Definition:

It is the process in which the gum tissue pulls back from the tooth surface and exposes the dental root.

Etiologic factors:

1. Trigger factors

-Bacterial plaque: Periodontal disease can lead to bone loss, and in consequence, to apical gingival migration and root exposure.

-Traumas:

  • Mechanical abrasion (Aggressive tooth brushing).
  • Direct occlusal trauma.
  • Surgical trauma.
  • Chemical trauma.

2. Predisposing factors

-Absent or insufficient attached gingiva.

-Shallow vestibule.

Frenulum insertion.

-Malpositioned teeth.

-Fenestration and dehiscence.

-Large dental root.

-Decreased alveolar bone crest thickness.

-Cervical caries.

-Non-carious Cervical Lesions.

3. Aggravating factors

-> Iatrogenic factors

-Dental crown or restoration (juxtagingival or intrasulcular cervical limits).

-Ill-fitting retainer or lingual bar (which are parts of a removable partial denture).

-Poorly conducted orthodontic treatment.

4. Other factors

-Malocclusion.

-Tobacco.

Classification

Cairo et al. (2011) classified gingival recession based on the assessment of CAL (Clinical attachment level) at both buccal and interproximal sites.

-Recession Type 1: Gingival recession with no loss of interproximal attachment.

-Recession Type 2: Gingival recession associated with loss of interproximal attachment. 

The amount of interproximal attachment loss (measured from the interproximal CEJ (cementoenamel junction) to the depth of the interproximal pocket) is less than or equal to the buccal attachment loss (measured from the buccal CEJ to the depth of the buccal pocket). 

-Recession Type 3: Gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss is higher than the buccal attachment loss. 

Treatment

-Monitoring the lesion without treatment:

If there is no aesthetic problem, hypersensitivity, or inflammation, and the hygiene is satisfactory → Solution: Avoid traumatic brushing.

-Prevention of a gingival recession:

In the case of a thin and fragile periodontium and orthodontic treatment or restoration with intrasulcular limits → Solution: Mucogingival surgery.

-Stabilization of the lesion:

If there is no aesthetic problem or hypersensitivity, but a persistent inflammation,

Graft and guided tissue regeneration

or tension of a frenum, or risk of progression → Solution: Surgery: supply of keratinized tissue.

-Covering attempt:

Aesthetic discomfort +/- root hypersensitivity → Solution: Periodontal plastic surgery: Regeneration or Soft tissue graft.

Reference

Cairo F, Nieri M, Cincinelli S, Mervelt J and Pagliaro U. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: An explorative and reliability study. J Clin Periodontol 2011;38:661-6.

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