Gingival Recession PDF

Gingival Recession Oral and Dental Sciences Miss Felix 2 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 co...

Gingival Recession Oral and Dental Sciences Miss Felix 2 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 3 Definition The displacement of the gingival margin apical to the cemento-enamel junction which results in exposure of the root surface. 4 Revision of the healthy gingival tissues Refer to Gingival Anatomy Lecture Healthy mouth 5 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 7 Causative factors of gingival recession Mechanical Gingival Recession Inflammatory Mechanical Factors 9 Mechanical factors Traumatic Incisor Trauma from Toothbrush trauma relationship foreign bodies Abnormal frenal Iatrogenic damage attachment Toothbrush trauma Prolonged aggressive tooth brushing technique Often with inappropriate oral hygiene aid Can you think of an example? 11 Trauma from foreign bodies Lower lip stud Tongue 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 14 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 17 Aetiological factors behind recession: Inflammatory factors Gingival biotype Periodontal disease Smoking Poor marginal fit of Orthodontic 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 Gingival Recessions in Thin or Thick Biotype - PubMed (nih.gov) 19 Imagine the impact on having different gingival biotype Say what you see…. 20 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 adults 24 The impact of gingival recession on the patient Dentine Aesthetic Root caries hypersensitivity considerations 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 29 Recession Summary of Start asking yourself: causative Mechanical Inflammatory Description of each factors Explanation Toothbrush Causative factors Gingival biotype How do we halt it? Stabilise? trauma What are the consequences Traumatic and other risks associated? Periodontal How we record it? Incisor disease relationship How do reiterate to the patient? Trauma from How do we manage? Smoking foreign bodies Remember this is just the start… Link with other lectures and Abnormal frenal Poor marginal fit attachment of restoration Year 2 learning Orthodontic Iatrogenic tooth damage movement Measuring & Monitoring Recession 30 31 How do you measure recession? Refer to Periodontal Indices Lecture 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) 33 Recession is noted in the patient: Inform the Refer patient Identify the Monitor cause Treat as Educate the currently patient needed Measure and record Miller’s Classification of Recession 35 Miller PD Jr. A good_practitioners_guide_ classification of 2016.pdf (bsperio.org.uk) marginal tissue recession. Int J Periodontics Restorative Dent 1985; 5(2): 8-13 36 37 38 39 Management of gingival recession Patient Reduction of Monitor education habitual factors Periodontal Do nothing & stabilisation stabilise Advice to patient Refer to hypersensitivy lecture Tooth brushing technique Recommend coaching with appropriate adjuncts appropriate oral hygiene for sensitivity aids Apply appropriate Habitual advice adjuncts for sensitivity Treatment modalities for clinical symptoms Periodontal Desensitising Gingival veneer treatment agent Refer for Composite surgical restorations intervention 42 Gingival veneer Case selection is vital why? A removable acrylic facing that improves the aesthetics in a patient with advanced and generalised recession. 43 Restorations Case selection is vital why? Composite placed to cover up sensitive , caries prone exposed dentine in the cervical region. 44 Gingival graft surgery Refer to Gingival Surgery Lecture Assorted complex periodontal surgery These have limited techniques that include involving palatal gingival compliance and success tissue transplanted to site Consider the difficulty with this type of treatment 45 Monitoring gingival recession Refer to Periodontal Indices Lecture Record all points of recession and monitor and Refer if needed respond to treatment needs accordingly 46 Finally, all animals who have teeth can get periodontal disease / gingival recession so take a look at your pets ! 47 Summary revision slide related to Gingival Recession (GR) Remind yourself what a healthy mouth looks like DEFINITION of GR How do you Inflammatory Mechanical factors measure GR/ LOA factors related to associated with GR GR Impact on the Treatment patient Modalities 48 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.com) 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 (nih.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 Thick Biotype. The International Journal of Periodontics & Restorative Dentistry, 36(3), pp.409–415. doi:https://doi.org/10.11607/prd.2249. Clinical Considerations on the Root Coverage of Gingival Recessions in Thin or Thick Biotype - PubMed (nih.gov)