1. Gingival recession is the exposure of root surface caused by an apical shift in gingival position. It can be classified as visible, hidden, localized, or generalized. 2. Miller and Atkin & Sullivan classified gingival recession defects based on their location and amount of bone loss. Common causes of recession include age, faulty brushing technique, tooth malposition, gingival inflammation, abnormal frenal attachment, and masochistic habits. 3. Recession can be treated non-surgically through modifying risks or surgically through pedicle or free soft tissue grafts to cover exposed root surfaces and reduce sensitivity.

1. GINGIVAL RECESSION

2. CONTENTS : 1. Definition 2. Classification 3. Etiology 4. Clinical examination 5. Clinical significance 6. Treatment

3. DEFINITION It is the exposure of root surface by an apical shift in the position of gingiva.

4. 3 The recession is determined by the actual position of the gingiva not by its apparent position

5. 5. Recession can be studied as, VISIBLE HIDDEN

6. Also it may be Localised Generalised

7. CLASSIFICATION OF RECESSION DEFECTS P.D.MILLER(1985) Class I : Marginal tissue recession not extending to the mucogingival junction. No loss of interdental bone or soft tissue. Class II : Marginal tissue recession extends to or beyond the mucogingival junction. No loss of interdental bone or soft tissue.

8. Class III : Marginal tissue recession extends to or beyond the mucogingival junction. Loss of interdental bone or soft tissue is apical to the CEJ, but coronal to the apical extent of marginal tissue recession Class IV : Marginal tissue recession extends beyond the mucogingival junction. Loss of interdental bone extends to a level apical to the extent of the marginal tissue recession.

10. Atkin & Sullivan classification I. Shallow-Narrow II. Shallow-Wide III. Deep-Narrow IV. Deep-Wide

11. Etiology: 1. Age 2. Faulty tooth brushing technique 3. Tooth malposition 4. Gingival inflammation 5. Abnormal frenal attachment 6. Trauma from occlusion 7. Masochistic habits

12. 1. Age It inraeses with age. 8% in children 50%, above age of 50 yrs Reason being , (a) Cummulative effect of minor pathological involvement (b) Repeated, minor direct trauma

13. 2. Faulty tooth brushing technique Brush with hard bristles Excessive or Aggressive brushing in horizontal direction. When used with highly abrasive dentrifice A Wedge shaped defect Surface – clear, smooth , polished.

15. 3. Tooth malposition Recession is affected by : a. Position of teeth in the arch. b. The root bone angle. c. The mesiodistal curvature of the tooth surface d. Rotated, tilted or facially displaced teeth

17. 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. Pressure from mastication or moderate tooth brushing damages the unsupported gingiva and produces recession.

18. Malpositioned teeth

19. 4. Gingival inflammation

20. 5. Abnormal frenal attachment

21. 6. Masochistic Habits

22. Clinical examination Measurement of amount of gingival recession is made by Periodontal probe from CEJ to the gingival crest

23. Clinical significance: 1. Exposed root surfaces are susceptible to caries. 2. Abrasion or erosion of the cementum Underlying dentinal suface Sensitivity

24. 3. Hyperemia of pulp may also result from excessive exposure of root surfaces. 4. Interproximal recession creates oral hygiene problems & resulting plaque accumulation

25. Treatment It can be treated Non-surgically Surgically

26. NON – SURGICAL METHOD 1. Correction of tooth brushing technique 2. Removal of masochistic habits 3. Correction of malocclusion 4. Treating the dentinal sensitivity

27. Surgically treated by two procedures : 1. Pedicle soft tissue graft procedures : Flaps used : Rotational flap Advanced flap 2. Free soft tissue graft procedures : Epithelialised graft Sub epithelial connective tissue graft

28. ROTATIONAL FLAP PROCEDURES Lateral sliding flap Double papilla flap ADVANCED FLAP Coronally Advanced flap Semilunar Coronally Advanced flap

29. Lateral sliding flap

30. Clinical view :

31. Double papilla flap procedure

32. ADVANCED FLAP PROCEDURES

33. Coronally advanced flap

35. Semilunar coronally repositioned flap

36. Guided tissue regeneration

39. FREE SOFT TISSUE GRAFT PROCEDURES Epithelialised graft Sub epithelial connective tissue graft

40. Epithelialized free soft tissue graft procedure

41. Free connective tissue graft combined with a coronally advanced flap procedure

42. REFRENCES : 1. Carranza : Textbook of Periodontics 2. Jan Lindhe : Clinical periodontology and Implant Dentistry