GINGIVAL RECESSION

R O A D M P DEFINITION CLASSIFICATION FACTORS PROCESS OF RECESSION PROGRESSION SYMPTOMS TREAMENT PREVENTION

MARGINAL TISSUE RECESSION Exposition of the radicular surface of the tooth due to destruction of the marginal gingiva and of the juntional epithelium that will be re-established at a more apical position.

B A S I C R E V W MARGINAL GINGIVA + ATTACHED GINGIVA= KERATINIZED GINGIVA ALVEOLAR MUCOSA MARGINAL /ATTACHED = FREE GINGIVAL GROOVE ATTACHED/ ALVEOLAR MUCOSA= MUCOGINGIVAL JUNCTION

MILLAR’S CLASSIFICATION OF GINGIVAL RECESSION:

CLASS II CLASS II

` CLASS III

C L A S IV

SALLIVAN & ATKINS: (1968) Shallow narrow Deep narrow Shallow wide Deep wide

ETIOLOGY DETERMINANT FACTORS Bacterial Plaque O`Leary et al found direct correlation between the increase of plaque index and 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 ETIOLOGY

INADEQUATE ATTACHED GINGIVA LIP & TONGUE PIERCING PARTIAL DENTURE CLASP INADEQUATE ATTACHED GINGIVA AMALGAM OVERHANGS

CO FACTORS Tooth Malposition Unfavorable Anatomy Orthodontic Movements 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

STILLMAN’S CLEFT

PATHOGENESIS

PROGRESSION OF RECEDING GUMS • Pink • Tight to teeth • Scalloped appearance around each tooth • Swollen • Bleeding • Bright red • Tender to touch • Gums pull away from teeth • Loose teeth • Pus between teeth and gums • Roots visible • Temperature sensitivity • Inflamed gums with pus • Tooth loss

SYMPTOMS: Tooth sensitivity Toothy smiles Notched tooth Color change Space between teeth becomes wider If the gum recession is caused by GINGIVITIS, the following symptoms may also be present Puffy, red, or swollen (inflamed) gums Gum bleeding while brushing or flossing Bad breath (halitosis)

TREATMENT Cause-specific treatment in non-progressive gingival recession Surgical root coverage in progressive gingival recession.

OBJECTIVES: Problems associated with attached gingiva Problems associated with shallow vestibule Problems associated with aberrant frenum

“AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE.” Non traumatic plaque control Treating gingivitis & peridontitis in early stages NO to ORTHODONTICS Treat occlusal trauma Caution in restorative procedures Contours help plaque control Design prosthetic appliances