Development Of Gingival Recession Research Articles

Difference in Buccal Gingival Thickness between the Mandible and Maxilla in the Aesthetic Zone: A Systematic Review and Meta-Analysis.

Background: Fragile gingival tissue is a risk factor for the development of gingival recessions. Despite the fact that gingival recessions are more commonly seen around anterior mandibular teeth, previous research has predominantly concentrated on the gingival dimensions in the anterior maxilla. The objective was to systematically compare buccal gingival thicknesses between the upper and lower jaws in individuals with healthy gingival conditions in the aesthetic zone. Methods: A comprehensive search of three databases was carried out until October 2023. Gingival thickness differences between the maxilla and mandible were evaluated by calculating the mean differences along with the corresponding 95% confidence interval (CI). Subgroup analysis was conducted based on the measurement area, measurement method, and tooth category. Results: A total of seventeen studies were included in this systematic review. Eleven studies were included in the quantitative analysis. Quantitative analysis comparing gingival thickness around 2100 teeth in the anterior mandible to 2056 teeth in the anterior maxilla revealed a statistically significant thinner buccal gingiva in the mandible (mean difference: 0.16 mm; 95% CI [-0.24, -0.07]; p = 0.0003). Conclusions: The present systematic review revealed a more delicate buccal gingiva in the anterior mandible. However, further scientific validation is required due to the considerable heterogeneity in study design and the potential presence of confounding variables.

Lower incisor inclination and thickness of the alveolar process and mandibular symphysis in the development of gingival recession: A retrospective cohort study

IntroductionRetrospective studies have found conflicting results regarding the relationship between lower incisor inclination and the development of gingival recession (GR) after orthodontic treatment. ObjectiveThis study aimed to investigate the relationship between lower incisor inclination and alveolar process (AP) and mandibular symphysis (MS) thickness in the development of GR. Materials and MethodsFrontal intraoral photography and cephalometric radiography were conducted before (T0) and after (T1) orthodontic treatment of 62 subjects. The presence of GR was considered when the cementoenamel junction was visible in the lower incisor on the frontal intraoral photograph.The circumstances for improvement, stability, and worsening of the gingival situation were based on the reduction, maintenance, and increase in the number of lower incisors with GR before and after treatment. To measure the incisor-mandibular plane angle (IMPA) andthe thickness of the AP and the MS were used the cephalometric radiographs. ResultsMen had a significantly thicker MS than women at T0 and T1 (p < 0.0004).There was a significant reduction of approximately 10% in AP between T0 and T1 (p < 0.0001).Among subjects without GR at T0, 70.4% presented a stable gingival situation at T1. For subjects with 1 lower incisor with GR at T0, 50% showed improvement in the gingival situation at T1, 21.4% remained stable, and 28.6% experienced worsening.Sixteen lateral incisors presented a worsening gingival situation, representing an increase of 129% compared to the central incisors. ConclusionNo relationship was found between lower incisor inclination and the thickness of the AP and MS in the development of GR.

Alveolar Bone Morphotype in Orthodontic Patients

Orthodontic treatments have been described as a risk factor for the development of gingival recessions. This descriptive and cross-sectional study was performed to evaluate the alveolar bone morphotype of the upper and lower anterior of 33 orthodontic treatment of candidate patients. The images were obtained from a high-resolution cone beam computerised tomography. Then, the thickness of the alveolar bone plate of teeth was measured in six levels, recording the presence of dehiscences and fenestrations. A total of 2,334 sites were evaluated. The average thickness of the maxillary alveolar bone at the buccal surface was 0.70, 0.62 and 1.43 mm at the cervical, middle and apical levels, respectively, while in the mandibular teeth it was 0.53, 0.50 and 2.96 mm. At the palatal and lingual surfaces, the bone was thicker than the buccal except at the apical level of the mandible. Most of the examined sites were measured less than 1 mm (n = 1,235, 52.9%), associated with high prevalence of bone dehiscences (57.6%) and fenestrations (33.3%), particularly in skeletal Class III patients. The observed bone morphotype involved a high vulnerability to bone resorption, and the subsequent gingival recession occurrence, face to orthodontic movements.

ПОИСК АССОЦИАЦИИ ПОЛИМОРФИЗМА rs3918242 ГЕНА ММР9 С РЕЦЕССИЕЙ ДЕСНЫ У ДЕТЕЙ

Subject. Gingival recession is a complex multifactorial disease, the development of which is influenced by the interaction of many genes and environmental factors (orthodontic and mucogingival anomalies, bad habits, muscle hypertonicity). Since, in addition to environmental factors, genes also influence the development of this pathology, the study of the molecular genetic basis of gum recession is an urgent task of modern dentistry. Such studies can make a decisive contribution to the creation of a concept describing the development of gingival recession, will help determine the prospects for its personalization and will allow the development of scientifically based comprehensive programs for the prevention of periodontal pathology.&#x0D; The aim is to study the association of the rs3918242 of the metalloproteinase 9 (MMP9) gene in children with the development of gum recession citizensof the Republic of Tatarstan.&#x0D; Methodology. The study sample included 284 patients, of which 200 relatively healthy ones constituted the control group (intact periodontium) and 84 - the observation group (gingival recession). DNA was isolated from buccal epithelial cells. Further genotyping of the rs3918242 polymorphism of the MMP9gene was performed using real-time polymerase chain reaction on a CFX96 amplifier (BioRad, USA) in accordance with the manufacturer's instructions (Sib-DNA, Novosibirsk). Statistical analysis was performed to assess the differences between the study groups.&#x0D; Results. There were no statistically significant differences in the frequency of alleles and genotypes of the rs3918242 polymorphism of the MMP9 gene between the study groups (p &gt; 0.05).&#x0D; Conclusions. The role of the rs3918242 polymorphism of the MMP9 gene in the development of gum recession in children living in the Republic of Tatarstan has not been established using the case-control methodological approach.

A Novel Surgical Approach to Modify the Periodontal Phenotype for the Prevention of Mucogingival Complications Related to Orthodontic Treatment.

Certain bone morphologies and soft tissue thickness (ie, phenotype) are considered to be risk factors for the development of gingival recessions following orthodontic tooth movement. Preoperative evaluation of the periodontal phenotype, in the frame of orthodontic treatment plan, identify teeth at high risk for mucogingival complications related to orthodontic therapy. The new surgical technique is illustrated in a clinical case. A patient with a thin phenotype without visible gingival recession had bone dehiscences in the anterior mandible. Prior to orthodontic treatment, simultaneous bone and soft tissue augmentation was performed using the combination of a highly cross-linked ribose porcine type I collagen membrane and a subepithelial palatal connective tissue graft. Two years after augmentation surgery and initiation of orthodontic treatment, a thick buccal tissue with a wide band of attached gingiva was observed without any clinical signs of root prominences, indicating a substantial change in periodontal phenotype. The clinical findings were corroborated by the 3D analysis, demonstrating substantial bone apposition on the buccal aspect of all roots in the treated area. The described surgical technique offers a valuable approach for regenerating hard and soft tissues in deficient areas prior to orthodontic therapy, thus preventing the development of gingival recessions.

МУКОГИНГИВАЛЬНЫЕ АНОМАЛИИ КАК ЭТИОПАТОГЕНЕТИЧЕСКИЙ ФАКТОР РАЗВИТИЯ РЕЦЕССИИ ДЕСНЫ

Subject. A review of the literature devoted to the current problem of dentistry - mucogingival anomalies (small vestibule of the mouth, short frenulum of the lips, tongue, muco-alveolar cords) is presented. Purpose of the study — study the materials of publications devoted to mucogingival anomalies as etiopathogenetic factors in the development of gingival recession. Methodology. In detail, in the light of modern ideas described mucogingival anomalies (shallow vestibule of the mouth, short frenulum of the lips, tongue, mucous-alveolar cords) and their effect on the development of gum recession. Results. It has been established that a large role in the occurrence and development of gingival recession is played by the ratio of the size of the attached and free gums, which is normally equal to 5: 1, and in pathology — 1: 1. The pathogenetic mechanism of the negative impact of mucogingival abnormalities is associated with the absence, first of all, of a sufficient width of the attached gums with a shallow vestibule of the mouth, which is a factor of constant chronic trauma to the gums with, leading to disturbances in microcirculation and tissue metabolism, resulting in resorption of bone structures, etermined radiographically. In the mechanism of gum recession, a significant role is also played by the pulling mucous-alveolar cords, shortened and massive frenum of the lips and tongue. The main signs of arising ischemic disorders are anemization and mobility of the marginal gums when the lower or upper lip, cheeks, and tongue are abducted. To prevent severe destructive lesions, it is necessary to timely identify and eliminate, with the help of vestibulo- or frenuloplasty operations, conditions conducive to functional chronic traumatization of the periodontal tissues. Conclusions. The results of the review indicate that knowledge of the anatomical and topographic parameters of the vestibule and oral mucosa is necessary to prevent the development of gingival recession, prescribe timely and adequate treatment, predict and prevent complications. However, it should be recognized that this problem, in our opinion, continues to remain relevant to this day due to the lack of an integrated approach to the prevention, diagnosis and treatment of gum recession.

Assessment of Maxillary Expansion by Piezocision-Assisted Orthodontics: A Pilot Study.

The correction of transverse malocclusions due to maxillary width deficiency in adults is challenging. Multiple surgical and nonsurgical procedures have been used in conjunction with orthodontics to address this situation, and most common is the surgically assisted rapid maxillary expansion (SA-RME). Although successful, it is quite aggressive. The present investigation assesses the usefulness of Piezocision-assisted orthodontics as a less-invasive option for treatment of transverse maxillary deficiencies in adults. Dental casts were taken before and after Piezocision-assisted palatal expansion in four patients. They were digitized into STL files and superimposed. Differences on cross-arch tooth torque, angulation/tipping, and movement distances between time points were quantified using a digital static and a novel digital 3D-movement evaluation method. For the buccolingual movement per tooth, first premolars averaged 3.33 ± 1.3 mm, second premolars averaged 3.63 ± 0.6 mm, and first and second molars averaged 1.56 ± 1.2 mm and 0.36 ± 1.2 mm, respectively. Bodily movement of the teeth was observed with minimal tipping and no development of gingival recessions. Piezocision-assisted palatal expansion is a safe and reliable procedure that can help patients with maxillary width deficiency. It is a new tool in the orthodontist's armamentarium that can be used as an accelerator of treatment and as a new way to solve orthodontic challenges in selected adult patients.

Association of hard and soft tissue factors with gingival recession in orthodontically treated patients: A retrospective study

Orthodontic treatment is thought as a contributory factor in the development of recession. The objective of this study was to determine the factors associated with a gingival recession in patients who underwent orthodontic mechano-therapy. A retrospective chart review of 72 post-orthodontic cases done at the dental clinics of Aga Khan University hospital that were treated from 2009 to 2017. After evaluating dental records patients were recruited based on inclusion and exclusion criteria. Patients were divided into two groups based on the presence or absence of gingival recession on posttreatment photographs. Patients in each group were further assessed on the following factors: (1) Lower incisor inclination (IMPA). (2) Tissue thickness on the facio-lingual dimension. (3) Alveolar bone height. (4) Alveolar bone thickness. The mean age of patients at the start of treatment was 16.56±5.66years. Gingival recession was found in 40.3% of our patients while 59.7% of patients had no recession found after orthodontic treatment. Univariable logistic regression was applied for factors associated with a gingival recession following orthodontic treatment which showed that the odds ratio of gingival recession in thin gingival biotype are 14.4 times more than in thick gingival biotype. Multivariable regression analysis showed that the cases had 10.2 times more recession in thin biotype than those in the thick gingival biotype while adjusting for pre- and posttreatment alveolar heights following orthodontic treatment and with a confidence interval [95% CI=2.69 to 38.40]. It was concluded from this study that 40% of patients developed gingival recession in one or more teeth during orthodontic treatment. Among different factors pre-treatment, gingival biotype of patients and male gender were the factors that were more associated with the development of gingival recession.

THE INFLUENCE OF THE AGE ON THE PREVALENCE OF GINGIVAL RECESSION IN PATIENTS WITH PERIODONTITIS

Gingival recession is a common clinical condition in the dental practice, which is characterized by the root surface exposure due to the apical displacement of the marginal gingival tissues. Since the teeth' root surfaces become open to the environment of the oral cavity, the consequences of gingival recession are a disturbance of aesthetics (mainly when they occur in the frontal area), the development of hypersensitivity root caries, and non-carious cervical lesions. Despite the numerous studies carried out, the exact mechanism of the development of gingival recession is not fully understood, and it is generally accepted that it has a multifactorial etiology. Gingival recession can occur directly due to an infectious and inflammatory process in the periodontal tissues, anatomical features, as a result of the effect of mechanical or iatrogenic factors on soft tissues, or their action in combination with each other. The prevalence of gingival recessions worldwide varies from 22 to 100% and mainly depends on age, the size of the studied population, diagnostic criteria, and statistical data processing methods. &#x0D; The aim was to determine the influence of age on the prevalence of gingival recession in patients with periodontitis. &#x0D; Materials and methods. One hundred thirty-three patients with periodontitis aged 29 to 59 years were included in the study and divided into four groups according to their age: 20–29 years, 30–39 years, 40–49 years, 50–59 years. Inclusion criteria were the presence of periodontitis, age over 20 years, and the presence of more than 20 teeth in the oral cavity. &#x0D; Participants were interviewed about demographic data, smoking status, and oral hygiene skills. All patients underwent a clinical examination using the clinical and instrumental program Florida Probe system. Gingival recession was recorded in the presence of root surface exposure of 1 mm or more. According to the size of the exposed surfaces of the tooth roots, three degrees of severity of gingival recession were assessed: mild gingival recession (less than 3 mm), moderate gingival recession (3 to 4 mm), severe gingival recession (5 mm or more). The severity of gingival recession was estimated in mm as the distance between the cemento-enamel junction and the gingival margin. Subsequently, the gingival recession was classified using the Miller recession classification [7].&#x0D; Results of the studies and their discussion. The study results showed that a high prevalence of gingival recession was found in patients with periodontitis in the Ukrainian population. Exposure of the surface of the teeth' roots by 1 mm or more was present in around 2233 teeth, which corresponds to 65.86 (61.4-70.3)% of all examined teeth. The average number of teeth with the gingival recession increases with age: in those aged 20-29, the gingival recession was present in 42,86% of the teeth, in patients 30-39 years of age, the gingival recession was present in around 59,59% of the teeth, in patients 40-49 years of age the gingival recession was present in around 70,49% of the teeth, in those, older than 50 years, the gingival recession was present in around 82.72% of the teeth. Incisors and first molars were the most affected teeth by the gingival recession. In patients with periodontitis, the gingival recession of mild degree (up to 3 mm) was determined around 44.01 (40.8-47.2) % of teeth, the gingival recession of moderate degree (from 3 to 4 mm) – around 17.41 (14.3-20.5) % of teeth, the gingival recession of severe degree (5 mm or more) – around 4.42 (2.7-6.2)% of teeth. The severity of recession in patients of different age groups was determined: the gingival recession's severity increases with age. The average severity of gingival recession (the length from the cemento-enamel junction to the gingival margin) was determined in patients of different age groups: in the group of 20 years old, it was 0.28 ± 0.28 (M ± SD) mm, in the group of 30 years old – 0.43 ± 0.37 (M±SD) mm, in the group of 40 years old – 0.78 ± 0.70 (M ± SD) mm, in the group of 50 years old – 1.20 ± 0.70 (M±SD) mm. According to the Millers classification, Class III of the gingival recession was more common in age groups I and II, Class IV of gingival recession, which have an unfavourable prognosis of treatment, were more often manifested in older patients age groups.

Do orthodontic patients develop more gingival recession in anterior teeth compared to untreated individuals? A systematic review of controlled studies

To investigate, in an evidence-based manner, the contemporary available information regarding the development of gingival recession in the anterior teeth of orthodontically treated and age-matched untreated individuals. Eight databases were searched without restrictions from the date of coverage initiation to June 30th, 2019 (registration in PROSPERO: CRD42018080948). Studies evaluating gingival recession development following comprehensive orthodontic treatment were reviewed. Following study selection, data extraction and risk of bias assessment, the random effects model was employed for exploratory data synthesis. The confidence in the retrieved estimates was appraised using current guidelines. Finally, three studies, with a follow-up of 6 years maximum, were identified. Overall, the amount of gingival recession did not increase significantly immediately after treatment with normal occlusion. However, for some of the comparisons considered, the risk for orthodontic patients to present with labial gingival recession seemed to increase, especially during retention [mandibular incisors 6 years post-treatment: Odds Ratio: 8.81, 95% Confidence Interval: 1.93-40.07, p=0.005]. Although the amount of recession does not differ, some increase in the risk for gingival recession development in the anterior teeth may be encountered in orthodontically-treated individuals compared to untreated subjects with normal occlusion. However, these findings should be viewed cautiously until more studies of high quality become available. Good practice would suggest that it is important to identify patients at potential risk and consider the possible implications for orthodontic treatment.

Long-term evaluation of lower incisors gingival recessions after orthodontic treatment.

The development of gingival recessions has been associated with orthodontic treatment; however, a clear etiology is still unknown. The aim of the present study was to further clarify potential association between the development of labial and lingual recessions and inclination of the lower incisors during orthodontic treatment, vertical facial morphology, width of the alveolar bone process, height and width of their symphysis after orthodontic treatment and at long-term retention. On dental casts and good quality lateral cephalograms of 126 orthodontically treated patients, relevant measurements were performed and gingival recessions were assessed and recorded before, immediately after treatment and at long-term retention. Taking into account the whole sample at three different occasions, on the buccal side, the lateral incisors have significantly less recessions than the central incisor. On the lingual side, tooth 32 presented with lower risk of recession compared to all other three incisors. No association was found between the width of the alveolar bone process at the apex (Wapex), at the level of the crest (Wcrest) and at mid of the root (Wmid), the width (D), the vertical skeletal pattern (AnsPns-Go'Me) and the onset of buccal or lingual recessions. Development of new recessions was clearly associated with males and with increasing age. The symphysis height (Me-Wcrest) was statistically related with the onset of lingual recessions on 32 and 42. The ratio between the symphysis height and the width at the crest level demonstrated a statistically significant association with the presence of buccal and lingual recessions. Excessive proclination (≥10°) of the lower incisors demonstrated an association with the onset of recessions in 25 per cent of the cases. Based on the sample of this study, there is some evidence that increased symphysis height (Me-Wcrest), and ratio between the symphysis height and the width at the crest level as well as big change of lower incisor inclination during treatment are associated with the development of recessions.

Gingival recession in orthodontic patients 10 to 15years posttreatment: A retrospective cohort study.

The aims of this study were to retrospectively investigate the long-term development of gingival recession in a cohort of orthodontic patients and to compare the prevalence of gingival recession in orthodontically treated patients 10 to 15years posttreatment to that of untreated subjects with malocclusion. The sample included 88 patients with mean ages of 12.1years (SD, 2.4years) at pretreatment, 15.1years (SD, 2.4years) at posttreatment, and 27.9years (SD, 2.5years) 10 to 15years posttreatment. The control group comprised 102 untreated patients seeking orthodontic treatment with a mean age of 28.7years (SD, 3.1years). Gingival recession was evaluated on study models. The prevalence of both labial/buccal and lingual/palatal gingival recession increased during orthodontic treatment with further increases during the long-term posttreatment period; 98.9% of the orthodontically treated participants had at least 1 labial/buccal recession, and 85.2% of the patients had at least 1 lingual/palatal recession 10 to 15years posttreatment. In addition, the proportion of patients with multiple labial/buccal or lingual/palatal recession sites increased considerably in the same time period. The prevalences of labial/buccal gingival recession were similar in the orthodontically treated patients 10 to 15years posttreatment and the untreated controls. Study group patients with a crossbite before treatment showed 2.73 more recessions (95% CI, 0.28-5.17; P = 0.029) than did those without a transverse discrepancy. Untreated subjects with crowding greater than 3mm per arch had 3.29 more recessions (95% CI, 0.73-5.68; P = 0.012) to 4.92 more recession sites (95% CI, 1.70-8.15; P = 0.003) than did those with mild or no crowding. Within the limitations of this study, it seems that, in regard to the prevalence of gingival recession, orthodontically treated patients are not compromised in the long term compared with those with malocclusion that was untreated for many years.

Influence of Periodontal Biotype on Root Surface Exposure During Orthodontic Treatment: A Preliminary Study

The aim of this study was to investigate the role of periodontal biotype in the development of gingival recession in patients who have undergone orthodontic treatment. A total of 60 mandibular incisors were analyzed. The qualitative assessment of periodontal biotype was performed with the use of a new biotype probe. A strong correlation was found between thin biotype and proinclination in terms of recession depth and keratinized tissue width. Patients with thin periodontal biotype are more prone to gingival margin instability, irrespective of the type of orthodontic movements. Thin periodontal biotype and proinclination orthodontic movement were related to loss of keratinized tissue width.

Gingival recession in mandibular incisors and symphysis morphology-a retrospective cohort study.

To evaluate if the morphology of the mandibular symphysis is associated with the development of gingival recession. A cohort of 177 patients was followed longitudinally for up to 5 years post-treatment. Based on the width of the symphysis, participants were divided into three groups: narrow (n = 57); average (n = 63), and wide symphysis (n = 57). Morphology of the symphysis and inclination of incisors were measured on lateral cephalometric radiographs before treatment (Ts), at the end of treatment (T0) and 5 years after treatment (T5). Gingival recession and the change of clinical crown heights in mandibular incisors were measured on plaster models made at TS, T0, and T5. From TS to T5 the change in inclination was comparable in the narrow, average, and wide groups. At T5, gingival labial recession was present in 19.3 per cent of patients with narrow symphysis, 20.6 per cent with average symphysis, and 14 per cent of patients with wide symphysis. The difference was not significant. The mean change of clinical crown height was <1 mm (TS - T5). The regression model showed some evidence that incisor inclination at Ts might have been associated with the change of mean clinical crown height (-2.51, 95% CI: -4.6 to -0.4, P = 0.02). The logistic regression model demonstrated that H1 (Height 1) might be associated with the development of gingival recession (OR = 0.75, 95% CI: 0.58 to 0.96, P = 0.03). Within the limitations of this study, there is no evidence that the overall morphology of the mandibular symphysis is associated with gingival recession development.

Long-term influence of fixed lingual retainers on the development of gingival recession: A retrospective, longitudinal cohort study.

To investigate the long-term influence of fixed lingual retainers on the development of mandibular gingival recession and to compare the prevalence with untreated individuals. The material consisted of 144 subjects: 96 orthodontically treated patients followed for 5 years after therapy and 48 untreated age-matched subjects. The treated patients were divided in two groups: one receiving a fixed mandibular retainer (n = 48) and one receiving no form of retention in the mandible (n = 48). The presence or absence of gingival recession and calculus accumulation were scored before treatment (T0), after debonding (T1), and 5 years after debonding (T5) for each tooth in the mandibular intercanine region using plaster models and intraoral photographs. The chi-square test, one-way ANOVA, and Cochran's Q test were used to evaluate inter- and intragroup differences. The prevalence of patients with recession increased gradually and significantly throughout the observation periods in all groups, but the intergroup differences at T5 were not significant. Significantly more calculus accumulation was observed at T5 in the retainer group compared with the group without retainers. Long-term presence of fixed lingual retainers does not seem to increase the development of mandibular gingival recession, but does increase calculus accumulation.

Prevalence of gingival recession after orthodontic tooth movements.

This study was designed to evaluate the long-term prevalence of gingival recession after orthodontic tooth movements, focusing on the effects of mandibular incisor proclination and expansion of maxillary posterior teeth. Records of 205 patients (162 female, 43 male) were obtained from 2 private practice orthodontists. Using pretreatment (age, 14.0±5.9years) and posttreatment (age, 16.5±6.0years) lateral cephalograms and dental models, mandibular incisor proclination and maxillary arch widths were measured. Gingival recession was measured based on posttreatment and postretention (age, 32.3±8.5years) intraoral photographs and models. Associations between tooth movements and gingival recession were evaluated statistically. Only 5.8% of teeth exhibited recession at the end of orthodontic treatment (only 0.6% had recession>1mm). After retention, 41.7% of the teeth showed recession, but the severity was limited (only 7.0%>1mm). There was no relationship between mandibular incisor proclination during treatment and posttreatment gingival recession. Incisors that finished treatment angulated (IMPA) at 95° or greater did not show significantly more recession than did those that finished less than 95°. There were weak positive correlations (r=0.17-0.41) between maxillary arch width increases during treatment and posttreatment recession. Orthodontic treatment is not a major risk factor for the development of gingival recession. Although greater amounts of maxillary expansion during treatment increase the risks of posttreatment recession, the effects are minimal.

Gingival Recession in Orthodontics: A Review

By clinical definition, gingival recession refers to the exposure of the root surface by an apical shift in the position of the gingiva. Recession is important because it can lead to poor esthetics, tooth hypersensitivity, loss of periodontal support, difficulties in maintenance of oral hygiene, and increased susceptibility to caries. Although its etiology is not fully understood, periodontal disease and mechanical trauma are considered the primary factors in the pathogenesis of gingival recession. Orthodontic treatment might also promote the development of gingival recessions. It has been well established that orthodontic forces can move roots close to or through the alveolar cortical plates, leading to bone dehiscence. In such instances, the marginal gingiva, without proper alveolar bone support, might be expected to migrate apically and lead to root exposure. This assumption is based on the fact that in areas of recession, a subjacent alveolar bone dehiscence is always present.

Post-orthodontic position of lower incisors and gingival recession: A retrospective study.

BackgroundTo evaluate if changes in lower incisor position following orthodontic treatment are correlated with development of gingival recessions.Material and MethodsPre- and post-treatment digital models and lateral cephalograms of 22 subjects were collected retrospectively. The clinical crown length, gingival scallop, and papilla height of the central lower incisor were measured along with the cephalometric incisor’s inclination, the distance from the mandibular plane, and the distance between the Infradentale and Menton points. Statistical correlations between gingival and cephalometric variables were studied. In addition, two groups were defined based on the post-treatment incisor inclination value (‘normal’ or ‘proclined’) and compared.ResultsThe incisor inclination was correlated with the change in gingival scallop and papilla height. Moreover, there was a statistically significant difference in clinical crown height and gingival scallop between the ‘normal’ group and the ‘proclined’ group.ConclusionsChanges in lower incisor position, especially an excessive proclination, after orthodontic treatment may play a role in the development of gingival recession. Key words:Orthodontic treatment, Incisor inclination, IMPA, Gingival recession, Alveolar bone.

The influence of primary occlusal trauma on the development of gingival recession

This study aimed to histometrically evaluate the presence of gingival recession in the mesial surface of the teeth of rats experimentally subjected to primary occlusal trauma. This evaluation verified the distance from the cement-enamel junction (CEJ) to the free marginal gingiva (FMG) and to the height of the alveolar bone crest (CEJ-crest bone distance). There were 10 animals, randomly divided into 2 groups: occlusal trauma (OT) (n=5) – creation of an occlusal interference by fixing an orthodontic wire segment on the mandibular first molar occlusal face, which was randomly chosen, and a Control Group (CG) (n=5) – five animals with no exposure to the OT variable were euthanised after 14 days to obtain the initial parameters. The inter-group evaluation showed there was no significant difference between OT×CG when the CEJ-FGM distance (P=0.192) was evaluated after 14 days, but there was a significant difference between the two groups as regards the CEJ-alveolar crest bone distance (P=0.0142). Thus, it can be concluded that the OT induction model, after 14 days of experiment, promoted bone resorption. This was observed by the increase in the CEJ-alveolar crest bone distance. It also did not promote gingival recession, which was evaluated by the CEJ-FGM distance.

Effect of a Multidirectional Power Toothbrush and a Manual Toothbrush in Individuals Susceptible to Gingival Recession: A 12-Month Randomized Controlled Clinical Study.

Clinical studies have explored the relationship between toothbrushing and development of gingival recession (GR), but relevant GR data for the multidirectional power toothbrush (PT) are lacking. The aim of this study is to evaluate the effect of brushing with either a multidirectional PT or American Dental Association reference manual toothbrush (MT) on mid-buccal preexisting GR (PreGR) during 12 months. This was a 12-month prospective, single-masked, parallel-group, randomized, controlled clinical study. Healthy participants without periodontitis with at least two teeth showing PreGR ≥2 mm were randomized to a group brushing with either an MT or PT. The primary outcome parameter was change at sites with PreGR ≥2 mm. All clinically based GR measurements were performed by one calibrated examiner at baseline, 6, and 12 months. Secondary outcomes were changes of GR at all mid-buccal sites (with or without PreGR), changes in percentage of GR sites demonstrating a change of ≥1 mm, and changes in probing depths. A total of 107 participants completed the study (PT: 55, MT: 52). During the 12-month study period the mean recession at sites with PreGR ≥2 mm decreased significantly from 2.2 to 2.1 mm in both groups (P <0.05). The extent of GR parameters did not differ between MT and PT groups at any time point. GR evaluated clinically and on stone casts was well correlated. Neither the PT nor MT led to an increase in PreGR during 12 months of daily use.