Gingival recession

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Gingival recession

  1. 1. <ul><li>GINGIVAL RECESSION </li></ul>
  2. 2. <ul><li>CONTENTS : </li></ul><ul><li>1. Definition </li></ul><ul><li>2. Classification </li></ul><ul><li>3. Etiology </li></ul><ul><li>4. Clinical examination </li></ul><ul><li>5. Clinical significance </li></ul><ul><li>6. Treatment </li></ul>
  3. 3. DEFINITION <ul><li>It is the exposure of root surface by an apical shift in the position of gingiva. </li></ul>
  4. 4. 3 <ul><li>The recession is determined by </li></ul><ul><li>the actual position of the gingiva </li></ul><ul><li>not by its apparent position </li></ul>
  5. 5. 5. <ul><li>Recession can be studied as, </li></ul><ul><li>VISIBLE </li></ul><ul><li>HIDDEN </li></ul>
  6. 6. <ul><li>Also it may be </li></ul><ul><li>Localised Generalised </li></ul>
  7. 7. CLASSIFICATION OF RECESSION DEFECTS <ul><li>P.D.MILLER(1985) </li></ul><ul><li>Class I : Marginal tissue recession not extending </li></ul><ul><li>to the mucogingival junction. No loss of </li></ul><ul><li>interdental bone or soft tissue. </li></ul><ul><li>Class II : Marginal tissue recession extends to or </li></ul><ul><li>beyond the mucogingival junction. No </li></ul><ul><li>loss of interdental bone or soft tissue. </li></ul>
  8. 8. <ul><li>Class III : Marginal tissue recession extends to </li></ul><ul><li>or beyond the mucogingival junction. </li></ul><ul><li>Loss of interdental bone or soft tissue </li></ul><ul><li>is apical to the CEJ, but coronal to the </li></ul><ul><li>apical extent of marginal tissue </li></ul><ul><li>recession </li></ul><ul><li>Class IV : Marginal tissue recession extends </li></ul><ul><li>beyond the mucogingival junction. </li></ul><ul><li>Loss of interdental bone extends to a </li></ul><ul><li>level apical to the extent of the </li></ul><ul><li>marginal tissue recession. </li></ul>
  9. 10. <ul><li>Atkin & Sullivan classification </li></ul><ul><li>I. Shallow-Narrow </li></ul><ul><li>II. Shallow-Wide </li></ul><ul><li>III. Deep-Narrow </li></ul><ul><li>IV. Deep-Wide </li></ul>
  10. 11. <ul><li>Etiology: </li></ul><ul><li>1. Age </li></ul><ul><li>2. Faulty tooth brushing technique </li></ul><ul><li>3. Tooth malposition </li></ul><ul><li>4. Gingival inflammation </li></ul><ul><li>5. Abnormal frenal attachment </li></ul><ul><li>6. Trauma from occlusion </li></ul><ul><li>7. Masochistic habits </li></ul>
  11. 12. <ul><li>1. Age </li></ul><ul><li>It inraeses with age. </li></ul><ul><li>8% in children </li></ul><ul><li>50%, above age of 50 yrs </li></ul><ul><li>Reason being , </li></ul><ul><li>(a) Cummulative effect of minor </li></ul><ul><li>pathological involvement </li></ul><ul><li>(b) Repeated, minor direct trauma </li></ul>
  12. 13. <ul><li>2. Faulty tooth brushing technique </li></ul><ul><li>Brush with hard bristles </li></ul><ul><li>Excessive or Aggressive brushing in horizontal direction. </li></ul><ul><li>When used with highly abrasive dentrifice </li></ul><ul><li>A Wedge shaped defect </li></ul><ul><li>Surface – clear, smooth , polished. </li></ul>
  13. 15. <ul><li>3. Tooth malposition </li></ul><ul><li>Recession is affected by : </li></ul><ul><li>a. Position of teeth in the arch. </li></ul><ul><li>b. The root bone angle. </li></ul><ul><li>c. The mesiodistal curvature of the tooth </li></ul><ul><li>surface </li></ul><ul><li>d. Rotated, tilted or facially displaced teeth </li></ul>
  14. 17. <ul><li>If the inclination of the root is not proper, then the bone in the cervical area is thinned or shortened and recession results from repeated trauma of the thin marginal gingiva. </li></ul><ul><li>Pressure from mastication or moderate tooth brushing damages the unsupported gingiva and produces recession. </li></ul>
  15. 18. <ul><li>Malpositioned teeth </li></ul>
  16. 19. <ul><li>4. Gingival inflammation </li></ul>
  17. 20. <ul><li>5. Abnormal frenal attachment </li></ul>
  18. 21. <ul><li>6. Masochistic Habits </li></ul>
  19. 22. <ul><li>Clinical examination </li></ul><ul><li>Measurement of amount of gingival recession is made by Periodontal probe from CEJ to the gingival crest </li></ul>
  20. 23. <ul><li>Clinical significance: </li></ul><ul><li>1. Exposed root surfaces are susceptible to </li></ul><ul><li>caries. </li></ul><ul><li>2. Abrasion or erosion of the cementum </li></ul><ul><li>Underlying dentinal suface </li></ul><ul><li>Sensitivity </li></ul>
  21. 24. <ul><li>3. Hyperemia of pulp may also result from </li></ul><ul><li>excessive exposure of root surfaces. </li></ul><ul><li>4. Interproximal recession creates oral </li></ul><ul><li>hygiene problems & resulting plaque </li></ul><ul><li>accumulation </li></ul>
  22. 25. <ul><li>Treatment </li></ul><ul><li>It can be treated </li></ul><ul><li>Non-surgically </li></ul><ul><li>Surgically </li></ul>
  23. 26. <ul><li>NON – SURGICAL METHOD </li></ul><ul><li>1. Correction of tooth brushing technique </li></ul><ul><li>2. Removal of masochistic habits </li></ul><ul><li>3. Correction of malocclusion </li></ul><ul><li>4. Treating the dentinal sensitivity </li></ul>
  24. 27. <ul><li>Surgically treated by two procedures : </li></ul><ul><li>1. Pedicle soft tissue graft procedures : </li></ul><ul><li>Flaps used : Rotational flap </li></ul><ul><li>Advanced flap </li></ul><ul><li>2. Free soft tissue graft procedures : </li></ul><ul><li>Epithelialised graft </li></ul><ul><li>Sub epithelial connective tissue graft </li></ul>
  25. 28. <ul><li>ROTATIONAL FLAP PROCEDURES </li></ul><ul><li>Lateral sliding flap </li></ul><ul><li>Double papilla flap </li></ul><ul><li>ADVANCED FLAP </li></ul><ul><li>Coronally Advanced flap </li></ul><ul><li>Semilunar Coronally Advanced flap </li></ul>
  26. 29. <ul><li>Lateral sliding flap </li></ul>
  27. 30. <ul><li>Clinical view : </li></ul>
  28. 31. <ul><li>Double papilla flap procedure </li></ul>
  29. 32. <ul><li>ADVANCED FLAP PROCEDURES </li></ul>
  30. 33. <ul><li>Coronally advanced flap </li></ul>
  31. 35. <ul><li>Semilunar coronally repositioned flap </li></ul>
  32. 36. <ul><li>Guided tissue regeneration </li></ul>
  33. 39. <ul><li>FREE SOFT TISSUE GRAFT PROCEDURES </li></ul><ul><li>Epithelialised graft </li></ul><ul><li>Sub epithelial connective tissue graft </li></ul>
  34. 40. <ul><li>Epithelialized free soft tissue graft procedure </li></ul>
  35. 41. Free connective tissue graft combined with a coronally advanced flap procedure
  36. 42. <ul><li>REFRENCES : </li></ul><ul><li>1. Carranza : Textbook of Periodontics </li></ul><ul><li>2. Jan Lindhe : Clinical periodontology and </li></ul><ul><li>Implant Dentistry </li></ul>

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