Gingival Recession Haris

8/6/2019 Gingival Recession Haris

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DrDr HarisHaris MehmoodMehmood

House OfficerHouse Officer PeriodontologyPeriodontology DepartmentDepartment

Islamic International Dental HospitalIslamic International Dental Hospital


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7. Treatment

6. Clinical significance

5. Clinical examination

3. Etiology

2. Classification

1. Definition

CONTENTS

8. Case Reports

4. PREVALENCE

9. Current Trends in Treatment

10. References


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The recession is determined by the

actual position of the gingiva not

by its apparent position


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Also it may be

Localized Generalized


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CLASS

IFICA

TIONOF

RECESSIONDEFECTS


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P.D.MILLER(1985)

Class I : Marginal

tissue recession not

extending to the

Mucogingival junction.

No loss of interdental

bone or soft tissue


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Class II :

Marginal tissue

recession extendsto or beyond the

Mucogingival

junction. No lossof interdental bone

or soft tissue


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Class III : Marginaltissue 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 ofmarginal tissue

recession


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Class IV :

Marginal tissuerecession extends

beyond theMucogingivaljunction.Loss of interdentalbone extends to a level

apical to the extentof the marginaltissue recession


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Atkin & Sullivan

classification

I. Shallow-Narrow

II. Shallow-Wide

III. Deep-NarrowIV. Deep-Wide


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Al Bander JM, Kingman A, Gingival recession, bleeding and calculus in adult

30 years of age and older in US 1988-1994. Journal of Periodontology1999;70;30-43.


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Banting DW, Ellen RP, Fillery ED, Prevalence of root caries among

institutionalized older patients. Community Dentistry and Oral Pathology1980;8;84-8.


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Al Bander JM, Kingman A, Gingival recession, bleeding and calculus in adult

30 years of age and older in US 1988-1994. Journal of Periodontology1999;70;30-43.


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Lohse WG, Carted HG, Brunelli JA, Prevalence of root caries in military

population, Military Medicine 1977;142;700-3


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Addy M, Mostafa P, Newcombe RG, Dentine Hypersensitivity, distribution of sensitivity,recession and plaque, Journal of Dentistry 1987;15;242-8.


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Addy M, Mostafa P, Newcombe RG, Dentine Hypersensitivity, distribution of sensitivity,recession and plaque, Journal of Dentistry 1987;15;242-8.


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Van Palensteien huldarman WH, Lambariti BS, Van der Weijden GA et. al.

Gingival recession and its association with calculus in subjects deprived ofprophylactic dental care . Journal of Clinical Periodontology, 1988;25;106-11.


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GingivalRecession

Chemicaltrauma

Plaque andCalculus

HighMuscle and

Frenalattachment

RestorativeDentistry

PeriodontalDisease

Smoking

Habits


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AGE:

It increases with age.8% in children

50%, above age of 50 yrsReason being(a) Cumulative effect of minor

pathological involvement(b) Repeated, minor direct

trauma


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GINGIVALINFLAMMATION

Bacterial toxins, enzymes and cytokines released

from neutrophils.

Bone resorption, as it is seen to occur in

response to repeated scaling of shallow pockets.

Shrinkage of tissue after treatment of pockets.

Williams DM, Hudges FJ, odell EW te. al. Pathology of Periodontal disease,Oxford, Oxford University press 1992.

Lindhe J, Nyman S, Karring T, Scaling and root planing in shallow pockets,

Journal of Clinical Periodontology, 1984; 55;713-9.


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MECHANISM

Systemic alteration

in immune response

Locally decreasedblood flow

Additional tooth

brush abrasionwhich try to removestaining due tosmoking habits


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Increased gingival recession in smokelesstobacco users.

Attachment loss was particularly noted inmandibular buccal areas where products

were placed.

Robertson PB, Walsh M, Green J. et.al Periodontal effects associated with use of

smokeless tobacco. Journal of Periodontology, 1990; 61; 438-43.


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2. FAULTYTOOTH BRUSHINGTECHNIQUE

Brush with hard bristles

Excessive or Aggressive brushing in horizontaldirection

When used with highly abrasive dentifrice


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Recessionisaffectedby :

Positionofteethinthearch. Therootboneangle.

Themesiodistal curvatureofthetoothsurface

Rotated,tiltedor faciallydisplacedteeth

TOOTHMALPOSITION


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Malpositionedteeth

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


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Clinical examination

Measurementof amountofgingival

recessionismadeby Periodontalprobe

from CEJtothegingivalcrest


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CLINICAL

SIGNIFICANCESusceptible to Caries

Abrasion and Erosion

Sensitivity


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i l i l


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4. Interproximal recession createsoralhygiene problems& resulting plaqueaccumulation


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SURGICALTREATMENT:1. Pedicle soft tissue graft procedures :

Flaps used : Rotational flapAdvanced flap

2. Free soft tissue graft procedures :

Epithelialised graftSub epithelial connective tissue graft


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ROTATIONAL FLAP PROCEDURES

Lateral sliding flap

Double papilla flap

ADVANCED FLAP

Coronally Advanced flap

Semilunar Coronally Advanced flap


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ADVANCED FLAPPROCEDURES


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GUIDEDTISSUEREGENERATION

Techniques for enhancing and directing cell growth to repopulatespecific parts of the PERIODONTIUM that have been damaged

by PERIODONTAL DISEASES; TOOTH DISEASES; or TRAUMA, or to

correct TOOTH ABNORMALITIES. Repopulation and repair is achieved by

guiding the progenitor cells to reproduce in the desired location byblocking contact with surrounding tissue by use of membranes

composed of synthetic or natural material that may include growth

inducing factors as well.


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FREESOFTTISSUEGRAFTPROCEDURES

1. Epithelialised graft

2. Sub epithelial connective tissue graft


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Epithelialized free soft tissue graft procedure


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Free connective tissue graftcombined with a coronally

advanced flap procedure


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A 19-year-old female presented whose chief complaintwas root sensitivity and poor aesthetics on her maxillary

lateral incisors and canines.


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The tunnel technique was selected to treat both sidessimultaneously presenting with Class I and II gingival

recession.

Vertical sounding with a probe of the Transversal sounding of the tunnel


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tunnel created beyond the MGJ. without detaching the peak of the

papillae.

Large and thick CTG after palatal

harvesting.

The CTG is inserted in the tunnel and

the flap is advanced and sutured with

the graft.


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The healing progressed uneventfully and the gingival

recession was totally covered with a beautiful aesthetic result

on both sides

The CTG, using 4-0 sutures, was delicately inserted inside th

pouch and was then stabilized with the flap using 5-0 Vicryl

sutures.


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The following conclusions can be drawn fromrecent analysis of20 papers on the treatment of

Class I and II localized gingival recession:

Better results were achieved by using the CTG

than with guided tissue regeneration (GTR).

There is no difference between resorbable andnonresorbable membranes.

A closer contact between the receiving bed and

th

e covering tissues is obtained.


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Enamel matrix derivative has been shown topromote cementogenesis and bone formation aswell as new attachment.

It has been shown that EMD possesses thepotential to stimulate the formation of newconnective tissue, new bone, new periodontalligament, and cementum.

WennstrmJL, Zucchelli G. Increased gingival dimensions. A significant factor for successfuloutcome of root coverage procedures? A 2-year prospective clinical study. J ClinPeriodontol1996;23(8):770-777.

Harris RJ. A comparative study of root coverage obtained with guided tissue regenerationutilizing a bioabsorbable membrane versus the connective tissue with partial-thickness doublepedicle graft. J Periodontol 1997;68(8): 779-790.


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Class I recessions on the

incisor teeth. The central incisor papilla

is compressed

due to lingual orthodontic therapy.

A partial-thickness flap is elevated via

gingivoplasty of the papillae peaks.

After root planing, the acid gel is

applied on the root surfaces.

Application of Emdogain (Straumann,

Andover, MA) on the exposed etched

and dried roots.


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The flap is advanced coronally over the

gel and sutured.

Aesthetic results 6 months following

surgery. Note the root coverage

keratinized gingiva

up to the CEJs and gingival thickness.


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A recent innovation in dentistry is the preparation

and use of Platelet-Rich Fibrin (PRF), a concentrated

suspension of the Concentrated Growth Factors

(CGF), found in platelets of the patient blood. Thesegrowth factors are involved in wound healing and

postulated as promoters of tissue regeneration.

There was less postsurgical discomfort, more rapid

soft tissue healing with less edema compared to thetunnel CTG and EMD techniques, and a relatively

unlimited source of graft material.


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Class I recession on the right

canine and the first bicuspid.

Class I recession on the left canine and

the first bicuspid.

Centrifuged vial of blood.

red blood cells, PRF, and platelet-poor

plasma.

The PRF gel is separated from the other

layers

and placed on special gauze prior to

compression. Clinical

aspects of three overlapped PRF

membranes.


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The membranes are placed on the right

vascularized recipient bed and over the

recession.

The membranes are placed on the left


recession.

The left flap is advanced coronally

without tension covering the PRF

membranes.

The right flap is advanced coronally

without tension covering the PRF

membranes.

The membranes are placed on the right


recession.


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Carranza : Textbook of Periodontics

Jan Lindhe : Clinical Periodontology and Implant

Dentistry Zabalegui I, Sicilia A, et al. Treatment of Multiple gingival

recessions with the tunnel subepithelial tissue graft. A clinicalreport. Intl J periodont Rest Dent 1999 ; 19 (2) : 199-206

http://www.periolondon.co.uk/dental-

information/periodontal-aesthetics.html Gingival Recession its significance and management

Journal of Dentistry (29) 2001 381-394 CURRENT TRENDS IN GINGIVAL RECESSIONCOVERAGEPART II: ENAMEL MATRIX

DERIVATIVE AND PLATELET-RICH PLASMAAndr P. Saadoun, DDS, MS* Pract Proced Aesthet Dent2006;18(8):A-G CURRENT TRENDS IN GINGIVAL RECESSIONCOVERAGEPART I: THE TUNNELCONNECTIVE TISSUE GRAFT

Andr P. Saadoun, DDS, MS*


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