Definition
- Gingival recession is the apical shift of the marginal gingiva to levels apical to the cemento-enamel junction
Gingival biotype
- Thick Vs Thin = translucency of free gingiva when probing De Rouck 2009
Thin gingiva
- Thin labial bony plate
- Narrow karatanised tissue – if less than 2mm can remain persistently inflamed Lang 1974
- Greater distance from CEJ – alveolar crest Cook 2011
- Greater likelihood of breakdown compared to thick gingiva Ericsson 1984
Occlusal trauma
- Increase tooth mobility
- Angular bone destruction
- Loss of attachment Lindhe 1974
- Recession defect improves after occlusal trauma removed
Bone thickness
- CBCT appropriate tool
- However can over-estimate defect due to limitations in Voxel size Patcas 2012
Orthodontic treatment with periodontal considerations
- Thickness of gingiva
- Direction of tooth movement
Labial movement of different gingival thickness
- Thin gingiva = reduction in free gingiva, reduction in thickness of connective tissue, reduction in bone height
- Thick gingiva – reduction in free gingiva and bone, BUT no change in connective tisse thickness
- Difference to labial movement = thick gingiva maintains connective tissue thickness
Transverse expansion
- Can cause gingival recession
- In older adolescence and adults surgically assistd expansion is recommended as resistance to expansion from Nasomaxillary, Zygomaxillary, Pterygomaxillary buttresses prevent bony change – dentition moved outside of the bony envelope
