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Gingival recessions are regarded by many people as an esthetical problem. Successively the etiology, the significance and the indications for therapy are discussed. Different kinds of therapy such as oral hygiene instruction, the free gingival graft and various pedicle grafts are explained. Finally it is advocated that surgical kinds of therapy have to be applied with reservedness.
Gingival mucus in an older patient is the site of the slowing-down of the cellular turnover, of a lessening of metabolic activity and of keratinisation. The resistance to mechanical attacks and bacteria lessens thus its potential for repair. Thus one notes a worsening state of parodontal complaints during old age. By means of a study carried out at the Clinique de Parodontie of the Institut d'Odonto-Stomatologie in Dakar, we propose to attempt to see if the presence of gingival retraction can be linked with parodontal senescence by means of observing 318 patients.
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Frequency severity of gingival recessions was studied with Stahl and Morris indices. The results showed that the localization of gingival recession was more important on the mandible (37%) than on the maxillary (27.6%) it, also demonstrated the importance of various etiologies and particularly the association of trauma - tooth malposition (81%).
The accurate assessment of gingival recession is important because of soft tissue deterioration and/or the state of soft tissue health. While recession of the gingival margin is a common and important symptom of periodontal disease, it also refers to the location of the gingiva and not to its condition. Recession can occur at all tooth surfaces. This paper describes a new system designed to measure two parameters of gingival recession. One parameter of recession is visible above the gumline to an observer, while another parameter is hidden by the gingiva itself. Visible recession is the shift of the marginal gingiva to a position apical to the cemento-enamel junction. Hidden recession is obscured by gingiva and can be assessed by measuring from the free gingival margin to the level of epithelial attachment. The system developed here differs from the current indices commonly used for gingival recession, since it combines both the visual portion with the hidden portion of recession for a total score. The assessment method is similar to the calculus scoring procedure of Volpe and Manhold and is called the Gingival Recession Total (GRT) scoring system.
A clinical case is presented where a 100% root coverage is performed with a free gingival graft in a one step method. The surgery technique is described in detail.
Aggressive or improper toothbrushing techniques may have a detrimental impact on the gingiva. The purpose of this study was to examine the relationship between chewing sticks (Miswak) and gingival recession. Gingival recession was measured on the mid facial surfaces of the incisors, canines, and premolars in 238 patients presenting for routine dental appointments. All patients had been interviewed previously regarding their oral hygiene habits and use of Miswak. Patients were divided into three groups: Miswak group, toothbrush group, and Miswak/toothbrush group. The Miswak users had significantly more (P less than or equal to .05) sites gingival recession than did the toothbrush users. Furthermore, the severity of the recession was significantly more (P less than or equal to .05) pronounced in the Miswak users than it was in the toothbrush users.
Gingival recession is a manifestation of periodontal breakdown. Plaque microorganisms are the primary aetiological factor, but other secondary conditions are also associated with its presence. This study examined the hypothesis that localized gingival recession is more prevalent in open-bite cases. The study included 26 children with untreated anterior open bite and a matched control group. Clinical crown length, recession depth, oral habits and periodontal indices were recorded for each individual. Although the plaque index was not significantly different between the two groups, the open-bite group showed significantly greater clinical crown length and gingival inflammation. This may be attributed to increased virulence of dehydrated plaque and it is suggested that open bite may predispose to the development of localized gingival recession in the anterior segments of young individuals.
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.
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.
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.
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.
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.
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.
A total of 1005 persons were examined using the CPITN criteria which were recorded for every tooth. All the teeth were also measured on both their buccal and lingual aspects to assess the amount of gingival recession. The combination of pocket depth and gingival recession was computed using a specially written program: 93.8 per cent of the teeth had 1 mm or less gingival recession; 82.5 per cent of the teeth with gingival recession did not present pockets; 26.6 per cent of all subjects had at least one tooth with gingival recession of 2 mm or more but only 9.9 per cent had at least one tooth with 2 mm or more gingival recession and a periodontal pocket.