Gum Recession 101: What You Should Know

Sometimes gum tissue disappears and teeth appear to be getting longer. Since the destruction is rarely painful, patients do not complain until moderate to extreme sensitivity is present. Most often they don’t notice until it becomes advanced. Consider what is actually occurring when gums disappear. The issues are as follows

  • The gum tissue disintegrates and disappears
  • The supporting bone underneath disappears: lower bone means a lower gum level
  • Exposure of the soft root surface                                             
  • Root abrasion, root wear/ destruction
  • Sensitivity
  • Greater tendency towards decay
1) Loss of Bone= Recession | 2) Damage to Roots | 3) Recession Beyond Bonding | 4) Post Invisalign, Patient age: 20

Which patients have the greatest need to have recession treated?

Younger individuals definitely have a greater need for treatment. If we observe 3 mm of recession in both a 30 and a 70 year old, who is at the greater risk for continued destruction? Under similar conditions, it is clearly the 30 year old. What are the chances that the 30 year old will arrive at age 70 with the tooth still intact when there are 40 more years of chemical and mechanical stress that will be placed on the exposed root?

Note above photo: Patient age 20… apx.12 months after orthodontics was completed.

Can bonded restorations be successfully and predictably used to treat recession?

No. We must be clear about one important fact. Bonding exposed root surfaces does not treat or stop recession and merely attempts to cover the exposed root surface. As you can see in the photo above, recession most often continues beyond the bonding. Thus, there is more loss of gingiva, more bone loss and more root damage occurs.

Can we predictably recover exposed roots with reconstruction procedures?

Yes. Several different techniques have been developed over the past 60 years that can predictably reattach to the root surface and recover the exposed root. The key is to treat early before any bone loss occurs. The bone levels determine the height of tissue.  When bone levels drop we cannot regain lost tissue to the original level. Studies that have followed gum reconstruction for up to 20 years indicate remarkable stability.

Do we really know what causes recession?

What we do know is the result of observation and case study. CT scan studies now show that many people have roots that stick through the bone and that alone or combined with any kind of orthodontic tooth movement causes recession. Individuals with a thin tissue type are more prone to recession than people with thick tissues. When we treat recession with reconstruction procedures, the new gum is thicker tissue over the areas where recession has occurred and that helps resist future destruction.

How serious a problem is recession?

Recession gets too little respect as a real issue. Recession not only damages the supporting structures but also very often promotes the destruction of the root as you can see in the above photos. Since root structure is so much softer than enamel, our ability to predictably restore these teeth long-term is very limited. The key is early diagnosis and treatment.

3 Different Cases

Traditional Inside Approach

BEFORE | AFTER

Traditional Outside Approach

BEFORE | AFTER

Pinhole Technique

BEFORE | AFTER

3 Different Cases

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