Gingival Recession

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 gingival recession in patients.
• Intended learning outcomes include explaining the various etiological factors related to gingival recession, recognizing the oral health consequences of gingival recession on the patient, identifying methods for measuring and monitoring gingival recession, and identifying different treatment approaches for gingival recession.
• GDC learning outcomes 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 are relevant to this topic.

Mechanical Factors

• The mechanical factors associated with gingival recession include toothbrush trauma, traumatic incisor relationship, trauma from foreign bodies, and abnormal frenum attachments.

Toothbrush Trauma

• Prolonged aggressive tooth brushing techniques are a contributing factor.
• Inappropriate oral hygiene aids often combine with this factor.

Trauma from Foreign Bodies

• Examples include lower lip piercings and tongue piercings.

Traumatic Incisor Relationship

• The bite occurs such that the lower incisors impinge on the palatal aspect of the upper incisors.

Abnormal Frenum Attachments

• A tight frenum can produce an apical pull on the gingival tissues.
• This can make oral hygiene challenging and lead to localized periodontal problems and gingival recession.

Inflammatory Factors

• Gingival biotype, periodontal disease, smoking, poor marginal fit of restorations, and orthodontic tooth movement are factors contributing to inflammation and/or gingival recession.

Gingival Biotype

• Gingival tissue often appears delicate and translucent.
• The tissue may be friable with a minimal zone of attached gingiva.

Periodontal Disease

• Apical migration of the gingival margin is a notable sign of periodontal disease.

Smoking

• Smokers are generally more susceptible to periodontal disease.
• Smoking has a profound impact on the periodontal health of a patient and can accelerate gingival recession and worsen outcomes.

Poor Marginal Fit of Restorations

• Low-grade irritation from sub-gingival margins can encroach upon the biological width of the gingival tissues.
• This can potentially lead to plaque stagnation and gingival recession.

Orthodontic Tooth Movement

• Orthodontic movement can cause gingival recession, particularly in patients with a thin gingival biotype, especially during rapid orthodontic treatment.

Impact on the Patient

• Dentine hypersensitivity, aesthetic considerations, root caries, comfort issues such as food trapping, and difficulties speaking are all potential consequences of gingival recession
• Hypersensitivity from exposed root surfaces following recession is a common issue.
• A patient's aesthetics, confidence, and ability to speak may be impaired.

Treatment Modalities

• Treatment may include periodontal treatment, desensitizing agents, gingival veneers, composite restorations, and surgical intervention.

Gingival Veneer

• A removable acrylic facing that enhances aesthetics in patients with significant gingival recession.

Restorations

• Composite restorations are applied to cover sensitive, caries-prone exposed dentine in the cervical areas.

Gingival Graft Surgery

• Complex periodontal surgical procedures can involve transplanting palatal gingival tissue.
• This procedure often has limited compliance and success rates.

Monitoring Gingival Recession

• All points of recession should be documented, monitored, and used to tailor the treatment approach.

Classification of Recession (Miller's Classification)

• Class I: Recession does not extend to the mucogingival junction with no loss of interdental bone or soft tissue.
• Class II: Recession extends to or beyond the mucogingival junction, with no loss of interdental bone or tissues.
• Class III: Recession extends to or past the mucogingival junction, with loss of interdental bone or tissue coronal to the apical extent of the recession.
• Class IV: Recession extends past the mucogingival junction, with loss of bone or soft tissue at or apical to the extent of the recession.

Management of Gingival Recession

• Patient education, monitoring, reduction of habitual risk factors, periodontal stabilization, and if necessary, a decision to do nothing or stabilize treatment.

Advice to the Patient

• Tooth brushing methods, oral hygiene aids, application of adjuvants for sensitivity, and a review of habitual factors are advised to the patient.

Treatment Modalities for Clinical Symptoms

• Periodontal treatment, desensitizing agents, gingival veneers, composite restorations, and referrals for surgical interventions are potential treatment options depending on the patient's needs.