Gingival recession

Question 1

What is recession? (4)

Answer 1

Recession is the apical shrinkage of the gingivae
beyond the amelo-cemental junction (measured
from the ACJ to gingival margin)
-may be localised or generalised
-indicator of past disease - but does not mean that active disease is present
-also occurs following healing from effective perio tx

Question 2

Predisposing factors (3)

Answer 2

Lack of bone
Thin gingival tissue
Role of fraenum? Unsure whether it is a cause or people just can’t clean there well

Question 3

Predisposing factors: lack of bone - developmental/ acquired (4)

Answer 3

Thin cortical plates/ Prominent roots
Dehiscences/ Fenestrations
Long standing periodontitis
Occlusal trauma or excessive ortho force may cause dehiscences
-deep overbite
-rotation around retainers

Question 4

Precipitating factors (6)

Answer 4

N.B: All causes of gingival inflammation – provoke recession if predisposing factors present
• Plaque induced gingival inflammation ie. gingivitis
and/or periodontitis
• Traumatic toothbrushing
• Direct repeated trauma (eg. complete overbite
impinging on lower gingivae)
• Parafunctional habits
• Iatrogenic cause eg. ortho. Bands, prostheses
• Food trauma

Question 5

Problems

Answer 5

• Patient anxiety? appearance, crown
margins visible?
• Stagnation area – plaque/calculus
• Sensitivity – exposed dentine
• Root caries leading to:
• Possible pulp death
• Continued breakdown
• Subgingival restorations?
• Oral appliances?
• Orthodontic tooth movement ?

Question 6

Management if recession (9)

Answer 6

• Explain and reassure
• Correct precipitating factors where possible eg. ensure
atraumatic plaque control
• Thorough scale and polish
• Restore carious root surfaces (with respect for periodontium)
• Control any sensitivity
• Fluoride application?
• Monitor
Where indicated;
• Aesthetics – e.g. gingival veneer
• Surgical options e.g. laterally repositioned flap, grafts, apically repostioned flaps with/without regenerative
techniques

Question 7

Outcome of management (5)

Answer 7

• Stabilisation/control of breakdown
• Residual stagnation areas
• Management of sensitivity – long term
• Management of the exposed root surface
to prevent caries
• Importance of review to maintain good
standard of home care

Question 8

Control of sensitivity (3)

Answer 8

• Plaque control
• Fluoride toothpastes
• Desensitisers eg:
SupaSeal, Duraphat, Seal and Protect,
Cervitec
Desensitising toothpastes
Dentine bonding agents

Question 9

Clinical questions (3)

Answer 9

• When to monitor a patient without surgical evaluation?
• When is the patient a candidate for surgical intervention?
• When should the patient be referred to a periodontal specialist?

Question 10

Monitor how?

Answer 10

• Measure in mm and record from CEJ to top of gingival margin – subject to error
• Clinical photographs
• Study models

Question 11

Miller classification (4)

Answer 11

• Class I:recession does not
extend mucogingival
junction, no loss of
interdental tissue/bone
• Class II:recession to or
beyond mgj, no loss of
interdental tissues
• Class III: +interdental
tissue loss, not beyond
recession
• Class IV: +interdental loss
beyond recession

Question 12

Indications for surgery (6)

Answer 12

• Continued inflammation
• Progressive breakdown
• Aesthetics
• Frenal pull
• Pocketing beyond MGJ
• Advanced restorative procedures planned

Question 13

Pre-operative assessment for surgery (6)

Answer 13

• Is surgical treatment warranted?
• Is recession stable following monitoring?
• Medical and social assessment
• Tooth vitality
• Radiographic examination
• Informed consent and clinical records

Question 14

Types of surgery (4)

Answer 14

Laterally repositioned flap
Free gingival graft
Free connective tissue graft
Coronally repositioned flap
Guided tissue regeneration
Emdogain - stimulates repair of enamel

Question 15

Systematic reviews: which type of surgery

Answer 15

(not including Emdogain)

Coronally Advanced Flap alone or assoc. with supepithelial CT grafts –> significant improvement