Gingival Recession Overview

Gingival Recession

• Gingival recession is the displacement of the gingival margin apically to the cemento-enamel junction, exposing the root surface.
• Causes of gingival recession include:
  • Mechanical factors: toothbrush trauma, traumatic incisor relationship, trauma from foreign bodies, abnormal frenal attachment, and iatrogenic damage.
  • Inflammatory factors: gingival biotype, periodontal disease, smoking, poor marginal fit of restorations, and orthodontic tooth movement.

Healthy Gingival Tissues

• The healthy mouth includes: alveolar mucosa, mucogingival junction, attached gingiva, free gingiva, interdental papilla, and stippling.
  • Free gingiva + Attached gingiva = Keratinized Tissue (KT)

Clinical Appearance

• Assess if gingival recession is localized or generalized.
• Localized recession is often confined to a single tooth surface, typically the labial/buccal aspect.
• Recession alone does not typically jeopardize periodontal support of the tooth.
• The underlying cause of recession should be considered.

Causative Factors

• Mechanical Factors:

  • Toothbrush trauma: prolonged aggressive brushing technique, often with inappropriate oral hygiene aids.
  • Traumatic Incisor relationship: bite where lower incisors impact palatally on upper incisors.
  • Trauma from foreign bodies: lower lip studs, tongue studs.
  • Abnormal Frenal attachment: marked frenal attachment causing apical pull of gingival tissues, making oral hygiene difficult.
  • Iatrogenic damage: well-recognized risk of successful periodontal treatment.

• Inflammatory Factors:

  • Gingival Biotype: delicate, translucent tissue, minimal attached gingiva.
  • Periodontal disease: apical migration of gingival margin, sign and symptom.
  • Smoking: significant impact on periodontal status of patient; smokers more susceptible.
  • Poor marginal fit of restorations: low-grade irritant, sub-gingival margins can encroach on biologic gingival width, potential for plaque stagnation.
  • Orthodontic tooth movement: tooth movement in thin biotypes can cause gingival recession, especially in rapid orthodontic movement in adults.

Impact of Gingival Recession

• Dentine hypersensitivity, aesthetic concerns, root caries, food traps/plaque stagnation, impacts on confidence and speaking, and other concerns like difficulty chewing and eating.

Measuring and Monitoring

• Recession is measured from the cemento-enamel junction (CEJ) to the gingival margin, using a probe parallel to the long axis of the tooth.
• Clinical loss of attachment (CLOA) or clinical attachment loss (CAL) also need consideration, which is a combination of recession and probing depth.

Miller's Classification of Recession

• Class I: recession does not extend to the mucogingival junction; no loss of interdental bone or soft tissue.
• Class II: recession extends to or beyond the mucogingival junction; no loss of interdental bone or soft tissue.
• Class III: recession extends to or beyond the mucogingival junction; loss of interdental bone or soft tissue coronal to the apical extent of the marginal tissue recession.
• Class IV: recession extends to beyond mucogingival junction; loss of interdental bone or soft tissue level with or apical to the extent of the marginal tissue recession.

Management

• Patient education, monitoring, treating as needed, reduction of habitual factors, and educating the patient.

Treatment Modalities

• Periodontal treatment, desensitizing agents, gingival veneers, composite restorations, and referral for surgical intervention.

Gingival Graft Surgery

• Assorted complex periodontal techniques involving palatal gingival tissue transplant to problematic area.

Summary

• Overview of the complexities of gingival recession including causative factors, impact on the patient, different classification methods, and management strategies.