Periodontal recessions, etiologies and diagnosis
Gum recession is a frequent reason for consultation, causing the patient both the fear of losing the tooth and a feeling of unsightly appearance that is little perceived or expressed.
- Reminder on the periodontal biotype
In 1992, Korbendau and Guyomard distinguished four types of periodontium:
- Type A: thick alveolar process with the marginal edge close to the enamel-mound junction (1 mm). The gingival tissue is thick and greater than 2 mm high.
- Type B: thin alveolar process with the marginal edge close to the cementoenamel junction (1 mm). The gingival tissue is quite thin and more than 2 mm high.
- Type C: thin alveolar process with the marginal edge at a distance from the cemento-enamel junction (presence of a dehiscence greater than 2 mm). The gingival tissue is thin and taut, with a height greater than 2 mm.
- Type D: thin alveolar process with the marginal edge at a distance from the enamel-cementum junction (dehiscence greater than 2 mm). The gingival tissue is thin and very reduced, with a height of less than 1 mm.
The same authors clearly specify that these four types of periodontium do not represent a pathological state:
- Type A corresponds to the ideal periodontium, which is resistant to bacterial aggression and mechanical stress if the patient is not susceptible to periodontal disease.
- Type B represents a more fragile periodontium which can, under the combined action of dental plaque and mechanical stress, evolve towards type C.
- Type C represents a fragile periodontium with the presence of bone dehiscence and thin gingiva. This type can progress to true marginal tissue recession;
- Type D represents a periodontium that must be monitored because it can progress within a few weeks to marginal tissue recession.
- Definition :
According to the AAP, gingival recession is defined as the displacement of the marginal gingiva apically to the cementoenamel junction.
- Etiologies:
The etiology of recession is considered multifactorial. Different factors each play a greater or lesser role but act in combination.
- Predisposing factors:
- Bone dehiscence
- Bone fenestration
- Thin bone table
- Absence of keratinized tissue
- Low thickness of keratinized tissue
- Dental malposition
- Brake traction and bridles
- Shallow vestibule
- Triggering factors:
- Traumatic brushing
- Non-carious cervical lesions
- Inflammation
- Poorly fitted fixed prosthesis
- Hook, bar or compressive band in removable prosthesis
- Violation of biological space
- Poorly located discharge incision
- Extraction
- Orthodontic movement outside the bone bases
- Occlusal trauma
- Tobacco
- Harmful habits.
- Clinical signs and diagnosis:
The patient presents one or more of the following four signs:
- Unsightly appearance when smiling or laughing, or simply bareness
radicular visible during speech, or not visible except when lifting the lip but considered aesthetically disturbing by the patient.
- The fear of losing one or more teeth;
- Radicular hyperesthesia, caused in particular by thermal or contact stimuli.
- Gum sensitivity, when brushing or chewing, especially when the marginal tissue is alveolar mucosa.
The diagnosis of gingival recessions is clinical, it involves assessing the position of the gingival margin which must be in an apical position in relation to the enamel-cement junction, thus a portion of the dental root is exposed and visible to the naked eye.
Stillman’s fissure : This is a superficial lesion of the epithelium and connective tissue, a sign of the progression of a recession or the onset of a future recession. It is a narrow clinical form of recession, its origin is often traumatic (incorrect brushing).
- Classifications:
In 1985, Miller proposed a classification that also took into account marginal tissue recession associated with periodontitis and, therefore, all forms of recessions. It has a therapeutic purpose.
Miller’s classification distinguishes four classes:
- Class I : The recession does not reach the mucogingival line. There is no interdental tissue loss.
- Class II : recession reaches or exceeds the mucogingival line, there is no interdental tissue loss.
- Class III : The recession reaches or exceeds the mucogingival line. There is interdental bone loss and the proximal gingival tissue is apical to the cementoenamel junction, while remaining coronal to the base of the recession.
- Class IV : The recession reaches or exceeds the mucogingival line. The proximal tissues are located at the base of the recession and it affects more than one surface of the tooth.
In 2011, Cairo and his team established a new classification based on the depth of recession and interproximal attachment loss.
Type 1 recession : this refers to a recession without loss of interproximal attachment.
Type 2 recession : Gingival recession is associated with interproximal attachment loss that is less than or equal to the vestibular attachment loss.
Type 3 recession : Gingival recession is associated with interproximal attachment loss that is greater than vestibular attachment loss.
RT 1 RT 2 RT 3
- Conclusion :
Gingival recession is a common pathology, its diagnosis is clinical, and its treatment begins with the identification and control of predisposing and triggering factors.
Bibliographic references:
[1] BORGHETTI A., MONNET-CORTI V, periodontal plastic surgery, cdp edition, 2001.
- BOUCHARD Philippe, periodontology and implant dentistry, volume 2: surgical techniques, Lavoisier edition, 2016.
- Zuchelli Giovanni, mucogingival aesthetic surgery, quintessence edition, 2012.
Periodontal recessions, etiologies and diagnosis
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