Restoring aesthetics when gingival recession takes hold – Dr Boota Uhbi

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  Posted by: The Probe      2nd December 2018

There is high demand for an aesthetic smile among today’s population. Whether due to societal pressures, personal preferences or self-confidence, more and more people are looking to improve the appearance of their teeth in some way. Tooth whitening, orthodontics, crowns and bridges are just some of the popular procedures being sought across the UK, but sometimes these are not enough to treat existing problems and deliver the results a patient desires. Another condition that can affect smile aesthetics is gingival recession.

The prevalence of gingival recession is believed to be high among the UK population, with one paper finding recession on at least one tooth in 100% of the young adult participants.[1]While this focused on a small sample size, it is indicative of the widespread occurrence of the condition.

 

Causes and impact

 

There are many possible causes of gingival recession, including build up of calculus leading to disease and inflammation,[2]history of and current ‘hard’ tooth brushing,[3]and misaligned teeth.[4]Lifestyle habits like smoking[5]and features such as lip piercings[6]have also been shown to promote the development of gingival recession.

When attempting to predict potential recession in patients, key characteristics such as thickness of the keratinized tissue, presence of periodontal disease and poor marginal fit of restorations have been associated with increased risk.[7] 

A major impact of gingival recession is what it does to the smile aesthetics – this is often the main complaint from the patient. It can also lead to plaque retention, gingival bleeding and inflammation, loose teeth and pain or discomfort.[8]Further still, recession can cause dentine hypersensitivity[9]and lead to continued discomfort for the patient that could affect their quality of life.

The old mantra that ‘prevention is better than cure’ applies here, as it does in most areas of dentistry. Patient education is key and they should be encouraged to appreciate the importance of good tooth brushing technique and products, effective interdental cleaning and regular dental check-ups with their dentist and / or dental hygienist in order to maintain oral health and avoid development and progression of receding gums.

 

Treatment of gingival recession

 

Where minor recession has occurred and it is detected early, there are some fairly simple treatment options available. Revision of home care routines and a review of any existing restorations or tooth alignment can help stop the condition from progressing any further. Where infection is identified, the appropriate topical antibiotics, antiseptics or antimicrobials can be applied. Alternatively, orthodontic treatment may be considered.

In cases where the recession is quite advanced, more complex intervention may be required, including periodontal plastic surgery. This encompasses a wide range of surgical procedures that involve improving the soft tissue aesthetics by restoring the position of the gingiva.

The main surgical procedures employed for root coverage can generally be placed into one of two categories:[10]

 

  1. Pedicle soft tissue graft procedures

These grafts allow soft tissue to be repositioned over the defect, but as they remain attached they retain their own blood supply. This type of graft includes coronally advanced flaps and laterally positioned flaps.

 

  1. Free soft tissue graft procedures

Where there is insufficient soft tissue close to the defect or tissue thickness needs to be increased, these procedures involve placing a grafted material from elsewhere – usually the palate. These include free gingival grafts and connective tissue grafts.

A connective tissue graft covered with an overlying flap is widely considered to be the gold standard treatment for gingival recession defects in the profession. It is believed that the two blood supplies afforded by this technique provide an optimal aesthetic outcome.[11]

 

Appropriate treatment

 

It is logical that a practitioner’s clinical experience could affect case selection and effectiveness of surgical skill when addressing gingival recession, so ensuring that you deliver treatment within your remit is essential to success. Treatment should begin with less invasive procedures when possible, but where greater gingival recession is identified, advanced intervention may be required. Referral to a colleague with the appropriate skills and experience may be in the best interests of your patient and working with the specialist team from BPI Dental could offer a solution. Accepting referrals for an array of periodontal plastic surgery procedures – including connective tissue grafts, as well as crown lengthening and ridge augmentation – the team can offer an extension to your services and ensure your patients receive the highest quality care with outstanding aesthetic outcomes.

 

For more information on the referral services available from Birmingham Periodontal & Implant (BPI) Dental, visit www.bpidental.co.uk,

call 0121 427 3210 or email info@bpidental.co.uk

 
[1]Seong J, Bartlett D, Newcombe RG, Claydon NCA, Hellin N, West NX. Prevalence of gingival recession and study of associated related factors in young UK adults. Journal of Dentistry. September 2018;76; 58-67
[2]Van Palenstein Helderman WH, Lembariti BS, Van Der Weijden GA, Van’t Hof MA. Gingival recession and its association with calculus in subjects deprived of prophylactic dental care. Journal of Clinical Periodontology. 1998;25(2); 106–111.
[3]Khocht A, Simon G, Person P, Denepitiya JL. Gingival recession in relation to history of hard toothbrush use. Journal of Periodontology. 1993;64(9); 900–905.
[4]Gorman W J. Prevalence and etiology of gingival recession. J Periodontol 1967; 38; 316–322.
[5]Banihashemrad SA, Fatemi K, Najafi MH. Effect of smoking on gingival recession. Dent Res J. 2018;5(1): 1-4
[6]Er N, Ozkavaf A, Berberoglu A, Yamalik N. An unusual cause of gingival recession: oral piercing. J Periodontol 2000; 71; 1767–1769.
[7]Patel M, Nixon PJ, Chan MFWY. Gingival recession: part 1. Aetiology and non-surgical management. British Dental Journal. 2011; 211(6): 251-254
[8]Healthline. Receding gums. Symptoms of receding gums. https://www.healthline.com/health/dental-oral-health-receding-gums#causes[Accessed September 2018]
[9]Strasslet HE, Drisko CL, Alexander DC. Dentin hypersensitivity: Its inter-relationship to gingival recession and acid erosion. Aegis Dental Network. June 2008; 29(5) https://www.aegisdentalnetwork.com/special-issues/2008/06/dentin-hypersensitivity-relationship-to-gingival-recession[Accessed September 2018]
[10]Alghamdi H, Babay N, Sukumaran A. Surgical management of gingival recession: A clinical update. The Saudi Dental Journal. 2009;21(2); 83-94. doi:10.1016/j.sdentj.2009.07.006.
[11]Wilcko M.T., Wilcko W.M., Murphy K.G., Carroll W.J., Ferguson D.J., Miley D.D. Full-thickness flap/subepithelial connective tissue grafting with intramarrow penetrations: three case reports of lingual root coverage. Int. J. Periodont. Rest. Dent. 2005;25(6): 561–569.

 


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