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)

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

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
Marginal tissue recession which does not extend to the mucogingival junction
No periodontal bone loss in the interdental area
100% root coverage
Miller, in 1985, classified marginal tissue recession by combining the 4 Sullivan and Atkins classifications into his 1st 2 classifications and then adding a 3rd and 4th classification. He indicated that the presence of interdental bone loss, soft tissue loss, or extruded teeth make it impossible to place a free gingival graft at the CEJ, making it impossible to obtain complete root coverage.
Based on this classification, 100% root coverage can be anticipated in Class I and Class II. All four of Sullivan and Atikins’ morphological categories (shallow-narrow, shallowwide, deep-narrow and deep-wide) fall within these two classes.
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
In Class III recession, partial root coverage can be expected. The amount of root coverage can be determined presurgically using a periodontal probe. The probe is placed horizontally on an imaginary line connecting the tissue level on the mid-facial of the 2 teeth on either side of the tooth or teeth exhibiting recession. Root coverage can be anticipated to that level.
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
In Class IV recession, root coverage is not anticipated although occasionally it can be obtained. Usually, however, root coverage is not attempted.
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

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 FACTORS CO 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 1975.
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

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

28. CPITN Probe