.

Gingival Graft Surgery

• This involves complex periodontal surgery procedures to transplant gingival tissue.
• Its use is limited by compliance and difficulty.

Monitoring Gingival Recession

• Recording recession measurements and monitoring response to treatment.
• Referrals are needed when appropriate.

Summary Revision

• Remind yourself of a healthy mouth.
• Discuss the definition of gingival recession.
• Explain how to measure and monitor recession and loss of attachment.
• Identify the mechanical and inflammatory factors associated with gingival recession.
• Explain the impact on the patient due to recession.
• Discuss treatment modalities.

This quiz delves into gingival recession, exploring its definition, causes, and impact on dental health. Participants will learn about measurement techniques and treatment options while covering the GDC Learning Outcomes related to this important topic. Ideal for dental students and professionals seeking to enhance their understanding of gingival specifics.