Gingival recession is a specific status of periodontal tissue where we can find a loss of attachment from the supporting bone and soft tissues addressed to many factors:
We might think that bacterial proliferation is the most common reason but Gingival Recession is the result of multifactorial elements that work together in different moments causing the mentioned situation and not a single etiology as the main factor.
*It is also important to mention that the Genetic Factors and Soft Tissue Biotype will mark certain tendency to compensate or increase the gingival recession when at least 1 of this 5 factors are present.
Lets mention the 5 most common reasons for gingival recession:
- Bacterial proliferation (plaque induced): The apical migration of bacterias at the gingival margin level will be a key factor for gingival inflammation, loss of attachment at different levels ( supra crestal fibers or periodontal ligament; this is fully explained at the Soft Tissue Management & Grafting Master course available in your Registration. This will cause a bone defect and established pockets at the inter proximal areas and gingival recession at buccal and lingual sides.
- Tooth malposition: Those teeth which are not hosted inside the alveolar bone or Bone Envelope will suffer from gingival recession derived from bone dehiscences and apical migration of hard and soft tissue.
- Malocclusion: Non balanced occlusion derived from teeth malposition will force trauma from occlusion, non carious cervical lesions, prematurities, excessive ware at excursive movements and many other pathologies that will increase over time if this issues are not fixed.
- Trauma from occlusion: Already mentioned is one of the most misdiagnosed reasons for Periodontal disease.
- Vertical and over forced brushing: It is usually an adding factor but not main factor for gingival recession unless it is excessive and performed over a very thin soft tissue biotype.
Some following factors might unavoidably increase gingival recession this is the reason we must know them and treat in advance such as:
- Orthodontic flaring effect: The buccal movement of teeth to create space might reduce the buccal plate thickness and also the overlying soft tissue creating gingival recession. For this reason we should take a CBCT previous orthodontic treatment to control the tooth movement and establish the limits or if needed increase the soft tissue quality before / during the orthodontic treatment (available in Soft Tissue Management & Grafting Master course).
- Periodontal Therapy: The healing of the tissues after a surgical or non surgical supportive periodontal therapy will derive into a shrinkage as a consequence of the maturation of the tissues.
- Biotype: Usually thin soft tissue biotype is addressed to thin buccal or lingual walls, so CBCT will also help us to assess the patient and ourselves.
An example of multifactorial effect would be:
- Patient with malpositioning will create a recession. Partial root exposure to oral cavity will increase the bacterial proliferation over a rough surface (the root has cement, much more rough than enamel surface), this will increase gingival inflammation which might become chronic or in a very slow progression which will mask the inflammation. In case of inflammation, pain might occur and no brushing as self protection habit will increase the bacterial proliferation.
- The case above presented is a consequence of many factors which combined, started and increased the gingival recession. The patient finished the orthodontic treatment 20 years ago and old thick retainer was placed from canine to canine. Debonding from laterals and one central was experienced with no check up controls and bending movement from canines and lever from laterals and central non attached to the retainer caused migration of apex towards buccal wall out of the envelope.
This proves that when we see a gingival recession we must know the etiology of the recession before planning the surgery to avoid relapse and complications.
Learn this and much more at the Soft Tissue Management & Grafting Master course to become predictable and avoid complications.