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Gingival Recession Etiopathogenesis (PowerPoint)

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					Gingival Recession
 Etiopathogenesis
                   Gingiva
• Orthokeratinized or
  parakeratinized
  epithelium

• Dense lamina propria
            Alveolar Mucosa
• Non-keratinized
  epithelium
• Elastic fibers
• Loosely bound to the
  perisoteum
• Permits movements
Morphologic Classification of
      Periodontium
Maynard and Wilson (1968)
  How much gingiva is required
• 1mm may create no
  problems in patients
  with good oral
  hygiene
    Marginal Tissue Recession
• Exposition of the radicular surface of the
  tooth due to destruction of the marginal
  gingiva and of the epithelial attachment that
  will be reestablished at a more apical
  position
           Classification
    Sullivan and Atkins (1968)
• Shallow narrow

• Deep narrow

• Shallow wide

• Deep wide
 Classification of Gingival Recession

• Class I
  – Marginal tissue recession
    which does not extend to
    the mucogingival junction
  – No periodontal bone loss in
    the interdental area
  – 100% root coverage




  Miller PD Jr. A classification of marginal tissue recession.
  Int J Periodontics Restorative Dent 1985;5:8-13
                                • Class II
                                    – Marginal tissue recession
                                      which extends to or beyond
                                      the mucogingival junction
                                    – No periodontal loss in the
                                      interdental area
                                    – 100% root coverage




Miller PD Jr. A classification of marginal tissue recession.
Int J Periodontics Restorative Dent 1985;5:8-13
• Class III
   – Marginal tissue recession
     which extends to or beyond
     the mucogingival junction
   – Bone or soft tissue loss in
     the interdental area or
     malpositioning of the teeth,
     preventing 100% root
     coverage
   – Partial root coverage


  Miller PD Jr. A classification of marginal tissue recession.
  Int J Periodontics Restorative Dent 1985;5:8-13
                                • Class IV
                                    – Marginal tissue recession
                                      which extends to or beyond
                                      the mucogingival junction
                                    – Severe bone or soft tissue
                                      loss in the interdental area
                                      and/or malpositioning of
                                      teeth
                                    – No root coverage


Miller PD Jr. A classification of marginal tissue recession.
Int J Periodontics Restorative Dent 1985;5:8-13
Most Common Anatomic Factors
• Area of root
  prominence
• Thin, narrow band of
  gingiva
• Thin mucosa
• Thin labial bone
  septum
           Friedman (1962)
  Inadequate zone of attached gingiva
  would:
1. Facilitate subgingival plaque formation
2. Favor attachment loss and soft tissue
recession
Moscow and Bressen (1965) listed
possible alternative causes of recession
• Uneven atrophy of the gingival margin
• Calculus deposits
• Direct trauma (accident, fingernails)
Two most important causes of recession

• Trauma caused by
  tooth brushing
• Gingival lesions
  associated with plaque
DETERMINANTS FACTORS                              CO FACTORS
•Bacterial Plaque                        •Tooth Malposition
   O`Leary et al found direct              Buccally displaced teeth or rotated
   correlation between the increase of      tooth due to altered tooth-bone
   plaque index ad the increase of          relationship
   marginal tissue recession             •Unfavorable Anatomy
•Trauma from toothbrushing                  High frenum insertion
   Improper technique                      Shallow buccal fold that produce
   Wrong toothbrush                        tension on the marginal gingiva
•Iatrogenic Factors                      •Orthodontic Movements
   Amalgam or prosthetic overhang
   Clamps
   Orthodontic appliances
•Habits
   Fingernails or any foreign object
              Pathogenesis
• Novaes et al 1975.
• Gingiva overlying a prominent root surface
  is thin and shows a poor organization of the
  connective tissue and collagen sandwiches
  between sulcular epithelium and oral
  epithelium
Ruben (1978): in prominent teeth, the bone
thickness could be as little as 0.15 mm( less
than the PDL)
• Spread of inflammation into the thin
  mucosa, will result in its severance.
• Inflammation is a constant factor
        Process of Recession
• Wounding may cause a split in the gingiva
  with resultant root exposure
• Existing gingiva may move apically with
  resultant root exposure
          Precipitating Factors
•   Vigourous brushing
•   Laceration
•   Recurrent inflammation
•   Iatrogenic factors
           Predisposing Factors
• Inadequate attached
  gingiva
      “High” frenum
       attachment
      “Shallow vestibule”

• Malpositioning of the
  teeth
   – Prominent roots
CPITN Probe

				
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