Transcript Gingival Recession Etiopathogenesis

Gingival Recession
Etiopathogenesis
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
Classification
Sullivan 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
•Bacterial Plaque
O`Leary et al found direct
correlation between the increase of
plaque index ad the increase of
marginal tissue recession
•Trauma from toothbrushing
Improper technique
Wrong toothbrush
•Iatrogenic Factors
Amalgam or prosthetic overhang
Clamps
Orthodontic appliances
•Habits
Fingernails or any foreign object
CO FACTORS
•Tooth Malposition
Buccally displaced teeth or rotated
tooth due to altered tooth-bone
relationship
•Unfavorable Anatomy
High frenum insertion
Shallow 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