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11 Apr 2022

When a gingival recession should be treated

Gingival recessions occur when the gum is apically to the cementoenamel junction (CEJ), exposing the root of the tooth. In other words, it occurs when the gum is away from the crown of the tooth and the root can be seen.

dental recession

Dental Recession factors

Recessions have a multifactorial etiology where predisposing factors, triggering factors and the presence of a thin biotype play an important role.

Predisposing factors

The predisposing factors correspond to the lack of keratinized gingiva, a long frenulum, dental malpositions…

Triggering factors

While the triggering factors would be:

  • Poor plaque control
  • Traumatic brushing
  • Iatrogenic treatments
  • Lacerations
  • Occlusal trauma
  • Piercings
  • Etc

Recessions tend to increase with age and the most affected teeth are usually the upper right central incisors and the lower left central incisors.

When should gingival recession be treated?

Recessions should be treated when they either cause a mucogingival problem or for esthetic reasons.

Mucogingival problems

The mucogingival problems that can cause recessions are the following: dental hypersensitivity, caries or abfractions and plaque accumulation. When the clinician encounters one of these 4 problems (including esthetics), that is when recessions should be treated.

Dental hypersensitivity

When the root is exposed, which normally should not be, the root cement is also exposed, and it is not prepared to be exposed. This is when dental hypersensitivity can appear, which is usually a brief and sharp pain that occurs, in general, due to the presence of a thermal stimulus (heat or cold). As the root surface is exposed, root caries may also appear.

Abfractions

Abfractions are lesions that are found at the junction of the tooth and gum, causing the gum to move away from the crown of the tooth. This injury causes a loss of enamel, exposing the dentin, which usually produces sensitivity when exposed.

Poor hygiene

Having poor hygiene leads to an accumulation of plaque and the formation of calculus that can cause damage to the periodontal tissues.

Dental recession treatments

To manage recessions, it is essential to know the cause that is triggering them to try to prevent them from reappearing instead of covering them up. If the defect that caused the recession is not corrected and instead is covered, it is possible that after a while, the defect will reappear. Therefore, the treatment consists of two phases; correct the cause and correct the consequences.

Depending on the type of recession that occurs, there are different treatment modalities from restorative treatment to surgical techniques. Within the surgical techniques there are different types of approaches such as a free gingival graft, a connective tissue graft or a coronally positioned flap. The adequate technique to use will be decision of each clinician according to the type of recession that the patient presents. 

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    Dr. José Nart Molina

    Dr. Jose Nart received his dental degree in 2001 from Universitat Internacional de Catalunya (UIC), Barcelona, Spain, and his Advanced Certificate in Periodontics and Implant Surgery from Tufts University in 2007. Dr. Nart was awarded Diplomate status by the American Board of Periodontology on May 2008, and he obtained his PhD in Dentistry in 2010 with the highest degree. Currently, he is Professor, Chairman and Program Director at the Department of Periodontology at UIC-Barcelona, and President for the Spanish Society of Periodontology and Osseointegration (SEPA). He maintains, with his family, a well-known multispecialty private practice in Barcelona, Nart Dental Clinic, as medical director. Dr. Nart is author of many international high-impact JCR publications (+110), worldwide speaker and reviewer of the highest impact factor Periodontology and Implant Dentistry journals.

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