GINGIVAL RECESSION

Drg. Ade Ismail A. K., MDSc., Sp.Perio

 Definition

Exposure of the tooth by the apical migration of

the gingiva
An apical displacement of the gingival margin
and involves loss of connective tissue
attachment and alveolar bone
 The Gingiva

Marginal gingiva + attaached gingiva = Keratinez

tissue/ gingiva
 The main complication
Esthetics.
Root dentine sensitivity.
Abrasion, erosion.
Root caries.
Classification of Gingival Recession

The first attempt to classify gingival recession

according to its amenability of being covered using
mucogingival surgical procedures was published by
Sullivan & Atkins (Sullivan HC et al, 1968)

The basis for their gingival recession classification

was the depth and width of the defect

The four categories to describe defects were: deep

wide, shallow wide, deep narrow and shallow narrow
 Classification
Sullivan and Atkins (1968)
Shallow narrow

Deep narrow

Shallow wide

Deep wide
 Classification of Gingival Recession
(Miller)

Class I
Marginal tissue recession
which does not extend to
the mucogingival junction
No periodontal bone loss in
the interdental area
100% root coverage
Class II
Marginal tissue recession which extends to or beyond the
mucogingival junction
No periodontal loss in the interdental area
100% root coverage
Class III
Marginal tissue recession which extends to or beyond the
mucogingival junction
Bone or soft tissue loss in the interdental area or
malpositioning of the teeth, preventing 100% root coverage
Partial root coverage
Class IV
Marginal tissue recession which extends to or beyond the
mucogingival junction
Severe bone or soft tissue loss in the interdental area and/or
malpositioning of teeth
No root coverage
 Most Common Anatomic Factors

Area of root prominence

Thin, narrow band of gingiva
Thin mucosa
Thin labial bone septum
 Friedman (1962)
Inadequate zone of attached gingiva would

1. Facilitate subgingival plaque formation

2. Favor attachment loss and soft tissue recession
 Moscow and Bressen (1965) listed possible
alternative causes of recession

Uneven atrophy of the gingival margin

Calculus deposits
Direct trauma (accident, fingernails)
 Two most important causes of recession

Trauma caused by tooth brushing

Gingival lesions associated with plaque
 DETERMINANTS
FACTORS
Bacterial Plaque
O`Leary et al found direct
correlation between the increase of
plaque index ad the increase of
marginal tissue recession
Trauma from toothbrushing
Improper technique
Wrong toothbrush
Iatrogenic Factors
Amalgam or prosthetic overhang
Clamps
Orthodontic appliances
Habits
Fingernails or any foreign object
CO FACTORS
Tooth Malposition
Buccally displaced teeth or
rotated tooth due to altered tooth-
bone relationship
Unfavorable Anatomy
High frenum insertion
Shallow buccal fold that
produce tension on the marginal
gingiva
Orthodontic Movements
 Pathogenesis
Novaes et al 1975.
Gingiva overlying a prominent root surface is thin and
shows a poor organization of the connective tissue and
collagen sandwiches between sulcular epithelium and
oral epithelium
 Process of Recession

Wounding may cause a split in the gingiva with resultant

root exposure
Existing gingiva may move apically with resultant root
exposure
 Precipitating Factors
Vigourous brushing
Laceration
Recurrent inflammation
Iatrogenic factors
 Predisposing Factors
Inadequate attached
gingiva
High frenum
attachment
Shallow vestibule

Malpositioning of the
teeth
Prominent roots
 Treatment
Cause-specific treatment in non-progressive
gingival recession

Surgical root coverage in progressive gingival

recession.
Treatment mapping
Prevention