Gingival recession is thought to affect more than half of the population and, despite this, awareness of the factors that predispose patients to the condition is limited, with many individuals only assuming the link with poor oral hygiene. It can affect all age groups, with a higher number of middle and older aged people experiencing the condition, and an overall prevalence ranging from 58%-99.7%. Because the UK has an aging population, and more patients are retaining their natural teeth for longer, the risk of gingival recession is likely to grow. Currently, it is estimated that 88% of people over the age of 65 have gingival recession on one or more of their teeth. As such, it’s important to promote greater understanding of this evermore common condition.
In terms of severity, most of the population has been shown to experience one mild site (with recession up to 1mm) whilst 30% of the population experience the condition moderately (1-3mm), and 5.9-40.7% of the population develop more severe symptoms (4mm+).ii The mandible is more likely to be affected by gingival recession than the maxilla, with the mandibular incisors the most common victims.ii
Causes of gingival recession
In addition to understanding the external factors which might influence gingival recession, there are a number of predisposing factors for developing the condition. This might include anatomical factors such as bone dehiscence, tooth malposition, thin gingival biotype, high frenal attachments, and a lack of keratinized tissue.ii
Further to this, there are a number of lifestyle factors and patient habits which may increase their risk of gingival recession, particularly if they also have predisposing factors. These include traumatic toothbrushing, dental treatment (in particular orthodontic and restorative), poor plaque control, mouth piercings, and trauma.ii
Miller’s classification of gingival recession
In order to communicate a patient’s situation effectively, it’s important to understand the classification system used for gingival recession. Miller’s classification system takes into account the extent of the recession, in relation to the mucogingival fold and the presence of hard and soft tissue interdentally. It then assigns a class of I, II, III, or IV, depending on the severity of the condition.ii
Miller’s classification is as follows:
• Class I: Marginal tissue recession that does not extend to the mucogingival junction.
• Class II: Marginal tissue recession that extends to or beyond the mucogingival junction with no periodontal attachment loss (bone or soft tissue) in the interdental area.
• Class III: Marginal tissue recession that extends to or beyond the mucogingival junction with periodontal attachment loss in the interdental area or malpositioning of teeth.
• Class IV: Marginal tissue recession that extends to or beyond the mucogingival junction with severe bone or soft tissue loss in the interdental area and/or severe malpositioning of teeth.
By understanding and identifying the severity of each gingival recession case, clinicians will be able to ascertain whether they have the skills, knowledge, and experience needed to manage the case themselves, or whether referral to a specialist may result in improved outcomes. This may also enable clinicians to discuss the full spectrum of treatment types and recommendations to improve the patient’s situation.
Different management techniques
Depending on the severity of the gingival recession, there are a number of therapies and treatments that might be provided to improve the clinical situation. This might range from hygiene measures like interdental cleaning, and scaling and root planing, to providing gingival grafts and performing flap surgery.i In order to produce an aesthetic outcome, with an excellent emergence profile, a combined restorative and periodontal treatment may be required. It is important that mucogingival surgery is performed by an experienced clinician who has undergone the relevant training.
Learning from the best
As such, it is important that clinicians who provide periodontal treatments learn from the very best. The Academy of Soft and Hard Tissue Augmentation (ASHA) Club offers the Soft Tissue Management Around Teeth & Implants course, presented by world-renowned periodontists Professor G. Zucchelli and Dr. Selvaraj Balaji. The course is ideal for those who are looking to improve their soft tissue management skills for both natural teeth and dental implants. Further to this, those who attend the course will gain access to the exclusive WhatsApp group and ongoing mentoring, for continued support following their studies.
Management of gingival recession presents a number of unique challenges for clinicians. As such, it is important to seek a deeper understanding of the condition, its classification, and management, and undertake the high standards of further education required to tackle their cases.
Find out more at https://www.ashaclub.co.uk/courses
Soft Tissue Management Around Teeth & Implants
15th & 16th November 2024 / 10th & 11th January 2025
To book, please call: 07974 304269 or email: info@ashaclub.co.uk
Author: Dr Selvaraj Balaji
Dr Balaji since he obtained the BDS Degree, he worked in Maxillo facial units in the UK for several years and gained substantial experience in surgical dentistry.For the past 15 years Dr Balaji has been working in his private dental practice which is based in Buckingham. He is the principal dentist and owner of The Gallery Dental Group which is made up of Meadow Walk Dental Practice and The Gallery Dental & Implant Centre.
He is the founder of the Academy of Soft and Hard Tissue Augmentation (ASHA) and run courses and lectures in the UK and around Europe, where he teaches other aspiring implantologists how to treat difficult cases. In addition, He also hosts study clubs, webinars.
[1] Cleveland Clinic. Gum Recession. Accessed July 24. https://my.clevelandclinic.org/health/diseases/22753-gum-recession
[1] Joshua Hudson, Ulpee Darbar, Gingival recession. Part 1: prevalence and aetiology, Dental Update 2024 51:3, 707-709.
[1] Alamri, Abdulrahman M., et al. “Dental Recession Aetiology, Classification and Management.” Archives of Pharmacy Practice 10.2-2019 (2019): 28-30.
[1] Zucchelli, Giovanni, et al. “Non‐carious cervical lesions associated with gingival recessions: A decision‐making process.” Journal of Periodontology 82.12 (2011): 1713-1724.
