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PubMed1997

Treatment of gingival recession using guided periodontal tissue regeneration.

Gingival recession is an apical displacement of the gingival margin and involves loss of connective tissue attachment and the supporting alveolar bone. Various treatment modalities have been utilized in the treatment of gingival recession in order to eliminate etiologic factors, achieve root coverage, regenerate the lost periodontal attachment, and prevent perpetuation of the disease. During the past two decades, the broad concept of guided tissue regeneration has become specific, identifying the specific treatment involved as guided bone regeneration and guided periodontal tissue regeneration. The learning objective of this article is to review the literature and principles of guided periodontal tissue regeneration in the treatment of gingival recession and to describe the surgical technique for clinical application of these principles. Several cases are utilized to illustrate the detailed clinical presentation of selective cell repopulation of gingival tissue defects.

Adult↗

PubMed1989

Occurrence of gingival recession in adults.

The occurrence of gingival recession was investigated in adults by age and gender and in relation to their dental status and frequency of toothbrushing. A total of 258 dentate subjects were clinically examined. Their mean age was 46 years and they had an average of 19.4 natural teeth. Gingival recession was recorded as present if any root surface was clearly visible without retraction of the gingival tissue. Recession was found on at least one tooth surface in 68% of subjects. Mean number of surfaces with recession was 7.2 for women and 10.4 for men. Subjects with gingival recession had fewer natural teeth than did those without recession. The two groups did not differ from each other in the number of filled teeth and decayed teeth. Mandibular teeth had more surfaces with recession than did maxillary ones. Sites of recession occurred quite symmetrically. Frequent toothbrushers had, both in the maxilla and mandible, more surfaces with recession than had those brushing their teeth infrequently. Frequent toothbrushing had a greater association with recession among women and in the youngest age group.

Adult↗

PubMed1992

The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession.

This paper describes the occurrence and levels of gingival recession in 2 cohorts of individuals participating in parallel longitudinal studies in Norway (1969-1988) and Sri Lanka (1970-1990), covering the age range from 15 to 50 years. In the Norwegian cohort gingival recession had begun early in life. It occurred in greater than or equal to 60% of the 20 year-olds and was confined to the buccal surfaces. At 30, greater than or equal to 70% had recession, which still was found mainly on buccal surfaces. As the group approached 50 years of age, more than 90% had gingival recession; greater than or equal to 25% of the buccal surfaces were involved, greater than or equal to 15% of lingual, and 3 to 4% of the interproximal surfaces. In the Sri Lankan cohort greater than or equal to 30% exhibited gingival recession before the age of 20 years. By 30 years, 90% had recession on buccal, lingual, and interproximal surfaces; and at 40 years, 100% of the Sri Lankans had recession. As they approached 50 years, gingival recession occurred in greater than or equal to 70% of the buccal, greater than or equal to 50% of the lingual, and 40% of the interproximal surfaces. Based on the special features of the two cohorts, the working hypothesis is advanced that there is more than one type of gingival recession and probably several factors determining the initiation and development of these lesions.

Age Factors↗

PubMed1996

Comparative study of a bioresorbable and a non-resorbable membrane in the treatment of human buccal gingival recessions.

Twelve patients with bilateral comparable gingival recessions were treated using a split mouth design, to compare the relative success of root coverage by two regenerative procedures. The areas of recession treated were Class I or II according to Miller's classification and caused either an esthetic problem and/or root sensitivity. The symmetrical defects, on the maxillary canines, 4 mm or deeper, were randomly assigned in each patient to surgical procedures with either a bioresorbable matrix barrier (test) or a non-resorbable expanded polytetrafluoroethylene membrane (control). Gingival recession, clinical attachment level, probing depth, and extension of keratinized tissue were measured at baseline and at 6 months postsurgically. Both procedures resulted in significant root coverage (P < 0.0001) and attachment gain (P < 0.0001). The gingival recession decreased from 4.75 +/- 0.22 mm to 0.83 +/- 0.24 mm and from 4.75 +/- 0.22 mm to 0.75 +/- 0.22 mm, corresponding to a mean root coverage of 82.4% and 83.2%, at the test and control sites respectively. The average clinical attachment gain was 4.33 +/- 0.44 mm at the test sites compared to 4.42 +/- 0.48 mm for the non-resorbable barrier. No significant changes were found for probing depth and keratinized tissue. Data analysis did not demonstrate any significant difference between the two procedures for any of the variables included. However, a questionnaire given to each patient revealed the single-step surgery to be the patients' choice.

Adult↗

PubMedDate not supplied

[Current therapy of gingival recession].

The muco-gingival surgery represents one of the facet of periodontal surgery. The gingival recessions, characterized by a total attachmentless uncovering the root surface, become an esthetic and painful problem for our patients. The recessions can be treated by different surgical procedures. After a review of the etiologic factors and of the different type of wound healing, the authors describe and illustrate respectively the gingival graft for root coverage and the laterally positioned flap.

Gingiva↗

PubMed2003

Coronally positioned flap with or without enamel matrix protein derivative for the treatment of gingival recessions.

PURPOSE: To evaluate, histometrically, the healing of gingival recessions treated by coronally positioned flaps associated with enamel matrix protein derivative (EMD-Group) and to compare it to that obtained with coronally positioned flaps alone (CPF-Group). METHODS: Five mongrel dogs were used. Gingival recessions were surgically created on the buccal aspect of the upper cuspids. The defects (5 x 7 mm) were exposed to plaque accumulation for 3 months. After a preparation period, the contralateral defects were randomly assigned to each group. After 3 months of healing, the dogs were sacrificed and the blocks were processed. The histometric parameters evaluated included: gingival recession, length of epithelium, new connective tissue attachment and new bone. RESULTS: The gingival recession was -0.1 +/- 0.2 mm for the EMD-Group and -0.8 +/- 1.3 mm for the CPF-Group (P = 0.17). The extension of the epithelium was 1.2 +/- 1.0 mm for the EMD-Group and 1.3 +/- 0.7 mm for the CPF-Group (P = 0.89). The new connective tissue attachment was 4.8 +/- 0.7 in the EMD-Group and 4.0 +/- 1.4 in the CPF-Group (P = 0.22). The new bone was 0.1 +/- 1.8 mm and -0.5 +/- 1.4 mm in the EMD-Group and CPF-Group, respectively (P = 0.50). Histologically, the defect coverage observed was 98.2% for the EMD-Group and 85.8% for the CPF-Group.

Acid Etching, Dental↗

PubMed1994

Orthodontic treatment and isolated gingival recession: a review.

Isolated gingival recession may occur in as many as 30 per cent of adolescents, and lead to problems of dentine hypersensitivity, root caries, and gingival inflammation in adult life. This review discusses the prevalence and aetiology of isolated recession, with particular reference to the implications for orthodontic treatment. Consideration is also given to the differing philosophies for management.

Adolescent↗

PubMed2003

A promising periodontal procedure for the treatment of adjacent gingival recession defects.

Various clinical reports on the reconstruction of gingival recession defects have been published in the past decade. Several techniques have been used to achieve root coverage, including creation of free gingival grafts, laterally positioned flaps or semilunar coronally positioned flaps, as well as guided tissue regeneration and connective tissue grafting. This article focuses on the importance of connective tissue grafting, combined with a recent approach known as the tunnel procedure, in managing gingival recession defects with a single operation. This procedure originated in 1985 with an envelope design and a subepithelial connective tissue graft for single gingival recession defects and is used today for coverage of multiple adjacent gingival recession defects. Histological evaluation of such connective tissue grafts demonstrates periodontal regeneration in human subjects. Clinical trials have yielded good results, including early tissue healing because of increased blood supply, good esthetic results, excellent patient cooperation and avoidance of secondary periodontal plastic surgery. These benefits underline the appropriateness of this technique, which improves the success rate of connective tissue grafting and increases the amount of root coverage.

Connective Tissue↗

PubMed2004

Gingival recession: epidemiology and risk indicators in a representative urban Brazilian population.

BACKGROUND: Gingival recession is a common manifestation of periodontal disease, but it is also associated with other risk factors. A few studies have investigated the epidemiology and risk factors of this condition. This study describes the epidemiology of gingival recession in a representative, urban Brazilian population and assesses various risk indicators. METHODS: A representative sample of 1,460 subjects was selected using a multi-stage, probability, cluster sampling strategy. The subjects were interviewed using a structured questionnaire and had a full-mouth clinical examination in a mobile examination center. RESULTS: More than half (51.6%) and 22.0% of the individuals and 17.0% and 5.8% of teeth per individual showed gingival recession > or = 3 mm and > or = 5 mm, respectively. The prevalence, extent, and severity of recession correlated with age. Recession showed a nonlinear relationship with age, with 25 to 50 year olds showing the highest level of recession. Males aged > or = 30 years showed significantly higher prevalence and extent of gingival recession than females. The percentage of teeth with recession was significantly higher in the lower socioeconomic groups irrespective of age, and in subjects > or = 30 years of age with irregular dental care than in subjects with regular care. Using a multivariable model, cigarette smoking and presence of supragingival calculus were the factors most significantly associated with localized and generalized recession, whereas gender, dental visits, and socioeconomic status were not significant risk indicators. CONCLUSIONS: The high level of gingival recession in this Brazilian population may be primarily related to destructive periodontal disease and is significantly associated with a high level of supragingival dental calculus and cigarette smoking. Population-based programs aimed at the prevention of periodontal diseases may reduce the prevalence of severe gingival recession in this and similar populations.

Adolescent↗

PubMed2001

Evaluation of gingival recession in left- and right-handed adults.

Recession is the exposure of the root surface by an apical shift in the position of the gingiva. Several factors have been implicated in the etiology of gingival recession. The aim of this study was to assess the relationship between gingival recession and the hand, right or left, duration, frequency, and technique of tooth brushing in left- and right-handed adults in Erzurum, Turkey. Fifty five left-handed (35 female and 20 male) and 55 right-handed (35 female and 25 male) subjects were included in the study. The left and right hand positions of the subjects were determined by using Oldfield's Edinburg Inventory Index, and they were divided into two groups as left-handed and right-handed. The amount of gingival recession and localization, oral hygiene situations, gingival bleeding, toothbrushing duration, frequency, and techniques of subjects were evaluated. The relationship between the amount of gingival recession and localization and the subjects' hand, duration, frequency and technique of tooth brushing were examined. The data were evaluated with variance analysis and student's t test. The oral hygiene situations in right- and left-handed subjects were determined. On comparing the left-handed subjects with the right-handed ones, it was observed that the left-handed subjects had better oral hygiene than the right-handed. But, this case was not statistically significant (p > .05). In both right-handed and left-handed subjects, women had better oral hygiene than men (p < .01). The rate of gingival recession was found more in the left-handed than in the right-handed (p < .05). In the right-handed subjects, gingival recession was found in the premolar and canine regions of upper right and lower right jaw. A similar result was also observed in the left-handed subjects, because gingival recession was seen on their upper left and lower left jaw. Incisive teeth were affected at the same rate in the left-handed and right-handed. The gingival recession was seen more in maxillary jaw than in mandibular jaw in both groups. A statistically significant relationship between gingival recession and frequency duration, and technique of tooth brushing was found. While the greatest amount of gingival recession was found in horizontal scrub technique, gingival recession increased with increasing tooth brushing duration and frequency. The relationship between gingival recession and hand using in tooth brushing was determined.

Adult↗

PubMed2001

Comparative 6-month clinical study of a subepithelial connective tissue graft and acellular dermal matrix graft for the treatment of gingival recession.

BACKGROUND: Different techniques have been proposed for the treatment of gingival recessions. This study compared the clinical results of gingival recession treatment using a subepithelial connective tissue graft and an acellular dermal matrix allograft. METHODS: Nine patients with bilateral Miller Class I or II gingival recessions were selected. A total of 30 recessions were treated and randomly assigned to the test group and the contralateral recession to the control group. In the control group, the exposed root surfaces were treated by the placement of a connective tissue graft in combination with a coronally positioned flap; in the test group, an acellular dermal matrix allograft was used as a substitute for palatal donor tissue. Probing depth, clinical attachment level, gingival recession, and width of keratinized tissue were measured 2 weeks prior to surgery and 3 and 6 months postsurgery. RESULTS: There were no statistically significant differences between the test group and the control group in terms of recession reduction, clinical attachment gain, and reduction in probing depth. The control group had a statistically significant increased area of keratinized tissue after 3 months compared to the test group. Both procedures, however, produced an increase in keratinized tissue after 6 months, with no statistically significant difference. CONCLUSION: The acellular dermal matrix allograft may be a substitute for palatal donor tissue in root coverage procedures.

Adult↗

PubMed2004

[Treatment of gingival recessions of teeth with ceramic full crown by autogenous connective tissue graft].

PURPOSE: The aim of this clinical study was to evaluate gingival recession of teeth with ceramic full crown treated with subepithelial connective tissue grafts. METHODS: In 20 systemically healthy, whose ages ranging from 31 to 58 years, 32 teeth with ceramic full crown developed gingival recession. Selection of gingival recession defects was based upon the following criteria: A minimum of 2 mm of root surface exposure in coronal-apical height. Miller class I and II recession. Interproximal and labial probing depth </=4 mm. No active caries or restorations on the tooth surfaces. Gingival recession were treated with subepithelial connective tissue grafts technique. RESULTS: The results indicated that subepithelial connective tissue grafts increased the height of gingival recession (GR) and gingival thickness (GT), the mean percentage of root coverage (RC) was 85.1%. CONCLUSION: These results suggest that subepithelial connective tissue grafts were able to successfully treat gingival recession defects. Moreover, the results has significant clinical benefit for aesthetics and treatment outcomes.

Adult↗

PubMedDate not supplied

The prevalence and distribution of gingival recession among U.E. dental students with a high standard of oral hygiene.

The aims of this study were to evaluate the prevalence and the distribution of the attachment loss and gingival recession at facial tooth surfaces in a population sample with a high standard of oral hygiene, at the same time, to determine the occurrence of gingival recession. An additional aim was to study the relationship between attachment loss and gingival recession and its relation to its etiologic factors. The subject sample comprised of 100 male and female dental students in the University of the East between the ages of 18 and 26 with a minimum of 25 natural teeth, no advance periodontitis or history of periodontal surgery were examined, gingival recession was scored as present whenever the free gingival margin was apical to the c.e.i. and root surface was exposed. The clinical examination involved assessment of gingivitis, probing depth, probing attachment and gingival recessions. The results of the combined cross-sectional and longitudinal analysis performed in the study demonstrated among 100 U.E. dental students with a high standard of oral hygiene showed that: 1) Facial gingival recessions was a frequent finding due to the compensatory and remodelling process caused by loss of approximal periodontal attachment; 2) Prevalence and distribution of gingival recessions is independent with the presence of attachment loss; 3) Facial gingival recessions can exist with or without attachment loss and teeth without gingival recessions may or may not present attachment loss; 4) And presence of gingival recessions in patients with a high standard of oral hygiene can either be attributed to orthodontic treatment or wrong toothbrushing technique, too much strength exerted in brushing, overbrushing, and usage of hard toothbrush bristles.

Adolescent↗

PubMed1991

The association between supragingival [correction of subgingival] calculus deposits and the extent of gingival recession in a sample of Thai children and teenagers.

A survey was performed on a sample of children and teenagers in Thailand. The sample consisted of 260 subjects ages 10-17 years. Assessments of the prevalence and amount of supragingival calculus (Volpe-Manhold) on the facial and lingual surfaces of the six mandibular anterior teeth were recorded. All subjects then received a thorough whole mouth prophylaxis. Two weeks later they were reexamined for gingival recession using the Gingival Recession Total (GRT) scoring system on the same six mandibular anterior teeth. For the analysis, the calculus scores were used to categorize the subjects as having slight, medium, or heavy calculus. Using the GRT scores, the same subjects were then categorized as having mild, moderate or extensive gingival recession. The categories of both calculus level and gingival recession level were statistically assessed using the Chi-square distribution and a significant difference was found indicating that the amount of calculus was related to total gingival recession. Subjects with slight calculus had more mild recession whereas medium or heavy calculus formers had more moderate or extensive total gingival recession scores.

Adolescent↗

PubMed1997

Alternative method of conservative esthetic treatment for gingival recession.

The health and appearance of gingival tissue play an essential role in esthetics. The esthetic function of the tissue is enhanced when it frames the restoration. With gingival recession, the effect of natural gingiva is created with pink composites or ceramics on the cervical part of the crown, as described in this clinical report. This goal depends on the absence of adverse effects on the color, shape, and health of the surrounding tissue. The new composites are more color stable and wear resistant, and the latest generation of dental bonding agents allows the bonding of composites to dentin, various metals, and porcelain. The application of soft-tissue colored composite on dentin cementum, enamel, or porcelain is a good solution for correcting gingival recessions.

Acid Etching, Dental↗

PubMed1978

Treatment of localized gingival recessions. Part II. Coronally repositioned flap with a free gingival graft.

Fourteen teeth with localized gingival recessions were treated using a coronally repositioned flap with a free gingival graft (Bernimoulin, 1973). The second step of the procedure was performed 1 month after the free gingival graft was done. Clinical measurements of the recession, sulcus depth and keratinized gingiva were taken preoperatively and at 30, 90 and 180 days after surgery. A mean reduction in the recession of 2.73 mm was obtained after 6 months, which was equivalent to a 64% decrease of the original recession. A significant increase in the width of the keratinized gingiva, averaging 3.27 mm, was found after 6 months. All results remained stable after 30 days postoperatively. The values for gingival recession, sulcus depth and width of keratinized gingiva on the teeth adjacent to the recessions remained unchanged, since they were undisturbed by the procedure.

Gingiva↗

PubMed1993

Gingival recession in relation to history of hard toothbrush use.

Gingival recession studies in the U.S. have related primarily to sex and age with little consideration of toothbrush hardness. This preliminary study examined the relation between a history of hard toothbrush use and gingival recession. A total of 182 subjects, male and female, between 18 and 65 years of age, with a minimum of 18 natural teeth, no advanced periodontitis or history of periodontal surgery were examined. Gingival recession was scored as present whenever the free gingival margin was apical to the cemento-enamel junction and root surface was exposed. History of hard toothbrush use was ascertained. Eighty-two subjects had a history of hard toothbrush use, 77 did not, and 23 did not know. The percentage of subjects with recession increased with age from 43% to 81%, with a figure of 63% for all age groups combined. Males tended to show slightly greater levels of recession than females. Regression analysis showed that females had about 4 percentage points less receded surfaces than males. Recession was also found to be more pronounced for subjects with a history of hard toothbrush use, with a mean of 9.4% receded surfaces versus 4.7% for those who had never used a hard brush. For users of hard toothbrushes, the percent of surfaces with recession showed a significant and dramatic increase with increasing brushing frequency; this effect did not exist for those without a history of hard brush use. The relation with age was highly significant, with regression analysis showing that the percent of surfaces with recession tends to increase about 3.5 percentage points per decade.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1977

Gingival recession and tooth mobility.

Tooth mobility measurements were carried out on 107 teeth with gingival recession in 20 subjects. Alveolar bone dehiscence around 43 of these teeth was measured during flap surgery in 13 subjects. No significant correlation was found between gingival recession and tooth mobility, and between tooth mobility and alveolar bone dehiscence. A positive, significant correlation was present between gingival recession and bone dehiscence. In 17 of the subjects, tooth mobility of 29 homologous contralateral teeth with and without gingival recession was compared. The difference was not significant. The role of trauma from occlusion in the etiology of gingival recession is questioned.

Adolescent↗