Recession Flashcards
What is recession?
Apical shrinkage of the gingivae beyond the amelo-cemental junction (measured from ACJ to the gingival margin)
May be localised or generalised
Indicator of past disease - but does not mean disease is present
Also occurs following healing from effective perio tx = swelling goes down causing recession
Aetiology of gingival recession?
Predisposing factors acting with precipitating factors
Predisposing factors of gingival recession?
Lack of bone - Developmental/acquired e.g. Thin cortical plates/prominent roots Dehiscences/fenestrations Long standing periodontitis Occlusal trauma or excessive ortho, force may cause dehiscences - Deep overbite - Rotation around retainers - Thin gingival tissue - Role of fraenum (in the way so people cannot clean properly?)
Precipitating factors of gingival recession?
All causes of gingival inflammation - provoke recession if predisposing factors present
- Plaque induced gingival inflammation (gingivitis or periodontitis)
- Traumatic toothbrushing
- Direct repeated trauma (e.g. complete overbite impinging on lower ginigvae)
- Parafunctional habits
- Iatrogenic cause e.g. ortho, bands, prostheses
- Food trauma
Self inflicting trauma
What problems can recession cause?
Pt 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? - dentures can impinge of gingivae = recession due to repeated trauma
Ortho tooth movement
Management of recession?
Explain and reassure Correct precipitating factors where possible e.g. ensure atraumatic plaque control Thorough scale and polish Restore carious root surfaces Control sensitivity Fluoride application? Monitor
Where indicated:
- Aesthetics e.g. gingival veneer (if good OH)
- Surgical options e.g. laterally repositioned flap, grafts, apically repositioned flaps with/without regenerative techniques
Outcome of recession management?
Stabilisation/control of breakdown
Residual stagnation areas
Management of sensitivity - long term
Management of exposed root surface to prevent caries
Importance of review to maintain good standard of home care
How to control sensitivity?
Plaque control Fluoride toothpastes Desensitisers e.g. supaseal, duraphat, seal and protect Desensitising tooth paste Dentine bonding agents
How to monitor recession?
Measure in mm and record from CEJ to top of gingival margin
Clinical photos
Study models
Miller classification of recession?
Class I: Recession does not extend to mucogingival junction, no loss of interdental tissue/bone
Class II: Recession to or beyond MGJ, no loss of interdental tissues
Class III: Plus interdental tissue loss, not beyond recession
Class IV: Plus interdental loss beyond recession
Indications for surgery for recession?
Continued inflammation Progressive breakdown Aesthetics Frenal pull Pocketing beyond MGJ Advanced restorative procedures planned
Pre-op assessment for surgical treatment?
Is surgical tx warranted? Is recession stable following monitoring? Medical and social assessment Tooth vitality Radiographic examination Informed consent and clinical records
What surgery can be done for the tx of recession?
Laterally repositioned flap Free gingival graft Free CT graft Coronally repositioned flap Guided tissue regeneration to stop the epithelium from growing down and guide the CT up
Results 12 month evaluation post surgical treatment of recession using Emdogain?
Average root coverage 73%
Clinical attachment gain 58%
Pt satisfaction 8.5%
Maintain shallow pockets and amount of keratinised gingiva
= Coronally repositioned flap in combination with the application of Emdogain gel is a predictable tx procedure for the achievement of soft tissue root coverage and gain of clinical attachment, while maintaining shallow pockets
What have systematic reviews found on root coverage procedures?
Evidence that mainly coronally advanced flap alone or associated with subepithelial connective tissue grafts led to statistically significant improvement in gingival recession and attachment level gain, with or without improvements in the width of keratinised tissue
