gingival recession , elevators dentistry


Case 4 l  Gingival Recession " ODELL'S CLINICAL PROBLEMS "


 

 to download full pdf CLICK HERE

FOLLOW US

Summary

  • A 30-year-old woman has gingival recession. Assess her condition, and discuss treatment options.

 

History

 

Complaint

  • The patient is worried about the gingival recession around her lower front teeth, which she feels is worsening.

 

History of Complaint

  • She remembers noticing the recession for at least the previous 5 years. She thinks it has worsened over the last 12 months. There has recently been some sensitivity to hot and cold and gingival soreness, most noticeably on toothbrushing or eating ice cream.
  • It is important to document the length of time the patient has been aware of the recession and any period in which it has progressed more rapidly.

 

Dental History

  • The person has been a patient of your practice for about 10 years and you have discussed her recession at previous visits and reassured her. She has a low caries rate and generally good oral hygiene.
  • Despite your previous reassurance, it is also important to establish and document why the patient remains concerned. Is she worried about potentially losing the lower teeth, or is the sensitivity the primary concern? Are her concerns related to aesthetics? The latter would be unlikely in this case but certainly could be a factor for upper anterior teeth in individuals with a high smile line and will have implications for management.

 

Medical History

  • The patient is a fit and healthy individual and is not a smoker.
  • What Further Specific Questions Would You Ask To Identify a Possible Cause?

 

How often does the patient brush her teeth?

  • Some individuals brush excessively in terms of frequency, duration and force used. Trauma from brushing is considered a factor in recession in some patients, and recession may indicate a need to reduce the frequency and duration of cleaning while maintaining its effectiveness. In this instance, the patient has a normal toothbrushing habit, but she should clean no more than twice each day and for a sensible period (2–3 minutes).

 

Has the patient ever had orthodontic treatment?

  • A lower incisor is missing, suggesting that some intervention may have taken place. Fixed orthodontics in
  • the lower labial segment is associated occasionally with gingival recession in patients with a thin periodontal phenotype – that is, thin buccal gingiva and narrow alveolar processes. There may have been correction of severe crowding previously. Plaque control may be compromised during the wearing of an orthodontic appliance, and even over a relatively short period, this can contribute to the problem. In this instance, the patient had undergone extraction of the incisor but had not worn an orthodontic appliance.

Examination

 

Intraoral Examination


  • What do you see?

  1.    Missing lower left central incisor
  2.    Unrestored teeth
  3.    No plaque visible except for a small amount at the gingival margin of the lower left lateral incisor
  4.    Gingival recession affecting all lower incisors and, to a lesser extent, the lower canines
  5.    Apart from the abnormal contour, pink and healthy buccal gingivae and normal interdental papillae.
  6. Reduction in width of keratinized attached gingiva; in places, absent attached gingiva

  • On performin g these clinical examinations you find thatall probing depths are 1–2 mm, with no bleeding. The width of the keratinized gingiva varies with the degree of recession.The lower left lateral incisor has no attached gingiva, and tension on the lip displaces the gingival margin. No teeth have increased mobility, and no possible occlusal factors are present. There is no reason to suspect loss of vitality, and all teeth respond to testing.

 

Investigations


What Radiographs are Indicated?

Radiographs would give little additional information. The degree of bone loss on the buccal aspect, including bone dehiscence and fenestrations, is not shown well on radiographs because of superimposition of the roots. 
Radiographs might help if interdental bone loss is suspected, but intact interdental papillae, together with minimal probing depths, suggest normal interdental bone height. A radiograph would be of value if mobility indicated a need to assess root length and bone height.