Gingival Recession Flashcards
What is gingival recession?
Migration of gingival margin apical to CEJ (cement-enamel junction)
Is recession indicator active disease?
No
Can indicate past active or active disease
Why is recession part of informed consent?
Recession is risk of healing and periodontal therapy
How can recession present?
Generalised or localised
When may see general recession?
Toothbrush trauma
Periodontal disease
When may see localised recession?
Localised labial defects
Localised pockets
Aetiology of recession?
Predisposing and precipitating factors?
Predisposing factors of recession?
Thin periodontal phenotype
Tooth position
Previous ortho tx - too far labail
Position muscle attachment
What are precipitating factors of recession?
Gingival inflamamtion Toothbrush trauma Iatrogenic trauma Self-inflicted trauma Deep OB
Stages of gingival recession?
Stage 1 = normal tissue w/ subclinical inflammation
Stage 2 = clinical inflammation
Stage 3 = increased epithelium proliferation, loss CT core
Stage 4 = merging epithelium = separation and recession gingival tissue
What is gingival phenotype?
Gingival thickness and keratinised tissue width
What keratinised tissue width?
Dimension from mucogingival junction to gingival margin
What is an adequate keratinised tissue width?
3mm
Is keratinised tissue width consistent in mouth?
No
What may be indication of thin gingival pheotype?
See periodontal probe - less 1mm thickness
How does sub gingival plaque interact with tissue?
Lateral/apical extension inflammatory cells
How does sub-gingival plaque affect thin and thick tissue?
In thick gingival tissue infiltrate only occupy small amount CT
In thin gingival tissue entirity CT can be affected by inflammatory infiltrate = degradation tissue = recession
Where more common to see recession in healing of periodontitis?
In areas of bone loss
Different traumatic elements that can be precipitating factor?
Mechanical - toothbrushing
Physical - piercings, poorly designed dentures
Chemical - drygs/ tobacco
What pattern recession expect to see in toothbrush recession?
Even distribution - buccal surface
Side opposite to dominant hand
Where might see recession associated w/ ill-fitting dentures?
Around abutment teeth
How can smoking contribute to recession?
Reduced gingival blood flow = reduced immune response
Altered cellular response
How can tooth position affect recession?
Position and orientation of tooth can influence thickness overlying gingival tissue
What teeth are most prone to recession?
Mandibular incsiors
How can ortho cause recession?
Movement of teeth labial - move through buccal plate
What is dehiscence?
Occur margin bone
What is fenestration?
Hole in bone which root can be seen to protrude
How does deep overbite influence recession?
Trauma to palatal tissue
Examples physical trauma?
Piercings
Poorly designed denture
Habitual - pen chewing
How can position of muscle attachment influence recession?
Don’t directly cause recession
Can impede OH = plaque build up, if thin phenotype more likely experience recession
Examples of iatrogenic damage?
Overheated scaler tip
Poorly contoured restoration = plaque retentive
Surgical proceudre
Rubber dam clamp
How do pt w/ recession present?
Dentine hypersensitivtity
Impaired aeshetics
Non-carious root lesion
Why are aesthetic impaired w/ gingival recession?
Open embrasure = black triangle
Exposed crown margin
How dx recession?
Thorough hx
Clinical assessment
Radiographic assessment
What anatomy want to assess when dx recession?
Gingival phenotype
Bone morphology
What classification is used to grade recession?
Millers classification
What is Millers Class I?
Marginal tissue recession doesn’t extend to MGJ
No loss inter proximal bone/soft tissue
Full root coverage
What is Millers Class II?
Marginal tissue recession extend to or beyond MGJ
No loss inter proximal bone//tissue
What expect Millers Class III?
Partial root coverage
What is Millers Class III?
Marginal tissue recession extend to/beyond
Loss interdental bone/ soft tissue
What is Miller Class III
Marginal recession to/beyond MGC
Severe loss interdental bone/soft tissue
What does Millers classification consider?
4 types recesison defect
Consider hard and soft periodontal tissue
Limitation of Millers?
Hard to identify muco-gingival junction Hard differentiate class I/II
Aims of management gingival recession?
Address pt concern
Prevent further recession
Cover exposed root surface
What is conservative management of recession?
Reassure
Take baseline measurements so can monitor
Manage sensitivity - F- vanrish, seal exposed surface
NCRL restored
Manage contirbuting factors
How manage contibuting factors of gingival recession?
Remove plaque retentive factors
Ortho - address tooth position
Atruamative tooth brushing technique
How management aesthetic concern of recession?
Pink composite - careful not create overhangs
Pink ceramic
Gingival veneers
What is a gingival veneer?
Provisional measure - make acrylic/silicone
Incorporates embrasure for retention
Issue gingival veneer?
Need optimum perio health - plaque retention
Minimal colour of acrylic
What is aim of surgical management of recession?
Complete root coverage and integration of tissue
3 main types surgical management of recession?
Pedicle flap procedure
Free soft tissue graft
Regeneration proceudre
Difference pedicle flaps and free soft tissue graft?
Pedicle flap - flap displaced which maintains vascular supply
Soft tissue graft - displace flap w/ no attached vascular supply
Examples regenerative procedures?
GTR
Enamel matrix derivative
Indication surgical management?
Progressive breakdown
Poor aeshtetic
Hypersensitivity
Unfavourable contour gingival margin
Contraindication surgical management?
Poor OH Smoking Periodontal pockets Uncontrolled aetiological factor Poor access MH
What included pre-op assessment for perio surgery?
Hx Pt complaint and expectation Conservative tx tried? MH Clinical assessment Clinical records Sensibility Radiograph exam ICG
What is included in clinical assessment prior surgery?
EO: smile line, access, muscle insertion
IO: dimension defect, presence interproximal tissue/bone, phenotype
What is a pedicle flap procedure?
Flap remains attached at base - retains own blood supply
Example of pedicle flaps?
Coronal advanced flap
Rotation flap
What is free soft tissue graft?
Displacement of tissue tissue w/ no attached vasculature supply
When are free gingival grafts used?
Narrow, isolated recession defects - increase band of keratinised tissue
If taking palatal graft what should avoid?
Palatine blood vessel
When is guided tissue regeneration used?
Manage alveolar bone loss - localised bony defect
Aim periodontal regeneration to exposed root surface
When can referral to periodontal be made?
Conservative options exhausted
Tx of lesions expected to involve tissue augmentation/regeneration
