gingival recession etiopathogenesis. gingiva orthokeratinized or parakeratinized epithelium dense...

Gingival RecessionEtiopathogenesis

Gingiva

• Orthokeratinized or parakeratinized epithelium

• Dense lamina propria

Alveolar Mucosa

• Non-keratinized epithelium

• Elastic fibers• Loosely bound to the

perisoteum• Permits movements

Morphologic Classification of Periodontium

Maynard and Wilson (1968)

How much gingiva is required

• 1mm may create no problems in patients with good oral hygiene

Marginal Tissue Recession• Exposition of the radicular surface of the

tooth due to destruction of the marginal gingiva and of the epithelial attachment that will be reestablished at a more apical position

ClassificationSullivan and Atkins (1968)

• Shallow narrow

• Deep narrow

• Shallow wide

• Deep wide

Classification of Gingival Recession

• Class I– Marginal tissue recession

which does not extend to the mucogingival junction

– No periodontal bone loss in the interdental area

– 100% root coverage

Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5:8-13

• Class II– Marginal tissue recession

which extends to or beyond the mucogingival junction

– No periodontal loss in the interdental area

– 100% root coverage

Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5:8-13

• 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

Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5:8-13

• 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

Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5:8-13

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 CO FACTORS

•Bacterial PlaqueO`Leary et al found direct correlation between the increase of plaque index ad the increase of marginal tissue recession

•Trauma from toothbrushingImproper techniqueWrong toothbrush

•Iatrogenic FactorsAmalgam or prosthetic overhangClampsOrthodontic appliances

•HabitsFingernails or any foreign object

•Tooth MalpositionBuccally displaced teeth or rotated tooth due to altered tooth-bone relationship

•Unfavorable AnatomyHigh frenum insertionShallow 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

Ruben (1978): in prominent teeth, the bone thickness could be as little as 0.15 mm( less than the PDL)

• Spread of inflammation into the thin mucosa, will result in its severance.

• Inflammation is a constant factor

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

CPITN Probe