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September 12, 2024
by Gabriele Maycher, CEO, GEM Dental Experts Inc. BSc, PID, dip DH, RDH: 

FACE (and embrace) THE FACTS!

Whether you’re right out of school or you’ve been practising in the trenches for decades, there are some fundamental truths that all hygienists should embrace in our efforts to provide exceptional client care – and some of these facts may surprise you.

FACT 1: It’s an equal opportunity condition. Gingival recession occurs when the gingival margin shifts apically, relative to the cementoenamel junction (CEJ). This condition is often linked with attachment loss and exposes the root surface to the oral environment. And it is found in populations around the world.

FACT 2: The list of contributors is long. The multiple factors contributing to gingival recession encompass periodontal disease, calculus buildup, inflammation, inadequate flossing techniques, vigorous toothbrushing, excessive frenal attachment, orthodontic pressure, malalignment, thin phenotype, and inadequately constructed dental restorations.

FACT 3: Half of your adult clients experience this condition. According to a national survey conducted in the United States, gingival recession is common among adults, tends to escalate with increasing age, and is observed in populations with varying levels of oral hygiene. Recent surveys have indicated that gingival recession is present in at least one site for 88% of individuals aged 65 years and older, as well as in 50% of those aged 18 to 64 years.

FACT 4: It looks bad, and it’s bad for clients. Numerous facets of gingival recession underscore its clinical significance. While its prevalence is high, primarily stemming from acquired and developmental causes rather than periodontal disease, its appearance is often deemed aesthetically displeasing by clients. Additionally, gingival recession may lead to dentin hypersensitivity and expose root surfaces to the oral environment, potentially resulting in carious and non-carious cervical lesions, including abrasions and erosions. Addressing these concerns is paramount in clinical management.

FACT 5: The new classification is much more comprehensive. The 2018 American Academy Periodontal (AAP) Classification introduced a contemporary approach to recession classification (proposed by Cairo et al.), which centers on interdental clinical attachment loss (CAL) measurement, offering a more comprehensive approach for treatment planning, particularly regarding root coverage procedures.

  • Recession Type 1 (RT1): Gingival recession with no loss of interproximal attachment. Interproximal CEJ is clinically not detectable at both mesial and distal aspects of the tooth. Can be associated with traumatic toothbrushing in healthy periodontal tissue.
  • Recession Type 2 (RT2): Gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss (measured from the interproximal CEJ to the depth of the interproximal sulcus/pocket) is less than or equal to the buccal attachment loss (measured from the buccal CEJ to the apical end of the buccal sulcus/pocket). Can be associated with horizontal bone loss.
  • Recession Type 3 (RT3): Gingival recession associated with loss of interproximal attachment. The amount of interproximal attachment loss (measured from the interproximal CEJ to the apical end of the sulcus/pocket) is greater than the buccal attachment loss (measured from the buccal CEJ to the apical end of the buccal sulcus/pocket). Can be associated with interproximal infrabony defects.

FACT 6: Regenerative therapy works. Root coverage procedures provide significant reduction in recession depth. The Cairo classification system outlines a more treatment-oriented approach, offering predictive outcomes for root coverage procedures based on the extent of attachment loss.

  • RT1: Predicts complete (100%) root coverage.
  • RT2: Indicates a threshold of interdental CAL loss, supported by evidence from various randomized clinical trials, where achieving complete root coverage is feasible through different root coverage procedures.
  • RT3: Recognizes scenarios where full root coverage is not attainable.

FACT 7: Surgery may be the best course of action. Surgical interventions may be warranted to alter the biotype or provide root coverage when there is an increased risk of pathology development or progression, and to meet aesthetic demands. Engaging in collaborative discussions with clients to address and prevent potential issues is integral to effective treatment. At this juncture, it may be prudent to consider referring the client to a periodontist for further evaluation and management of any periodontal concerns.

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