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Gingival Recession Etiopathogenesis. Gingiva Orthokeratinized or parakeratinized epithelium Dense lamina propria.

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Presentation on theme: "Gingival Recession Etiopathogenesis. Gingiva Orthokeratinized or parakeratinized epithelium Dense lamina propria."— Presentation transcript:

1 Gingival Recession Etiopathogenesis

2 Gingiva Orthokeratinized or parakeratinized epithelium Dense lamina propria

3 Alveolar Mucosa Non-keratinized epithelium Elastic fibers Loosely bound to the perisoteum Permits movements

4 Morphologic Classification of Periodontium Maynard and Wilson (1968)

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6 How much gingiva is required 1mm may create no problems in patients with good oral hygiene

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8 Marginal Tissue Recession Exposition of the radicular surface of the tooth due to destruction of the marginal gingiva and of the epithelial attachment that will be reestablished at a more apical position

9 Classification Sullivan and Atkins (1968) Shallow narrow Deep narrow Shallow wide Deep wide

10 Classification of Gingival Recession Class I –Marginal tissue recession which does not extend to the mucogingival junction –No periodontal bone loss in the interdental area –100% root coverage Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5:8-13

11 Class II –Marginal tissue recession which extends to or beyond the mucogingival junction –No periodontal loss in the interdental area –100% root coverage Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5:8-13

12 Class III –Marginal tissue recession which extends to or beyond the mucogingival junction –Bone or soft tissue loss in the interdental area or malpositioning of the teeth, preventing 100% root coverage –Partial root coverage Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5:8-13

13 Class IV –Marginal tissue recession which extends to or beyond the mucogingival junction –Severe bone or soft tissue loss in the interdental area and/or malpositioning of teeth –No root coverage Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent 1985;5:8-13

14 Most Common Anatomic Factors Area of root prominence Thin, narrow band of gingiva Thin mucosa Thin labial bone septum

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16 Friedman (1962) Inadequate zone of attached gingiva would: 1. Facilitate subgingival plaque formation 2. Favor attachment loss and soft tissue recession

17 Moscow and Bressen (1965) listed possible alternative causes of recession Uneven atrophy of the gingival margin Calculus deposits Direct trauma (accident, fingernails)

18 Two most important causes of recession Trauma caused by tooth brushing Gingival lesions associated with plaque

19 DETERMINANTS FACTORSCO FACTORS Bacterial Plaque  O`Leary et al found direct correlation between the increase of plaque index ad the increase of marginal tissue recession Trauma from toothbrushing  Improper technique  Wrong toothbrush Iatrogenic Factors  Amalgam or prosthetic overhang  Clamps  Orthodontic appliances Habits  Fingernails or any foreign object Tooth Malposition  Buccally displaced teeth or rotated tooth due to altered tooth-bone relationship Unfavorable Anatomy  High frenum insertion  Shallow buccal fold that produce tension on the marginal gingiva Orthodontic Movements

20 Pathogenesis Novaes et al Gingiva overlying a prominent root surface is thin and shows a poor organization of the connective tissue and collagen sandwiches between sulcular epithelium and oral epithelium

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22 Ruben (1978): in prominent teeth, the bone thickness could be as little as 0.15 mm( less than the PDL)

23 Spread of inflammation into the thin mucosa, will result in its severance. Inflammation is a constant factor

24 Process of Recession Wounding may cause a split in the gingiva with resultant root exposure Existing gingiva may move apically with resultant root exposure

25 Precipitating Factors Vigourous brushing Laceration Recurrent inflammation Iatrogenic factors

26 Predisposing Factors Inadequate attached gingiva “High” frenum attachment “Shallow vestibule” Malpositioning of the teeth –Prominent roots

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28 CPITN Probe


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