Gingival Recession

Author: Gum Specialist Dr Sajni

Gingival recession is the apical shift of the gingival margin with exposure of the root surface to the oral cavity. Potential consequences of gingival recession include pain or sensitivity, poor aesthetics, root caries, abrasion cavities and plaque retention. Management of gingival recession may include monitoring and use of conservative measures, or surgical intervention.

It is essential to try and establish the patient-specific aetiology of recession prior to embarking on treatment. Common predisposing factors include tooth positioning, thin buccal bone, thin phenotype, high frenal attachments and shallow vestibular depth. Precipitating factors include trauma, for example from improper use of cleaning aids and piercings, and plaque accumulation. Often, a combination of these factors will result in gingival recession.

Trauma-induced recession is described as centripetal, as the aetiological agent acts on the external gingival surface. In contrast, bacteria-induced recession is centrifugal, as the inflammatory process acts from the inside to the outside.

The 2017 classification of gingival recession is used for describing recession defects and be specifically helpful to plan surgical management. RT1 (Recession Type 1) is gingival recession with no loss of interproximal attachment. RT2 is gingival recession with loss of interproximal attachment that is less than or equal to the buccal attachment. In RT3, the interproximal attachment loss is greater than the buccal attachment loss. Additional factors that are assessed include the depth of recession, gingival thickness, keratinised tissue width, whether or not the cemento-enamel junction (CEJ) is visible, and if the presence of a root surface concavity.

Gingival recession may be monitored with the use of clinical measurements photographs or scans. Indications for surgical intervention may include aesthetic concerns, augmentation of keratinised tissue and preventing progression of the recession. Management of the modifiable aetiological factors is essential and may include educating patients on atraumatic oral hygiene regimes.

The most commonly used surgical techniques to treat gingival recession are free gingival grafts and coronally advanced flaps with or without connective tissue grafts. In patients with loss of interproximal attachment loss, surgical intervention may not be appropriate for root coverage. In these cases, gingival veneers may be considered to restore the aesthetics.