GINGIVAL RECESSION

CONTENTS :
1. Definition
2. Classification
3. Etiology
4. Clinical examination
5. Clinical significance
6. Treatment
DEFINITION
It is the
exposure of root
surface by an
apical shift in the
position of
gingiva.
3

The recession is determined by

the actual position of the gingiva
not by its apparent position
5.
Recession can be
studied as,
VISIBLE
HIDDEN
Also it may be

Localised Generalised
CLASSIFICATION OF
RECESSION DEFECTS

P.D.MILLER(1985)
Class I : Marginal tissue recession not extending
to the mucogingival junction. No loss of
interdental bone or soft tissue.
Class II : Marginal tissue recession extends to or
beyond the mucogingival junction. No
loss of interdental bone or soft tissue.
Class III : Marginal tissue recession extends to
or beyond the mucogingival junction.
Loss of interdental bone or soft tissue
is apical to the CEJ, but coronal to the
apical extent of marginal tissue
recession
Class IV : Marginal tissue recession extends
beyond the mucogingival junction.
Loss of interdental bone extends to a
level apical to the extent of the
marginal tissue recession.
Atkin & Sullivan classification
I. Shallow-Narrow
II. Shallow-Wide
III. Deep-Narrow
IV. Deep-Wide
Etiology:
1. Age
2. Faulty tooth brushing technique
3. Tooth malposition
4. Gingival inflammation
5. Abnormal frenal attachment
6. Trauma from occlusion
7. Masochistic habits
1. Age
It inraeses with age.
8% in children
50%, above age of 50 yrs
Reason being ,
(a) Cummulative effect of
minor
pathological involvement
(b) Repeated, minor direct
trauma
2. Faulty tooth brushing
technique

Brush with hard bristles

Excessive or Aggressive brushing in
horizontal direction.
When used with highly abrasive dentrifice
A Wedge shaped defect
Surface – clear, smooth , polished.
3. Tooth malposition

Recession is affected by :
a. Position of teeth in the arch.
b. The root bone angle.
c. The mesiodistal curvature of the
tooth
surface
d. Rotated, tilted or facially displaced
teeth
 If the inclination of the root is not
proper, then the bone in the cervical
area is thinned or shortened and
recession results from repeated trauma
of the thin marginal gingiva.

Pressure from mastication or

moderate tooth brushing damages the
unsupported gingiva and produces
recession.
Malpositioned teeth
4. Gingival inflammation
5. Abnormal frenal attachment
6. Masochistic Habits
Clinical examination

Measurement of amount of
gingival recession is made
by Periodontal probe from
CEJ to the gingival crest
Clinical significance:
1. Exposed root surfaces are susceptible to
caries.
2. Abrasion or erosion of the cementum

Underlying dentinal suface

Sensitivity
3. Hyperemia of pulp may also result from
excessive exposure of root surfaces.

4. Interproximal recession creates oral

hygiene problems & resulting plaque
accumulation
Treatment

It can be treated
Non-surgically
Surgically
NON – SURGICAL METHOD

1. Correction of tooth brushing technique

2. Removal of masochistic habits
3. Correction of malocclusion
4. Treating the dentinal sensitivity
Surgically treated by two procedures :

1. Pedicle soft tissue graft procedures :

Flaps used : Rotational flap

Advanced flap

2. Free soft tissue graft procedures :

Epithelialised graft
Sub epithelial connective tissue graft
ROTATIONAL FLAP PROCEDURES

Lateral sliding flap

Double papilla flap

ADVANCED FLAP

Coronally Advanced flap

Semilunar Coronally Advanced flap
Lateral sliding flap
 Clinical view :
Double papilla flap procedure
ADVANCED FLAP PROCEDURES
Coronally advanced flap
Semilunar coronally repositioned flap
Guided tissue regeneration
FREE SOFT TISSUE GRAFT PROCEDURES

Epithelialised graft
Sub epithelial connective tissue graft
Epithelialized free soft tissue graft procedure
Free connective tissue graft
combined with a coronally
advanced flap procedure
 REFRENCES :
1. Carranza : Textbook of Periodontics
2. Jan Lindhe : Clinical periodontology and
Implant Dentistry