Etiology of gingival recession

The “Clinician’s Corner” article in the June issue reporting spontaneous improvement of gingival recession is well written and nicely documented. But by casting blame on previous orthodontic treatment, I believe that the authors may have overlooked the etiology of gingival recession. The patient was 30 years of age. The completion date of the initial orthodontic treatment was not stated. Presumably, a few years (or more) passed since active orthodontic treatment was completed and fixed lingual retention placed.

In this patient, I believe that the mandibular bonded lingual retainer might have been the primary cause of postactive orthodontic root movement and subsequent gingival recession.

To explain: attaching the anterior teeth to a wire on the lingual aspect above the cingulum may allow centers of rotation well above the centers of resistance. As the crowns overlap and the crown is forced lingually, the root tip moves labially (mandibular right central incisor). Conversely, with facial crown movement, the root tip must move lingually (mandibular left central incisor). This may have occurred in this interesting case. A similar event was reported in the AJO-DO in December 2012. In that article, the etiology of recession was reported to be onychophagia (nail biting).

Having completed more than 40 years of private orthodontic practice in 1 city and as head of the largest group of orthodontic practices in Georgia, I bear the scars of numerous usual and unusual long-term orthodontic events. Typically, we don’t have the opportunity to follow our teenaged patients to adulthood and beyond. Many clinicians may consider this a lucky event. These “fortunate” orthodontists may remain unaware of the potential damaging consequences of long-term and continuous fixed lingual retention.

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Apr 6, 2017 | Posted by in Orthodontics | Comments Off on Etiology of gingival recession
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