Definition And Etiology Of Gingival Recession

Gingival recession (GR): Defined as change in location of marginal gingiva leading to root surface exposure. According to American Academy of Periodontology (AAP), cementoenamel junction by movement of coronal extent of gingiva apically.

Position of the gingiva

There are two positions of gingiva which include

• Actual position - coronal extent of epithelial attachment on tooth.
• Apparent position - crest of the marginal gingival.

Actual position plays important role in identifying recession severity but not by its apparent position.

Visible recession - cementoenamel junction exposure by apical migration of gingiva. Hidden recession - loss of attachment which is apical to the soft tissue margin.

Etiology

The common etiologic factors are (1) local factors, (2) periodontal disease, (3) mechanical forces, (4) iatrogenic factors, and (5) anatomical factors.

Local factors: Plaque and calculus are associated with inflammation in the connective tissue (CT) nearer to the junctional epithelium causes gingival recession.

Periodontal disease: Bacteria present in the plaque interacts with immune response of the host results in bone resorption, and downgrowth of the epithelium, resulting in gingival recession.

Mechanical forces: Aggressive tooth brushing abrades the gingival tissue. One of the etiological agent for mucogingival problems was occlusal traumatism.

Iatrogenic factors: Marginal and papillary tissue modified by Orthodontic tooth movement. Dehiscence created during movement of teeth orthodontically leads to gingival recession, it occurs mainly in premolar extraction cases and the teeth commonly affected are mandibular incisors and the mesio-buccal root of first molars, but it can occur in any location. GR occurrence during or after orthodontic treatment can be anticipated by assessing the quantity of soft tissue.

Restorations which placed sub-gingivally, overhanging clasps can favor accumulation of plaque which leads to GR.

Anatomical factors: Dehiscence of alveolar bone, abnormal frenal attachment, tooth position and morphology of gingiva play role in GR development. Inadequate keratinized gingiva (KG) commonly associated with GR. Periodontal biotype can be thin and scalloped, or thick and flat. Recession of the facial and papillary gingival is common in thin biotype because the alveolr bone is thin in these patients which is the cause of dehiscence and fenestrations, even minimal brushing force can result in gingival recession and exposure of the root in these patients and it continues until the gingival margin approaches the bone margin in presence of inflammation and in absence of inflammation this process is stopped and it is called as self-limiting recession.

There is also association between root prominence and gingival recession, if a tooth is positioned facially, the soft tissue and bone on the facial aspect of that tooth are thinner and more susceptible to soft tissue recession than the adjacent teeth.