Management of Gingival Recession

• Definition of gingival recession?

  The location of the gingival margin apical to the cemento - enamel junction resulting in  exposure of the root surface
• Incidence?

  • canines and premolars mostly effected
  • Labial and buccal surfaces
• Who wrote the classification?

  Miller 1985
• Class 1?

  Marginal tissue recession not extending to the mucogingival junction

  no loss of id bone or soft tissue
• Class 2

  Marginal tissue recession extends to or beyond the mucogingival junction

  no loss of ID bone or soft tissue
• Class 3?

  marginal tissue recession extends to or beyond mucogingival junctions

  Loss of ID bone or soft tissue is apical to CEJ but coronal to the apical extent or the marginal tissue recession
• Class 3


  Class 3

  
• Class 4?

  Marginal tissue recession extends to or beyond the mucogingival junction

  Loss of ID bone extends to a level apical to the extent of the marginal tissue recession
• Pathogenesis?

  1. plaque induced inflammation of connective tissue
  2. Trauma induced inflammation of connective tissue
  3. connective tissue destructions
  4. Proliferation of epithelium from both sides
  5. Interconnecting cord of epithelium formed between oral area and the pocket epithelium
  6. Subsidence of the epithelium surface creating reduced margin

  
• Aetiological causes?

  1. Pathological bone disease
  2. trauma
  3. Local PRF
  4. Ortho tooth movement
  5. Anatomy
• Orthodontic aetiology?

  Excessive proclination especially when fixed appliances have or are being used
• Anatomical aetiology?

  • fenestration
  • dehiscence
  • thin gingival tissue
• Local PRF aetiological factors?

  • calculus
  • subgingival restorative margins
  • high muscle attachments
  • frenal pulls
  • overhanging restorations
• Trauma aetiological factors?

  • Tbing
  • fictitious injury (fingernail picking)
  • Malocclusion (class 2, div 2 w/ traumatic overbite)
  • poorly designed partial denture
  • chemical trauma eg. cocaine
  • Lip or tongue stud
• Pathological bone disease aetiological factors?

  • perio disease
  • perio Tx
  • Smoking
• What is the biological width?

  Epithelial attachment + connective tissue attachment
• Epithelial attachment


  0.97
• connective tissue attachment?

  1.07
• Biological width

  2.04
• Restorations invading the biological width can...

  cause gingival recession
• gingival recession complications ?

  • pain from exposed dentine
  • root caries
  • tooth abrasion
  • PRF and gingival inflammation
  • Aesthetics
• Management ?

  • Px from dentist
  • History and examination to id aetiological factors
  • Monitor
  • Manage aetiogical factors
  • manage consequences
• How to monitor?

  • record in notes
  • Study models
  • Pictures
  • Measure with probes
• Managing aetiological factors

  • Advise on an atraumatic brushing technique
  • Advice relating to traumatic habits
  • Advice on smoking cessation
  • Plaque control and OHI
  • Remove all local factors e.g. scaling, overhang removal
  • Dentist to correct deficient partial denture design
  • Margins of restorations need to be placed supragingival where possible
• Managing consequences

  • dentine hypersens
  • root caries
  • aesthetics
  • Mucogingival surgery
• Managing dentine hypersens

  • diet advice (-- acid)
  • antisensitivity TP
  • fluoride MW
  • Professional products (FV, dentine bonding agents)
  • restorations
• what qualities does the ideal desensitising agent have?

  • rapid in action
  • effective for long period
  • non staining
  • consistently effective
  • easily applied
  • non irritant to pulp
  • painless to apply
• Fluoride agents?

  occludes dentinal tubules

  
  

  duraphat = 22600ppm

  Gel kam = 0.4% stannous fluoride at 1000ppm

  MW = fluoriguard 2500ppm
• Potassium salts

  direct desensitising effect on pulpal nerves

  sensodyne F = potassium nitrate 5%

  colgate sensitive = potassium citrate 5.5%
• Strontium


  occludes dentinal tubules

  sensodyne mint = strontium acetate 8.0%
• Colgate Sensitive Pro-Relief Desensitising Paste ?

  Tubules occluded by a calcium rich layer created by the interaction of arginine and calcium carbonate

  • Based on the amino acid arginine and calcium carbonate
  • Available as a toothpaste and polishing paste used by the professional
• root caries?

  • F
  • diet advice
  • restoration
• Aesthetics?

  ginginval veneers to cover exposed root surfaces and hide ID spaces
• Mucogingival surgery ?

  • Root coverage using pedicle grafts
  • Free grafts
  • Guided tissue regeneration
• Pedicle graft

  maintains connection with the donor site after placement at recipient site (laterally or coronally poistioned)
• Free grafts?

  Completely deprived of their connection with the donor area

  E.g. Dissected from the palate and used elsewhere