Gingival Recession PDF

Gingival Recession Oral and Dental Sciences Miss Felix Aim: To give the student a well-rounded knowledge of the ae8ology, treatment and management of the pa8ent who presents with gingival recession Intended Learning outcomes Explain the mul8ple ae8ological factors in connec8on with gingival reces...

Gingival Recession Oral and Dental Sciences Miss Felix Aim: To give the student a well-rounded knowledge of the ae8ology, treatment and management of the pa8ent who presents with gingival recession Intended Learning outcomes Explain the mul8ple ae8ological factors in connec8on with gingival recession. Recognise the oral health impact of gingival recession on the dental pa8ent. Iden8fy how recession is measured and monitored. Iden8fy the diEerent treatment modali8es for gingival recession in the dental pa8ent. 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 De>ni?on The displacement of the gingival margin apical to the cemento-enamel junc?on which results in exposure of the root surface. Revision of the healthy gingival ?ssues Refer to Gingival Anatomy Lecture Healthy mouth Of healthy gingival tissues Clinical appearance: Is the gingival recession localised or generalised? Localised Generalised Recession It is oKen conLned to a single surface of the tooth, typically the labial/buccal aspect Sometimes can be found lingually and palatalised but less common Recession alone does not usually jeopardise the periodontal support of the tooth The underlying cause of the recession needs to be considered Causa?ve factors of gingival recession Mechanical Gingival Recession InRammator y Mechanical Factors Mechanical factors Trauma?c Incisor Trauma from Toothbrush trauma rela?onship foreign bodies Abnormal frenal Iatrogenic damage aKachment Toothbrush trauma Prolonged aggressive tooth brushing technique OKen with inappropriate oral hygiene aid Can you think of an example? Trauma from foreign bodies Lower lip stud Tongue stud Trauma?c incisal rela?onship 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 aKachments A marked frenal aXachment can cause an apical pull of the gingival 8ssues Making oral hygiene diYcult therefore leading to a localised periodontal issue and subsequent recession  attachment a recession -a Iatrogenic damage A well-recognised risk of successful treatment of periodontal disease Pa8ents should always be warned of the impact of recession when trea8ng periodontal disease InMammatory Factors Ae?ological factors behind recession: InMammatory factors Gingival biotype Periodontal disease Smoking Poor marginal >t of Orthodon?c tooth restora?on movement  Gingival Biotype Gingival tissues don’t appear as delicate or thin The gingival 8ssue tends to Gingival tissues appear to be delicate and almost translucent be delicate and almost translucent in appearance The 8ssue appears friable with a minimal zone of aXached gingiva Compare pictures of the gingival 8ssue type Clinical Considera8ons on the Root Coverage of Gingival Reces sions in Thin or Thick Biotype - PubMed (nih.gov)  Imagine the impact on having diPerent gingival biotype Probing can help to highlight gingival bio type - place probe under gingival margin and we can see how much we can see the probe under the tissues Can see probe and mm markings Say what you see…. Periodontal disease Doesn’t always impact one surface of the tooth The apical migration of the gingival margin is a well-established sign and symptom of periodontal disease. DeLning periodontal health - PubMed (nih.gov) Smoking Smoking has a signiLcant impact on the periodontal status of the pa8ent Smokers are more suscep8ble to periodontal disease Refer to Smoking and Periodontal Disease Lecture Poor marginal >t of restora?ons leads to : Low grade irritant, placement of sub-gingival margins can encroach on biologic gingival Biological width Poten8al for plaque stagna8on May lead to gingival recession as part of periodontal disease in the suscep8ble pa8ent  Orthodon?c movement Orthodon8c movement of teeth can give rise to gingival recession in a pa8ent with thin biotype This is especially noted in rapid orthodon8c movement in adults The impact of gingival recession on the pa?ent Den?ne Aesthe?c Root caries hypersensi?vity considera?ons Food trap/ plaque Con>dence Speaking stagna?on Comfort e.g. ea?ng and food trapping Den?ne hypersensi?vity Recession exposes the den8ne root surface crea8ng hypersensi8vity for the pa8ent Hyperaemia of pulp may also result from exposure of root surfaces Refer to Den?ne Sensi?vity Lecture Aesthe?c considera?ons There is the poten8al for recession to cause poor aesthe8cs Crea8ng 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 5.5 What is the cri?cal pH of enamel & then den?ne? 6.5 Fluorapatite = 4.5 critical Ph If caries does occur the speed of destruc8on is also much faster Refer to Dental Caries Lecture Plaque stagna?on and food trapping with black triangles: Important to recommend appropriate oral hygiene aid Food stagna8on is uncomfortable for the pa8ent and gives rise to other poten8al problems  Recession Summary of Start asking yourself: causa?ve Mechanical InMammatory Descrip8on of each factors Explana8on Toothbrush Causa8ve factors Gingival biotype trauma How do we halt it? Stabilise? What are the consequences Trauma8c and other risks associated? Periodontal Incisor disease How we record it? rela8onship How do reiterate to the pa8ent? Trauma from How do we manage? Smoking foreign bodies Remember this is just the start… Link with other lectures and Abnormal frenal Poor marginal Lt aXachment of restora8on Year 2 learning Orthodon8c Iatrogenic tooth damage movement Measuring & Monitoring Recession 30 How do you measure recession? Refer to Periodontal Indices Lecture From the Cement Enamel Junc?on (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 aKachment (LOA) – how is it measured? It is a combina8on of recession and probing depth combined Some8mes described as clinical loss of aXachment (CLOA) or clinical aXachment loss (CAL) Recession is noted in the pa?ent: Inform the Refer pa?ent Iden?fy the Monitor cause Treat as Educate the currently pa?ent needed Measure and record Miller’s Classi>ca?on of Recession  Miller PD Jr. A good_prac88oners_guide_ classiLca8on of 2016.pdf (bsperio.org.uk) marginal 8ssue recession. Int J Periodon8cs Restora8ve Dent 1985; 5(2): 8-13 Management of gingival recession MUST MAKE VERY DETAILED CLINICAL Inform patient of your findings Discuss cause NOTES! If localised or generalised This will come from clinical examinations and history Pa8ent Reduc8on of Monitor educa8on 6ppc to record recession Intra oral photographs at different stages during habitual factors Smoking treatment to monitor Toothbrushing Piercings Periodontal Do nothing & stabilisa8on stabilise If present Advice to pa?ent Refer to hypersensi8vy lecture Tooth brushing technique Recommend coaching with appropriate adjuncts appropriate oral hygiene for sensi8vity aids Apply appropriate Habitual advice adjuncts for sensi8vity Treatment modali?es for clinical symptoms Periodontal Desensi8sing Gingival veneer treatment agent Refer for Composite surgical restora8ons interven8on Guided tissue regeneration with or without bone grafting BEYOND SCOPE Need to recognise when i am unable to manage patients recession Gingival veneer Case selec?on is vital why? A removable acrylic facing that improves the aesthe8cs in a pa8ent with advanced and generalised recession. Improves aesthetics not function Restora?ons Case selec?on is vital why? Sensitivity might be indication of placement of composite May be case selection due to moisture control required for composite Composite placed to cover up sensi8ve , caries prone exposed den8ne in the cervical region. Gingival gra^ surgery Refer to Gingival Surgery Lecture BEYOND SCOPE OF DENTAL THERAPIST Assorted complex periodontal surgery These have limited techniques that include involving palatal gingival compliance and success 8ssue transplanted to site Consider the diYculty with this type of treatment Monitoring gingival recession Refer to Periodontal Indices Lecture Record all points of recession and monitor and Refer if needed respond to 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 InRammatory Mechanical factors measure GR/ LOA factors related to associated with GR GR Impact on the Treatment pa8ent Modali8es References Palaparthy, R Durvasula S AND Vidya S (2012) Gingival recession: Review and Strategies in Treatment of Recession. Volume 2012. Ar8cle ID 563421. Case reports in Den8stry Chapters 2,3,4 & 5. Gingival Recession: Review and Strategies in Treatment of Recession (hindawi.com) Dersot, J.-M. (2012). Gingival recession and adult orthodon8cs: A clinical evidence-based treatment proposal. Interna2onal Orthodon2cs, 10(1), pp.29–42. doi:hXps://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]. Mariop, A. and HeKi, A.F. (2015). DeLning periodontal health. BMC Oral Health, 15(S1). doi:hXps://doi.org/10.1186/1472-6831-15-s1-s6. DeLning periodontal health - PubMed (nih.gov) Kahn, S., Almeida, R., Dias, A., Rodrigues, W., Barceleiro, M. and Taba, M. (2016). Clinical Considera8ons on the Root Coverage of Gingival Recessions in Thin or Thick Biotype. The Interna2onal Journal of Periodon2cs & Restora2ve Den2stry, 36(3), pp.409–415. doi:hXps://doi.org/10.11607/prd.2249.