THE SET-UP
“Gingival recession is one of the most prevalent periodontal pathologies. In this article we examine the different contributing factors to be considered for an accurate diagnosis."
—Dr. Peter O. Cabrera, team lead
Recession is commonly defined as the apical migration of the periodontal attachment. From a practical clinical perspective, most clinicians apply a visual standard in diagnosing this type of pathology. From a more detailed analysis, however, what is commonly called gingival recession is really a combination of pathologies that result in bone loss, root damage, decay and significant patient discomfort in the form of root sensitivity.
Given this variety of presentations, root exposure is a more comprehensive and descriptive term than gingival recession. I propose the term “gingival recession” be eliminated and substituted with a more comprehensive definition, which is “root exposure.” The word recession is generally misunderstood and frequently misdiagnosed, which is why clinicians need to refine and rethink how they look at it.
Diagnosing root exposure
There are many factors that can lead to root exposure (see “What causes root exposure"), from thin bone to trauma. Clinicians need to be able to spot it and diagnose it. Diagnosing root exposure should be part of a comprehensive periodontal exam and can be organized in three categories:
1. Disease evaluation. This includes probing depth, notation of bleeding on probing, the distance of the marginal tissue from the cementoenamel junction (CEJ), and root lesions whether they’re the result of trauma, abfraction or abrasive.
2. Structural evaluation. There are many structural characteristics that can predispose patients to root exposure.
- Periodontal biotype is one of the least used diagnostic criteria in periodontal evaluation, and also is one of the most useful. Periodontal biotypes are generally defined as the thick, flat periodontium and the thin, scalloped periodontium. It is in the thin biotype where the patient presents with thin bone and tissue where we are likely to see root exposure. Although root exposure also can occur in the thick biotype, depending on the clinical circumstances, it is more common in the thin biotype.
- Tooth position in the alveolar process also can be seen in structural evaluation. The more facially or lingually positioned a tooth is in the alveolar process, the thinner the bone becomes and the more likely you are to see root exposure. This can occur with normal wear and tear. Extreme labial or lingual position of the roots can place the tooth outside of the alveolar process.
3. Functional (parafunction, abrasion and restorative trauma).
- Parafunction, especially in the presence of occlusal interferences, can lead to abfractive cervical lesions.
- Abrasion, whether it is the result of aggressive brushing or it’s chemical, can lead to migration of the apical attachment as well as enamel erosion and dentin exposure.
- Restorative trauma is violation of the periodontal attachment, either in subgingival preparation or insertion of margins, and has deleterious consequences—typically in the periodontium. The result is inflammation and increased probing depths. In the thin periodontium, we tend to see apical migration of the attachment and thus root exposure.
