Gingival Recession Haris
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Transcript of Gingival Recession Haris
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DrDr HarisHaris MehmoodMehmood
House OfficerHouse Officer PeriodontologyPeriodontology DepartmentDepartment
Islamic International Dental HospitalIslamic International Dental Hospital
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7. Treatment
6. Clinical significance
5. Clinical examination
3. Etiology
2. Classification
1. Definition
CONTENTS
8. Case Reports
4. PREVALENCE
9. Current Trends in Treatment
10. References
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The recession is determined by the
actual position of the gingiva not
by its apparent position
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Also it may be
Localized Generalized
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CLASS
IFICA
TIONOF
RECESSIONDEFECTS
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P.D.MILLER(1985)
Class I : Marginal
tissue recession not
extending to the
Mucogingival junction.
No loss of interdental
bone or soft tissue
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Class II :
Marginal tissue
recession extendsto or beyond the
Mucogingival
junction. No lossof interdental bone
or soft tissue
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Class III : Marginaltissue 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 ofmarginal tissue
recession
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Class IV :
Marginal tissuerecession extends
beyond theMucogingivaljunction.Loss of interdentalbone extends to a level
apical to the extentof the marginaltissue recession
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Atkin & Sullivan
classification
I. Shallow-Narrow
II. Shallow-Wide
III. Deep-NarrowIV. Deep-Wide
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Al Bander JM, Kingman A, Gingival recession, bleeding and calculus in adult
30 years of age and older in US 1988-1994. Journal of Periodontology1999;70;30-43.
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Banting DW, Ellen RP, Fillery ED, Prevalence of root caries among
institutionalized older patients. Community Dentistry and Oral Pathology1980;8;84-8.
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Al Bander JM, Kingman A, Gingival recession, bleeding and calculus in adult
30 years of age and older in US 1988-1994. Journal of Periodontology1999;70;30-43.
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Lohse WG, Carted HG, Brunelli JA, Prevalence of root caries in military
population, Military Medicine 1977;142;700-3
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Addy M, Mostafa P, Newcombe RG, Dentine Hypersensitivity, distribution of sensitivity,recession and plaque, Journal of Dentistry 1987;15;242-8.
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Addy M, Mostafa P, Newcombe RG, Dentine Hypersensitivity, distribution of sensitivity,recession and plaque, Journal of Dentistry 1987;15;242-8.
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Van Palensteien huldarman WH, Lambariti BS, Van der Weijden GA et. al.
Gingival recession and its association with calculus in subjects deprived ofprophylactic dental care . Journal of Clinical Periodontology, 1988;25;106-11.
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GingivalRecession
Chemicaltrauma
Plaque andCalculus
HighMuscle and
Frenalattachment
RestorativeDentistry
PeriodontalDisease
Smoking
Habits
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AGE:
It increases with age.8% in children
50%, above age of 50 yrsReason being(a) Cumulative effect of minor
pathological involvement(b) Repeated, minor direct
trauma
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GINGIVALINFLAMMATION
Bacterial toxins, enzymes and cytokines released
from neutrophils.
Bone resorption, as it is seen to occur in
response to repeated scaling of shallow pockets.
Shrinkage of tissue after treatment of pockets.
Williams DM, Hudges FJ, odell EW te. al. Pathology of Periodontal disease,Oxford, Oxford University press 1992.
Lindhe J, Nyman S, Karring T, Scaling and root planing in shallow pockets,
Journal of Clinical Periodontology, 1984; 55;713-9.
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MECHANISM
Systemic alteration
in immune response
Locally decreasedblood flow
Additional tooth
brush abrasionwhich try to removestaining due tosmoking habits
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Increased gingival recession in smokelesstobacco users.
Attachment loss was particularly noted inmandibular buccal areas where products
were placed.
Robertson PB, Walsh M, Green J. et.al Periodontal effects associated with use of
smokeless tobacco. Journal of Periodontology, 1990; 61; 438-43.
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2. FAULTYTOOTH BRUSHINGTECHNIQUE
Brush with hard bristles
Excessive or Aggressive brushing in horizontaldirection
When used with highly abrasive dentifrice
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Recessionisaffectedby :
Positionofteethinthearch. Therootboneangle.
Themesiodistal curvatureofthetoothsurface
Rotated,tiltedor faciallydisplacedteeth
TOOTHMALPOSITION
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Malpositionedteeth
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
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Clinical examination
Measurementof amountofgingival
recessionismadeby Periodontalprobe
from CEJtothegingivalcrest
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CLINICAL
SIGNIFICANCESusceptible to Caries
Abrasion and Erosion
Sensitivity
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i l i l
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4. Interproximal recession createsoralhygiene problems& resulting plaqueaccumulation
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SURGICALTREATMENT:1. Pedicle soft tissue graft procedures :
Flaps used : Rotational flapAdvanced flap
2. Free soft tissue graft procedures :
Epithelialised graftSub epithelial connective tissue graft
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ROTATIONAL FLAP PROCEDURES
Lateral sliding flap
Double papilla flap
ADVANCED FLAP
Coronally Advanced flap
Semilunar Coronally Advanced flap
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ADVANCED FLAPPROCEDURES
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GUIDEDTISSUEREGENERATION
Techniques for enhancing and directing cell growth to repopulatespecific parts of the PERIODONTIUM that have been damaged
by PERIODONTAL DISEASES; TOOTH DISEASES; or TRAUMA, or to
correct TOOTH ABNORMALITIES. Repopulation and repair is achieved by
guiding the progenitor cells to reproduce in the desired location byblocking contact with surrounding tissue by use of membranes
composed of synthetic or natural material that may include growth
inducing factors as well.
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FREESOFTTISSUEGRAFTPROCEDURES
1. Epithelialised graft
2. Sub epithelial connective tissue graft
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Epithelialized free soft tissue graft procedure
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Free connective tissue graftcombined with a coronally
advanced flap procedure
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A 19-year-old female presented whose chief complaintwas root sensitivity and poor aesthetics on her maxillary
lateral incisors and canines.
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The tunnel technique was selected to treat both sidessimultaneously presenting with Class I and II gingival
recession.
Vertical sounding with a probe of the Transversal sounding of the tunnel
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tunnel created beyond the MGJ. without detaching the peak of the
papillae.
Large and thick CTG after palatal
harvesting.
The CTG is inserted in the tunnel and
the flap is advanced and sutured with
the graft.
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The healing progressed uneventfully and the gingival
recession was totally covered with a beautiful aesthetic result
on both sides
The CTG, using 4-0 sutures, was delicately inserted inside th
pouch and was then stabilized with the flap using 5-0 Vicryl
sutures.
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The following conclusions can be drawn fromrecent analysis of20 papers on the treatment of
Class I and II localized gingival recession:
Better results were achieved by using the CTG
than with guided tissue regeneration (GTR).
There is no difference between resorbable andnonresorbable membranes.
A closer contact between the receiving bed and
th
e covering tissues is obtained.
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Enamel matrix derivative has been shown topromote cementogenesis and bone formation aswell as new attachment.
It has been shown that EMD possesses thepotential to stimulate the formation of newconnective tissue, new bone, new periodontalligament, and cementum.
WennstrmJL, Zucchelli G. Increased gingival dimensions. A significant factor for successfuloutcome of root coverage procedures? A 2-year prospective clinical study. J ClinPeriodontol1996;23(8):770-777.
Harris RJ. A comparative study of root coverage obtained with guided tissue regenerationutilizing a bioabsorbable membrane versus the connective tissue with partial-thickness doublepedicle graft. J Periodontol 1997;68(8): 779-790.
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Class I recessions on the
incisor teeth. The central incisor papilla
is compressed
due to lingual orthodontic therapy.
A partial-thickness flap is elevated via
gingivoplasty of the papillae peaks.
After root planing, the acid gel is
applied on the root surfaces.
Application of Emdogain (Straumann,
Andover, MA) on the exposed etched
and dried roots.
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The flap is advanced coronally over the
gel and sutured.
Aesthetic results 6 months following
surgery. Note the root coverage
keratinized gingiva
up to the CEJs and gingival thickness.
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A recent innovation in dentistry is the preparation
and use of Platelet-Rich Fibrin (PRF), a concentrated
suspension of the Concentrated Growth Factors
(CGF), found in platelets of the patient blood. Thesegrowth factors are involved in wound healing and
postulated as promoters of tissue regeneration.
There was less postsurgical discomfort, more rapid
soft tissue healing with less edema compared to thetunnel CTG and EMD techniques, and a relatively
unlimited source of graft material.
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Class I recession on the right
canine and the first bicuspid.
Class I recession on the left canine and
the first bicuspid.
Centrifuged vial of blood.
red blood cells, PRF, and platelet-poor
plasma.
The PRF gel is separated from the other
layers
and placed on special gauze prior to
compression. Clinical
aspects of three overlapped PRF
membranes.
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The membranes are placed on the right
vascularized recipient bed and over the
recession.
The membranes are placed on the left
vascularized recipient bed and over the
recession.
The left flap is advanced coronally
without tension covering the PRF
membranes.
The right flap is advanced coronally
without tension covering the PRF
membranes.
The membranes are placed on the right
vascularized recipient bed and over the
recession.
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Carranza : Textbook of Periodontics
Jan Lindhe : Clinical Periodontology and Implant
Dentistry Zabalegui I, Sicilia A, et al. Treatment of Multiple gingival
recessions with the tunnel subepithelial tissue graft. A clinicalreport. Intl J periodont Rest Dent 1999 ; 19 (2) : 199-206
http://www.periolondon.co.uk/dental-
information/periodontal-aesthetics.html Gingival Recession its significance and management
Journal of Dentistry (29) 2001 381-394 CURRENT TRENDS IN GINGIVAL RECESSIONCOVERAGEPART II: ENAMEL MATRIX
DERIVATIVE AND PLATELET-RICH PLASMAAndr P. Saadoun, DDS, MS* Pract Proced Aesthet Dent2006;18(8):A-G CURRENT TRENDS IN GINGIVAL RECESSIONCOVERAGEPART I: THE TUNNELCONNECTIVE TISSUE GRAFT
Andr P. Saadoun, DDS, MS*
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