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. 2016 Jun;21(3):18-29.
doi: 10.1590/2177-6709.21.3.018-029.oin.

Gingival recession: its causes and types, and the importance of orthodontic treatment

Ana Suzy Jati  1 , Laurindo Zanco Furquim  2 , Alberto Consolaro  3
Affiliations

Gingival recession: its causes and types, and the importance of orthodontic treatment

Ana Suzy Jati et al. Dental Press J Orthod. 2016 Jun.

Abstract
in English, Portuguese

Gingival recession has direct causes and predisposing factors. Orthodontic treatment is able to prevent recession and even contribute to its treatment, with or without periodontal approach, depending on the type and severity of gingival tissue damage. There is no evidence on the fact that orthodontic treatment alone might induce gingival recession, although it might lead the affected teeth (usually mandibular incisors or maxillary canines) to be involved in situations that act as predisposing factors, allowing direct causes to act and, therefore, trigger recession, especially when the buccal bone plate is very thin or presents with dehiscence. Several aspects regarding the relationship between orthodontic treatment and gingival recession have been addressed, and so has the importance of the periosteum to the mechanism of gingival recession formation. Clinical as well as experimental trials on the subject would help to clarify this matter, of which understanding is not very deep in the related literature.

As recessões gengivais têm causas diretas e fatores predisponentes. O tratamento ortodôntico pode prevenir as recessões e, até, contribuir para o seu tratamento, com ou sem uma abordagem por parte do periodontista, dependendo do tipo e da severidade do comprometimento dos tecidos gengivais. Não há evidências de que o tratamento ortodôntico possa induzir, de forma primária, as recessões gengivais, muito embora possa levar os dentes envolvidos (comumente, os incisivos inferiores e os caninos superiores) a situações que ajam como fatores predisponentes para que as causas diretas possam atuar e produzir recessões - em especial, quando deixa-se uma tábua óssea vestibular muito fina ou, até, com deiscência. Vários aspectos da relação entre o tratamento ortodôntico e as recessões gengivais já foram abordados, assim como a importância do periósteo no mecanismo de formação delas. Trabalhos clínicos e experimentais sobre o assunto ajudariam a esclarecer o assunto, que ainda se apresenta muito pouco aprofundado na literatura pertinente.

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Figures

Figure 1
Figure 1. Radiographic image reveals the structural fragility of human buccal bone plate in the region of maxillary incisors, in addition to its dimensional relationship with the periodontal space and the mineralized tooth structures. In B, this proportionality and subtleness are also microscopically revealed (B = 20X HE).
Figure 2
Figure 2. U-shaped gingival recession associated with inadequate tooth brushing, with cervical abrasion of maxillary canines and premolars. Recession is more severe in mandibular premolars.
Figure 3
Figure 3. U-shaped local gingival recession associated with reduced alveolar bone plate thickness, a slight increase in dental plaque buildup and inadequate brushing.
Figure 4
Figure 4. V-shaped gingival recession as a part of occlusal trauma lesion caused by traumatic occlusion.
Figure 5
Figure 5. Buccal bone plate with severe canine dehiscence and premolar fenestration.
Figure 6
Figure 6. CT scan revealing absence of apical as well as buccal bone plate of a mandibular incisor with gingival recession. Note the presence of inflammation associated with dental plaque and occlusal interference.
Figure 7
Figure 7. Anatomical piece highlighting buccal bone plate fragility in the region of mandibular incisors (Source: Sgrott, Moreira, 2010 15).
Figure 8
Figure 8. Under orthodontic movement conditions, with balanced load distribution, frontal bone resorption (white arrows) is compensated by deposition of new bone layers on the buccal surface of the buccal bone plate by the periosteum (red arrows) (A and B = 20X, HE).
Figure 9
Figure 9. CT scan revealing absence of apical as well as buccal bone plate of a mandibular incisor with gingival recession. Note the red festoon surrounding the recession, which suggests the presence of inflammation associated with dental plaque.
Figure 10
Figure 10. In the same clinical case presented in Figure 9, local gingival recession is associated with dental plaque and severe occlusal interference.
Figure 11
Figure 11. U-shaped local recession corrected by orthodontic repositioning of the mandibular incisor, which allowed the buccal bone plate to become thicker and the exposed root area to be covered by gingiva.
See this image and copyright information in PMC

References

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MeSH terms