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- Gingival Recession -An Overview of Etiology and Treatment

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Trung Tran DDS, MS

What are we

Treatment Plan Development

• Recognition/Diagnosis of Gingival Recession• Determine Etiology• Counsel Patient on Plaque Control and any Modifiable Factors• Determine Need for Treatment• Determine Type of Treatment Indicated

Gingival Recession: Location of the gingival marginapical to the CEJ

AAP

How much recession is out there?

Estimated that over 23 million people in the U.S. have at least one tooth with 3mm of

recession

Over 50% of Americans older than

30 have gingival recession of 1mm

Albander and Kingman 1999

Primary Etiology

InflammationTrauma

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Secondary FactorsAberrant Frenum

Thin Tissue Biotype Lack of Facial Alveolar Bone

Labially Positioned Teeth Orthodontic Tooth Movement

Violation of Biologic Width by Subgingival Restoration

Inflammation

Toothbrush Trauma Aberrant Frenum

Lack of Facial Boneor

Thin tissue

Labially Positioned Teeth

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Facial OrthodonticMovement Does an exposed root have to be treated?

Research has proven that minimal amounts of attached gingiva can resist additional recession,

as long as plaque control is ideal and hygiene is atraumatic.

Dorfman, Kennedy, Bird 1982

Indications for Treatment

Esthetic ConcernThermal Sensitivity

Cervical DecayProgressive Loss of Attachment

Orthodontic ConsiderationsPlanned Subgingival Restorations

Lack of Attached Gingiva - Mucogingival Defect

Treatment Options and Goals

No TreatmentClass V Restoration

Tissue Graft for Root CoverageTissue Graft to Augment Existing Marginal Tissue

Classification of Recession DefectsP. D. Miller 1985

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Miller Class I Miller Class II

Miller Class III Miller Class IV

The only types of recession defects that can be grafted predictably for complete root

coverage are Miller Class I and IIMiller 1985

The Tissue is the Issue

But

The Bone Sets the Tone

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Periodontal Techniques for Treating Gingival Recession

Free Gingival GraftCoronally Positioned FlapConnective Tissue Graft

Tissue Allograft – Alloderm

Harvesting Free Gingival Graft

Free Gingival Graft and Coronally Positioned Flap

Miller Class II defect with associated thin tissue and frenum

Complete Root Coverage is not possible due to

proximal bone loss

Free Gingival Graft

Miller Class III defects

Tissue Attachment is beyond Mucogingival Junction

Graft to Aid in tissue health by:- Deepening vestibule- Increasing width of

keratinized attached tissue

Coronally Positioned Semilunar Flap

Miller Class I Defect #8

Connective Tissue Harvest

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Connective Tissue Graft

Miller Class II Defect

Alternative Tissue Source

-Epidermis removed with buffered salt solution-Dermal cells removed with patented non-denaturing detergents

-Cryogenesis / Freeze Dried

Alloderm after hydration in saline and patient’s blood

Miller Class I and II defects

Large span not ideal for autogenous tissue harvest

Alloderm Tissue Graft Symbios™ PerioDerm® Acellular Dermis

Features Benefits

No cross-linking (no gamma irradiation used in processing)

• Faster incorporation Predictable outcomes

• Less risk of surgery site inflammation and rejection

Over 90% thickness consistency Uniform revascularization and esthetic results

Excellent handling • Rehydrates quickly (3-5 minutes)

• No refrigeration required

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Perioderm

Soft Tissue Grafting versus Cervical Composites

True Biologic RestorationLong Term StabilityEsthetic Potential

Perioderm Guidelines for Selecting Cases with Cervical Decay for Tissue Grafting

• Miller Class I and II defects only

• Depth of decay must be less than 2mm

• Decay should not extend coronally into enamel

• High esthetic demand

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Consider Class V Restoration

Connective Tissue Graft with Cervical Decay

Miller Class II Defects

Connective Tissue Graft with Cervical Decay

Miller Class II Defect

Conclusions

• Treatment of gingival recession is not mandatory

• Not all recession defects can be covered by tissue grafts, although grafting may still be needed to augment existing marginal tissue

• If possible, patients should be given the option of tissue grafting

• In select cases, alternatives to harvesting autogenous tissue exist

• In select cases, tissue grafting should be considered as a treatment choice for cervical decay

Bibliography

• Sato N. Periodontal Surgery. Quintessence Publishing. 2000.• Nevins M, Mellonig J. Periodontal Therapy – Clinical Approaches and Evidence of

Success. Vol I. Quintessence Publishing. 1998.• Henderson R. Root Coverage Using Alloderm Acellular Dermal Graft Material –

Masters Thesis. University of Louisville. 2000.• Albander J, Kingman A. Gingival recession , gingival bleeding, and dental calculus

in adults 30 years of age and older in the united States, 1988-1994. J. Periodontol 70(1):30-43, 1999.

• Miller PD. A classification of marginal tissue recession. Int Journ Perio Rest Dent. 5:9:, 1985.

• Dorfman H, Kennedy J, Bird W. Longitudinal Evaluation of Free Autogenous Gingival Grafts – A Four Year Report. J Periodont 53:349-352, 1982.

Questions