Gingival Recession

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Gingival recession is described as the tendency of the root surface of the tooth to be exposed due to the gingival margin apical displacement to the cementoenamel junction. The cementoenamel junction is where the enamel that covers the crown of a tooth meets the cementum that covers the root part of a tooth. This condition is common in the dental field, and according to research, it is estimated that approximately more than one surface of the tooth in 23% of adults in the US who are between the age of 30-90 present this case.

When you refer to the classification system that was created by the American Academy of Periodontology, conditions that surround the teeth include mucosal/gingival tissue recession, decreased depth of the vestibular, low levels of keratinized gingiva, the position of the aberrant frenal muscle, abnormal color and gingival excess.

There has to be a deep understanding of the investigation of the cause of gingival-recession because when this condition is treated without addressing the causes, it can interfere with the results.

Causes of gingival-recession

The cause of the gingival-recession is more multifactorial. These causes are usually categorized into precipitating factors and predisposing factors. Since the predisposing factors are commonly associated with anatomical factors like the presence of the jaw bone and the biotype of the gingival, inflammation can easily be formed.

Other anatomical predisposing factors include inadequate keratinized gingiva ( inadequate attached gingiva). Studies that made comparisons of inadequate attached mucosa identified that loss of attachment or recession never progressed.

But in some meta-analysis that evaluated 1647 dental sites of buccal-gingival-recession, 78% of the sites experienced gingival-recession progression after 24 months. The study concluded that when an untreated gingival-recession is present, it has a high chance of progressing, even if you take good care of the condition.

Precipitating factors

Since poor oral hygiene and inflammation are gingival-recession precipitating factors, excellent oral hygiene can negatively affect the gingiva. When you brush your teeth using a lot of force, the most common result is the facial recession on the prominent teeth in the arch.

When looking at the effects of brushing, the underlying factors that cause gingival-recession include duration, frequency, the hardness of the bristles, the frequency of changing toothbrushes, and the scrub method. Another factor is the remodeling of the gingival tissue because of the effects of the extraction of a tooth or a periodontal disease.

Additional precipitating factors include oral piercing and tobacco chewing. Although orthodontic therapy has been suggested to be a precipitating factor, a comprehensive review indicated that gingival-recession is less than 10% in orthodontic patients.

Treatment

Although several indications are available for gingival-recession treatment, the aesthetic appeal is the primary indication for it to happen. Below is a list that shows the description of the factors that influence the treatment of gingival-recession, along with the considerations that affect the planning of the procedure.

Predisposing factors

  • Thin tissue
  • Frenal pull
  • Bone dehiscence
  • Tooth malposition
  • Inadequate attached mucosa

Precipitating factors

  • Plaque-induced inflammation
  • Subgingival restoration, orthodontist treatment, and other therapies
  • Habits like oral piercing and smoking
  • Aggressive brushing of the teeth

Aesthetics that are not satisfactory is one of the primary reasons as to why gingival-recession patients go for treatments. Another major reason is hypersensitivity which has significantly reduced after a root coverage procedure. There are cases where the complete resolution of root sensitivity requires additional treatment like class V restoration.

In sites which have root sensitivity and minimal gingival-recession, non-invasive procedures are the best options for an option such as surgical root coverage is taken.

Defect progression

If a recession progresses without the intervention of a surgical treatment, it usually needs surgical treatment to lose the attachment and stop any extra progression.

Orthodontic and restorative needs

It has been shown that keeping a keratinized gingiva around intracrevicular margins restorations assures a healthy tissue. Although orthodontic forces don’t damage the periodontium permanently, there is a high risk of recession with lingual or facial tooth movement in a thin gingival biotype( thickness of gingiva) on the periodontium (specific tissues surrounding and supporting the teeth in the mandibular and maxillary bones).

The result is a gingival augmentation that is usually recommended in sites with a thin gingival biotype or when orthodontic therapy moves the tooth out of the housing of the alveolar ( sockets in the jaw where the roots of the teeth are mounted).

Patients who are undergoing orthodontic therapy need to be placed on a regular checkup to look for recession signs, and when the case arises, they may require surgical intervention in treatment. The risk of recession is higher when there are other factors in play, like thin gingival biotype or a high score of plaque.

It can be hard to clean areas that lack keratinized gingiva which will lead to the accumulation of biofilm (dental plaque). This kind of accumulation promotes the inflammation that can cause progression of the recession. Patients should be schooled on how to maintain good dental hygiene, and orthodontists should look for treatments that increase the keratinized gingiva zone.

Conclusion

Early gingival-recession diagnosis is essential for a timely intervention to achieve successful outcomes. It is not certain that all the recession cases require treatment, but orthodontists evaluate any causes and factors that can show the need for treatments like gum grafting.

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