Gingival recession is an intriguing and complex phenomenon. Recession frequently disturbs patients because of sensitivity and esthetics. Many surgical techniques have been introduced to treat gingival recession, including those involving autogenous tissue grafting, various flap designs, orthodontics, and guided tissue regeneration. This article describes different clinical approaches to treat gingival recession with emphasis on techniques that show promising results and root coverage.
Gingival recession is an intriguing and complex phenomenon. Recession frequently disturbs patients because of sensitivity and esthetics. Many surgical techniques have been introduced to treat gingival recession, including those involving autogenous tissue grafting, various flap designs, orthodontics, and guided tissue regeneration (GTR). This article describes different clinical approaches to treat gingival recession with emphasis on techniques that show promising results and root coverage.
Etiology and prevalence
Recession can be defined as the displacement of the gingival margin apically from the cementoenamel junction (CEJ), or from the former location of the CEJ where restorations have distorted the location or appearance of the CEJ. Gingival recession can be localized or generalized, and be associated with one or more surfaces.
Many people exhibit generalized gingival recession without any awareness of the condition and without symptoms. However, patients are often anxious about gingival recession for one or several reasons, including fear of tooth loss, dentinal hypersensitivity, or poor esthetics. Because many possible contributing factors interact to contribute to gingival recession, it is difficult to predict whether further changes in gingival recession may occur at a given site.
Albandar and Kingman studied the prevalence of gingival recession among subjects 30 to 90 years old. Using a sample of 9689 subjects, they projected that 23.8 million persons in the United States have one or more tooth surfaces with 3 mm or more gingival recession. Those investigators also found that the prevalence of 1 mm or more recession in persons 30 years and older was 58%, and increased with age. Males had significantly more gingival recession than females, and African Americans had significantly more gingival recession than members of other racial/ethnic groups. Recession also was more prevalent and severe at buccal than at interproximal surfaces of teeth. Similarly, Gorman found that the frequency of gingival recession increased with age, and was greater in males than females of the same age. Malpositioned teeth and toothbrush trauma were found to be the most frequent etiologic factors associated with gingival recession. Recession associated with labially positioned teeth occurred in 40% of patients 16 to 25 years old, and increased to 80% of patients in the 36- to 86-year-old group. Those findings were corroborated by Gorman, who examined 4000 subjects and found that the incidence of gingival recession increased with age.
The indications for surgical treatment of gingival recession include reducing root sensitivity, minimizing cervical root caries, increasing the zone of attached gingiva, and improving esthetics.
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