Recession

Recession is the loss of gum tissue covering the root of a tooth. This occurs when there is toothbrush trauma, lack of "tough gum," or secondary to crown margins placed under very thin gingival tissue, to mention some common reasons.
Toothbrush trauma is caused by excessive brushing or using a stiff brush. This typically happens on the outside surfaces of the teeth where people habitually start their brushing. It is because of this that I recommend brushing the inside (tongue side) of the teeth first. Avoiding natural, non-nylon bristle toothbrushes, is a must since their cut ends are very sharp and can cause severe abrasion to the tooth and gingiva.
A minimum of 2.0 mm of "tough gum," i.e., keratinized, attached gingiva, is needed to prevent further recession. This type of gum tissue is able to withstand tooth brushing and mastication much better than the thinner movable mucosa.
All crown margins are rough microscopically and when placed under the gingiva, bacteria will hide at the margin where toothbrushes can not clean. This bacteria, i.e., plaque, will irritate the gingiva causing the recession, just like periodontitis.
The most common solution to recession is to correct the cause and repair the area with a connective tissue graft. This is a procedure where tissue from under the roof of the mouth is transplanted to the area of recession to cover the defect. This technique differs from the once popular free-gingival graft where the top layer of skin is grafted leaving a large open wound that was very uncomfortable afterwards. The donor site for connective tissue grafts can be treated in a way that is almost painless. The usual pain medication given for this procedure is ibuprofin (i.e., Motrin, Advil, or Nuprin) which is taken the day of and sometimes the day after.
Alloderm^® is donor sub-epithelial tissue that is that is used by plastic surgeons to treat burn victims. It also can be used as a graft material to repair recession and to establish greater amounts of "tough gum," i.e., keratinized gingiva. Although this is a good alternative to getting tissue from the palate, the best tissue is fresh tissue from the same mouth.

Recession on a dental implant Connective tissue graft repair

Recession exposing Repaired with a

a crown margin connective tissue graft

Recession Repaired with a

connective tissue graft

	Back
	Home