(4) Gingival recession

Question 1

What are some specific medical history questions to ask for a patient presenting with gingival recession?

Answer 1

• How often do you brush your teeth?
  
  • Trauma from brushing
    
    • Reduce frequency and and duration
    • Maintain effectiveness
• Have you had orthodontic treatment?
  
  • Thin buccal gingiva, narrow alveolar processes, and correction of severe crowding

Question 2

What are clinical assessments in a patient with gingival recession?

Answer 2

• Recession
• Probing depths
• Bleeding on probing
• Amount of attached gingiva
• Presence of functional attached gingiva
• Tooth mobility
• Vitality testing
• Occlusion

Question 3

What is the importance of each assessment for a patient with gingival recession?

Answer 3

• Recession
  
  • Provides baseline readings to assess progression
• Probing depths
  
  • Detects associated loss of attachment undermining the reduced width of attached gingiva
• Bleeding on probing
  
  • Indicates the presence of gingival inflammation and poor oral hygiene
• Amount of attached gingiva
  
  • Gives the amount of apparent attached gingiva bound down to bone and thus functional
• Presence of functional attached gingiva
  
  • If the gingival margin is displaced from the teeth or is otherwise mobile there is inadequate functional width of attached gingiva, regardless of its absolute measurement
• Tooth mobility
  
  • Important if teeth are very mobile, but not a very useful diagnostic or prognostic indicator with small amounts of buccal recession only
• Vitality testing
  
  • Nonvital teeth are compromised and this needs to be taken into account in treatment planning
• Occlusion
  
  • If a traumatic overbite is present it may cause or exacerbate recession

Question 4

List some of the multifactorial aetiology of gingival recession?

Answer 4

• Anatomical variation
  
  • Gingival tissue biotype
  • Soft tissue
  • Bone
• Traumatic toothbrushing
• Plaque-induced marginal inflammation
• Traumatic occlusion

Question 5

Is gingival recession reversible?

Answer 5

No. Gingival recession is irreversible.

Question 6

What is the function of the free graft (palatal connective tissue and overlying keratinized epithelium)? Why is it not placed over the root to treat recession?

Answer 6

• It stabilizes the gingival margin against displacement on lip movement
• The root surface does not provide a nutrient bed required for the survival of the free graft

Question 7

What treatment can be considered to ‘hide’ the gingival recession?

Answer 7

• Thin acrylic gingival stent or veneer
• Only for extensive recesssion in highly visible areas