PERIODONTAL RECESSION
I-INTRODUCTION:
Mucogingival problems represent a major reason for consultation due to the appearance of clinical signs or aesthetic damage, even if, most often, the durability of the teeth on the arch is not called into question.
II- DEFINITION:
Periodontal recession is defined as a denudation of the root surface following apical migration of the marginal tissue edge. This superficial transformation is associated with a loss or absence of alveolar bone without the prognosis of the tooth being really affected.
This withdrawal appears most often on the vestibular surfaces, more rarely on the lingual or palatine surfaces, it is very frequently characterized by a non-inflammatory clinical state.
It is evident that bone resorption pre-exists, precedes or accompanies the apical migration of the attachment system.
PERIODONTAL RECESSION
The American Academy of Periodontology (AAP) Glossary of periodontal terms defines gingival recession as “the displacement of the marginal gingiva apically to the cementoenamel junction.”
According to Benqué et al, this rupture of the gingival band is therefore characterized by a loss or absence of the alveolar bone and by the exposure of the cementum in the oral cavity.
III-ETIOLOGIES:
- Predisposing factors:
- Absence of keratinized epithelium
- Low thickness and height of keratinized tissue
- Dental malposition (the bone does not cover the tooth well, resulting in gums that cover and retract quickly).
- Brake and bridle traction
- Shallow vestibule
- Bone dehiscence
- Bone fenestration
- Thin bone table
These factors are mostly anatomical
Note that there are different types of periodontium morphology (Maynard and Wilson classification (1980), type I, II, III, IV) and that type IV (periodontium + thin bones) is a periodontium predisposed to periodontal recessions.
- Triggering factors:
- As with all periodontal diseases, the presence of bacterial plaque and the inflammation that results from it play a key role in the onset of periodontal recession.
- traumatic brushing which represents a very important factor. Before performing an intervention, it is imperative to modify the brushing method and teach an atraumatic technique
- Occlusal trauma
- Excessive or poorly controlled orthodontic movement (outside the bony bases or vestibuloversion).
– the presence of iatrogenic prostheses (poorly adapted fixed prosthesis with violation of the biological space)
– tobacco and harmful attitudes: nail biting…
IV-PATHOGENESIS:
The traumatic lesion begins with an ulceration of the epithelium which progresses in depth, gradually destroying the connective tissue, thus leaving the root surface exposed.
The inflammatory lesion progresses in the opposite direction, from the pocket epithelium to the external epithelium. When the periodontium is thin there is little connective tissue and the fusion of these 02 epithelia is at the origin of root denudation.
V-Classifications
The use of lesion classifications has proven necessary to assist in the surgical decision (choice of technique based on the desired objectives), but also to assess the scar potential and thus to be able to give a postoperative prognosis in terms of recovery.
The shape and location of the recession are essential criteria that must be taken into account during the consultation.
PERIODONTAL RECESSION
A- MILLER CLASSIFICATION
This is the most widely used classification in mucogingival surgery, because it allows a prognosis of recovery to be given based on the type of lesion observed.
– class I: recession not extending beyond the mucogingival line and preserved interdental bone septa;
– class II: recession extending beyond the mucogingival line and preserved interdental bone septa;
– class III: recession extending beyond the mucogingival line and moderate destruction of the interdental bone septa;
– class IV: recession extending beyond the mucogingival line and major destruction of the interdental bony septa (with disappearance of the papillae).
These periodontal recessions can be single or multiple in the same area.
Thus, if the expected post-surgical recovery rate can be 100% in class I and II recessions, it is much more random and never complete in the case of damage to the interdental bone septa (in class III and IV lesions).
B-CLASSIFICATION OF SULLIVAN AND ATKINS (1968 )
Class 1: Deep (>3 mm) and wide (>3mm)
Class 2: shallow and wide
Class 3: Deep and narrow
Class 4: shallow and narrow
C-CLASSIFICATIONS OF BENQUE ET AL 1983
-in U with poor prognosis
-short or long V with favorable prognosis
-in I with good prognosis
D-Miller classification modified by Mahajan 2010 :
-class I: gingival recession defects (GDR) not reaching the mucogingival line
-class II: gingival recession defects (GRD) reaching or exceeding the mucogingival line
-class III: gingival recession defects (GRD) with bone or soft tissue loss in the
interdental areas up to 1/3 cervical of the root surface with/without dental malposition.
– Class IV: gingival recession defects (GRD) with severe extent of interdental bone and soft tissue beyond the cervical 1/3 of the root surface with/without severe dental malposition.
NB : GRD: gingival recession defects .
VI-PREVALENCE:
Kassab and Cohen (2003) reviewed recent epidemiological studies that found that 50% of people aged 18 to 64 and 88% of people aged 65 and over have one or more sites with recessions.
VII-conclusion :
As we have seen previously, periodontal recessions can cause some discomfort for the patient. Thus, the therapeutic goal of eliminating these lesions will be the gingival coverage of the root in order to inhibit these inconveniences.
Nowadays, mucogingival surgery offers us many possibilities to achieve this. Indeed, many techniques have succeeded one another over time and root coverage in order to stabilize a periodontal situation at risk is now well mastered and easily achieved. But over time and techniques, the requirements have evolved, the objective today being to obtain complete coverage of the recession with the best possible aesthetic integration.
Good oral hygiene is essential to prevent cavities and gum disease.
Regular scaling at the dentist helps remove plaque and maintain a healthy mouth.
Dental implant placement is a long-term solution to replace a missing tooth.
Dental X-rays help diagnose problems that are invisible to the naked eye, such as tooth decay.
The dentist uses local anesthesia to minimize pain during dental treatment.