Why Gingival Recession Matters

Mucogingival defects are characterized by the deviation of the normal dimension and morphology between the gingival margin and mucogingival junction. Gingival recession and lack of attached gingiva are among the most commonly diagnosed mucogingival defects. Gingival recession is described as the apical migration of the gingiva beyond the cementoenamel junction and appears to be prevalent in more than 50% of adults.¹

If left untreated, the prevalence, severity and extent of recession could increase with age.² It has been observed that accumulation of bacterial plaque around the gingival margin could lead to periodontal inflammation and tissue breakdown, resulting in gingival recession.³ However, contributing factors — including toothbrush abrasion, history of orthodontic therapy, aberrant frenal attachment, and lack of attached gingiva — can also lead to recession.^4–7

The undesired consequences of gingival recession include dentinal hypersensitivity, poor esthetics, root caries, and development of other mucogingival defects, such as lack of attached gingiva, rendering the area vulnerable to inflammation and plaque retention.⁸

Attached gingiva is the zone of keratinized tissue extending from the free gingival margin to the alveolar mucosa that is firmly attached to the underlying bone. Attached gingiva increases resistance to injury and stabilizes the gingival margin; it also helps bind the margin and enhances plaque removal around gingival margins.⁹ Lack of attached gingiva can be diagnosed when, upon probing, the periodontal probe invades the mucogingival junction. Less than 2 mm of attached gingiva has been shown to exhibit clinical gingival inflammation and accelerate tissue breakdown.⁷

Biologic width is the dimension of the soft tissue that extends from the sulcus to the crest of the alveolar bone. The sum of this epithelial and connective tissue is approximately 2 mm.¹⁰ Violations of biologic width often occur when restorative margins are extended far below the gingival crest, impinging on the attachment apparatus. This could lead to chronic inflammation and recession, which could be worse in patients with a thin gingival phenotype.¹¹ When considering subgingival restorations, it is imperative to maintain at least a 2 mm zone of attached gingiva to minimize gingival inflammation and tissue breakdown and help maintain gingival health.¹²

References

1. Loe J, Anerud A, Boysen H. The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession. J Periodontol. 1992;63:489–495.
2. Serino G, Wennström JL, Lindhe J, Eneroth L. The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene. J Clin Periodontol. 1994;21:57–63.
3. Baker DL, Seymour GJ. The possible pathogenesis of gingival recession. A histological study of induced recession in the rat. J Clin Periodontol. 1976;3:208–219.
4. Litonjua LA, Andreana S, Bush PJ, Cohen RE. Toothbrushing and gingival recession. Int Dent J. 2003;53:67–72.
5. Steiner GG, Pearson JK, Ainamo J. Changes of the marginal periodontium as a result of labial tooth movement in monkeys. J Periodontol. 1981;52:314–320.
6. Ewen SJ. Frena: their roles especially in periodontics. N Y State Dent J. 1968;34:626–630.
7. Lang NP, Loe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol. 1972;43;623–627.
8. Clerehugh V, Tugnait A, Genco RJ. Periodontology at a Glance. Oxford: Wiley-Blackwell; 2009:64,66.
9. Carnio J, Camargo PM, Passanezi E. Increasing the apico-coronal dimension of attached gingiva using the modified apically repositioned flap technique: a case series with a 6-month follow-up. J Periodontol. 2007;78:1825–1830.
10. Gargiulo AW, Wentz FM, Orban B. Dimensions and relations of the dentogingival junction in humans. J Periodontol. 1961;32:261–267.
11. Jorgic-Srdjak K, Plancak D, Maricevic T, Dragoo MR, Bosnjak A. Periodontal and prosthetic aspect of biological width Part I: Violation of biologic width. Acta Stomatol Croat. 2000;34:195–197.
12. Stetler KJ, Bissada NF. Significance of the width of keratinized gingiva on the periodontal status of teeth with submarginal restorations. J Periodontol. 1987;58:696–700.

This information originally appeared in Shaikh S, Regahi P. Soft tissue graft alternatives for treating mucogingival defects. Decisions in Dentistry. 2023;9(1):26-29.