Gingival Recession - Oral and Dental Sciences PDF

Gingival Recession Oral and Dental Sciences Miss Felix Aim: To give the student a well-rounded knowledge of the aetiology, treatment and management of the patient who presents with gingival recession Intended Learning outcomes Explain the multiple aetiological factors in connection with gingival...

Gingival Recession Oral and Dental Sciences Miss Felix Aim: To give the student a well-rounded knowledge of the aetiology, treatment and management of the patient who presents with gingival recession Intended Learning outcomes Explain the multiple aetiological factors in connection with gingival recession. Recognise the oral health impact of gingival recession on the dental patient. Identify how recession is measured and monitored. Identify the different treatment modalities for gingival recession in the dental patient. 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, 1.10.6 Definition The displacement of the gingival margin apical to the cemento-enamel junction which results in exposure of the root surface. Revision of the healthy gingivalRefer to tissues Gingival Anatomy Lecture Healthy mouth Clinical appearance: Is the gingival recession localised or generalised? Recession It is often confined to a single surface of the tooth, typically the labial/buccal aspect Recession alone does not usually jeopardise the periodontal support of the tooth The underlying cause of the recession needs to be considered Causative factors of gingival recession Mechanica l Gingival Recession Inflammat ory Mechanical Factors Mechanical factors Traumatic Toothbrush Trauma from Incisor trauma foreign bodies relationship Abnormal Iatrogenic frenal damage attachment Toothbrush trauma Prolonged aggressive tooth brushing technique Often with inappropriate oral hygiene aid Can you think of an example? Trauma from foreign bodies Lower lip Tongue stud stud Traumatic incisal relationship The bite is such that the lower incisors impact palatally of the upper incisors Look at the purple circle where are the lower incisors? Abnormal frenal attachments A marked frenal attachment can cause an apical pull of the gingival tissues Making oral hygiene difficult therefore leading to a localised periodontal issue and subsequent recession Iatrogenic damage A well-recognised risk of successful treatment of periodontal disease Patients should always be warned of the impact of recession when treating periodontal disease Inflammatory Factors Aetiological factors behind recession: Inflammatory factors Gingival Periodontal disease Smoking biotype Poor marginal Orthodontic fit of tooth restoration movement Gingival Biotype The gingival tissue tends to be delicate and almost translucent in appearance The tissue appears friable with a minimal zone of attached gingiva Compare pictures of the gingival tissue type Clinical Considerations on the Root Coverage of Gi ngival Recessions in Thin or Thick Biotype - PubMe d (nih.gov) Imagine the impact on having different gingival biotype Say what you see…. Periodontal disease The apical migration of the gingival margin is a well-established sign and symptom of periodontal disease. Defining periodontal health - PubMed (nih.gov) Smoking Smoking has a significant impact on the periodontal status of the patient Smokers are more susceptible to periodontal disease Refer to Smoking and Periodontal Disease Lecture Poor marginal fit of restorations leads to : Low grade irritant, placement of sub-gingival margins can encroach on biologic gingival width Potential for plaque stagnation May lead to gingival recession as part of periodontal disease in the susceptible patient  Orthodontic movement Orthodontic movement of teeth can give rise to gingival recession in a patient with thin biotype This is especially noted in rapid orthodontic movement in The impact of gingival recession on the patient Dentine Aesthetic hypersensiti consideratio Root caries vity ns Food trap/ plaque Confidence Speaking stagnation Comfort e.g. eating and food trapping Dentine hypersensitivity Recession exposes the dentine root surface creating hypersensitivity for the patient Hyperaemia of pulp may also result from exposure of root surfaces Refer to Dentine Sensitivity Lecture Aesthetic considerations There is the potential for recession to cause poor aesthetics Creating the appearance of what is frequently described as black triangles Can you think of any other problems associated with this? Root caries The exposed root surface is less mineralised than enamel and therefore more prone to the caries process What is the critical pH of enamel & then dentine? If caries does occur the speed of destruction is also much faster Refer to Dental Caries Lecture Plaque stagnation and food trapping with black triangles: Important to recommend appropriate oral hygiene aid Food stagnation is uncomfortable for the patient and gives rise to other potential problems  Recession Summary Start asking yourself: Inflammato of Mechanical ry Description of each causative Explanation Causative factors factors Toothbrush trauma Gingival biotype How do we halt it? Stabilise? Traumatic What are the Periodontal Incisor disease consequences and other relationship risks associated? How we record it? Trauma from How do reiterate to the foreign Smoking bodies patient? How do we manage? Abnormal Poor Remember this is just frenal marginal fit the start… attachment of restoration Link with other lectures and Year 2 learning Orthodontic Iatrogenic tooth damage movement Measuring & Monitoring Recession 30 How do you measure recession? Refer to Periodontal Indices L From the Cement Enamel Junction (CEJ) to the gingival margin = Recession Important that the probe is held parallel to the long axis of the tooth and a probe with clear markings is used. Loss of attachment (LOA) – how is it measured? It is a combination of recession and probing depth combined Sometimes described as clinical loss of attachment (CLOA) or clinical attachment loss (CAL) Recession is noted in the patient: Inform Refer the patient Identify Monitor the cause Treat as Educate currently the needed patient Measure and record Miller’s Classification of Recession  Miller PD Jr. A good_practitioners_g classification of uide_2016.pdf (bsperi marginal tissue o.org.uk) recession. Int J Periodontics Restorative Dent 1985; 5(2): 8-13 Management of gingival recession Reduction of Patient Monitor habitual education factors Periodontal Do nothing & stabilisation stabilise Advice to patient Refer to hypersensitivy lecture Tooth brushing Recommend technique coaching appropriate with appropriate oral adjuncts for hygiene aids sensitivity Apply appropriate Habitual advice adjuncts for sensitivity Treatment modalities for clinical symptoms Periodontal Desensitisin Gingival treatment g agent veneer Refer for Composite surgical restorations intervention Gingival veneer Case selection is vital wh A removable acrylic facing that improves the aesthetics in a patient with advanced and generalised recession. Restorations Case selection is vital wh Composite placed to cover up sensitive , caries prone exposed dentine in the cervical region. Gingival graft surgery Refer to Gingival Surgery Assorted complex periodontal surgery These have limited techniques that include involving palatal compliance and gingival tissue success transplanted to site Consider the difficulty with this type of treatment Monitoring gingival recession Refer to Periodontal Indices Record all points of recession and monitor and respond to Refer if needed treatment needs accordingly  Finally, all animals who have teeth can get periodontal disease / gingival recession so take a look at your pets ! Summary revision slide related to Gingival Recession (GR) Remind yourself what a healthy mouth looks like DEFINITION of GR How do you Mechanical Inflammatory measure GR/ factors factors LOA associated with related to GR GR Impact on the Treatment patient Modalities References Palaparthy, R Durvasula S AND Vidya S (2012) Gingival recession: Review and Strategies in Treatment of Recession. Volume 2012. Article ID 563421. Case reports in Dentistry Chapters 2,3,4 & 5. Gingival Recession: Review and Strategies in Treatment of Recession (hindawi.co m) Dersot, J.-M. (2012). Gingival recession and adult orthodontics: A clinical evidence-based treatment proposal. International Orthodontics, 10(1), pp.29–42. doi:https://doi.org/10.1016/j.ortho.2011.09.013. Gingival recession and adult orthodontics: a clinical evidence-based treatment proposal - PubMed (ni h.gov) Johnson, T.M. (2017). Smoking and periodontal disease. U.S. Army Medical Department Journal, [online] (3-17), pp.67–70. Available at: Smoking and periodontal disease - PubMed (nih.gov) Accessed 21 Dec. 2023]. Mariotti, A. and Hefti, A.F. (2015). Defining periodontal health. BMC Oral Health, 15(S1). doi:https://doi.org/10.1186/1472-6831-15-s1-s6. Defining periodontal health - PubMed (nih.gov) ‌Kahn, S., Almeida, R., Dias, A., Rodrigues, W., Barceleiro, M. and Taba, M. (2016). Clinical Considerations on the Root Coverage of Gingival Recessions in Thin or