• The Journal of the Korean dental association
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• v.55 no.3
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• pp.249-256
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• 2017

Gingival recession is one of the common mucogingival problems during the orthodontic treatment. The causes of the gingival recession are similar to gingival recession in patients with periodontal diseases. Accumulation of bacterial deposits around the natural teeth induces the gingival inflammation and gingival recession occurs in the teeth with the lack of the supporting bone. However, malpositioned teeth which are labially positioned teeth or rotated teeth are more risky for gingival recession. Once root is exposed to oral cavity due to gingival recession, the orthodontic tooth movement is compromised and esthetic problems appeared. In addition, excessive gingival recession over the mucogingival junction jeopardizes the oral hygiene control, which has a risk of further gingival recession and bone loss around the tooth. To cover exposed root or to prevent further gingival recession, mucogingival surgery with gingival graft is recommended for the patients under orthodontic treatment. This case report aimed to present the mucogingival treatments of gingival recession observed during orthodontic treatment. Case I had had initial slight gingival recession before the orthodontic treatment. However, during the retraction phases, the gingival recession progressed and the periodontal treatment was referred. In case II, miller Class III gingival recession was occurred after correction of rotation. Both cases were treated by coronally advanced flap with free gingival grafts and recovered to the level of adjacent teeth despite of complete root coverage was not achieved in Case II. After periodontal treatment, orthodontic treatment was successfully completed. In conclusion, mucogingival surgery during the orthodontic treatment is recommended for the successful orthodontic treatment as well as periodontal health.

• Journal of Periodontal and Implant Science
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• v.36 no.1
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• pp.139-146
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• 2006

Many factors have been implicated in the etiology of gingival recession, including faulty toothbrushing, the position of the tooth in the arch(malalignment), the presence of inflammation, frenal attachment, impingement of restoration margins, orthodontic treatment and trauma from occlusion. Among the many factors, this study was to evaluate the relationship of occlusion and gingival recession. 640 teeth without other etiologic factors of gingival recession were evaluated in 40 subjects aged 21-59 years. Only 1st, 2nd premolar and molar were included in this study. We recorded nonworking contacts, working contacts, cervical abrasion, sex, gingival recession and evaluated that relation of occlusion and gingival recession. The results of this study were as follows; 1. Teeth with nonworking contacts were significantly more gingival recession than teeth without nonworking contacts.(p<0.01) 2. Teeth with working contacts were significantly more gingival recession than teeth without working contacts.(p<0.01) 3. Teeth with cervical lesion were significantly more gingival recession than teeth without cervical lesion.(p<0.01) 4. Men's teeth were more gingival recession than women's teeth but it was not significant.(p>0.01)

• The Journal of the Korean dental association
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• v.58 no.1
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• pp.8-18
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• 2019

This case report presents results for gingival recession coverage following gingival grafting and for gingival biotype enhancements by visualizing soft tissue volume changes using intraoral three-dimensional scanning. A 28 year old female patient with multiple gingival recessions and a 19 year old female patient with a single gingival recession on mandibular anterior area were treated. Root coverage was performed in both cases using autogenous subepithelial connective tissue harvested from palate. Intraoral 3D scan data were obatained presurgery and at 3 months, 1 year, and 2 years postsurgery. The recession areas were recovered successfully by subepithelial connective tissue graft combined with pedicle flap repositioning, and the patients showed neither further recurrence nor post-operative complication. Soft tissue biotype changes were identified by superimposing and analyzing scan data, revealing that gingival biotype was enhanced in both cases. These cases suggest that SCTG could be advantageous in terms of the gingival biotype enhancement, as well as gingival recession coverage, and intraoral 3D scanning might be suitable for assessing post-surgical gingival biotype change.

• Journal of Periodontal and Implant Science
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• v.36 no.1
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• pp.51-60
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• 2006

Gingival recession is clinically manifested by an apical displacement of the gingival tissue and dentin hypersensitivity is often used to describe a painful condition in which exposed dentin is unduly sensitive to intraoral stimuli. The objects of this study were primarily to investigate the prevalence and distribution of gingival recession and hypersensitivity and secondarily to determine whether a relationship exists between gingival recession and hypersensitivity. The study population was 195 patients (102 males, 93 females) who were attended the department of periodontology, Pusan National University Hospital. 189 patients exhibited gingival recession at least more than 1 tooth, the prevalence was 96.9%. The maxillary and mandibular first premolar and mandibular incisors had the highest prevalence. The majority of patients (139 patients, 71.3%) were diagnosed as having dentin hypersensitivity. Dentin hypersensitivity was determined to 3 seconds application of cold air to the exposed root surface after isolating the test tooth and was commonest in maxillary and mandibular first premolars and mandibular incisors. Relationship between recession and hypersensitivity was analyzed using chi-square test (p=0.05), significant relation (p=0.000) was existed. Gingival recession was more severe, the prevalence of hypersensitivity was higher.

• The Journal of the Korean dental association
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• v.55 no.7
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• pp.450-456
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• 2017

The purpose of this case report is to present a case of free gingival graft for treatment of mandibular incisor labial gingival recession relapsed after laterally positioned flap surgery. A 22 year-old female patient with discomfort and labial gingival recession on left mandibular central incisor was treated. The patient had been treated root coverage on same site by laterally positioned flap surgery, but treated site had relapsed in one month. Exposed root surface was covered by free gingiva from left palatal area. Although gingival color did not completely match with adjacent gingiva, more than 5mm keratinized gingiva was attained. The patient showed no further recurring pain and recession on gingiva after 5 months from the surgery. In conclusion, the root coverage with gain of keratinized gingiva could be achieved through free gingival graft from palate on relapsed gingival recession.

• Journal of Periodontal and Implant Science
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• v.38 no.2
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• pp.215-224
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• 2008

Purpose: These case reports show the orthodontic treatment of lower anterior incisors with gingival recession. Materials and Methods: Three cases were treated by an orthodontist and a periodontist. Each case had lingually tilted lower anterior incisors, anterior crossbite and skeletal Cl III pattern. Results: A variety of etiological factors were thought to cause gingival recession: aging, oral hygiene, tooth malpositioning, occlusal trauma. Conclusion: Due to the interaction among many possible contributing factors, it is difficult to predict whether further gingival recession may occur at a given site. The position and the movement of the lower anterior incisors with gingival recession are important factors in diagnosis and orthodontic treatment planning.

• Journal of Periodontal and Implant Science
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• v.50 no.3
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• pp.146-158
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• 2020

Purpose: The aim of this study was to investigate and identify the main causes of periodontal tissue change associated with labial gingival recession by examining the anterior region of patients who underwent orthodontic treatment. Methods: In total, 45 patients who had undergone orthodontic treatment from January 2010 to December 2015 were included. Before and after the orthodontic treatment, sectioned images from 3-dimensional digital model scanning and cone-beam computed tomography images in the same region were superimposed to measure periodontal parameters. The initial labial gingival thickness (IGT) and the initial labial alveolar bone thickness (IBT) were measured at 4 mm below the cementoenamel junction (CEJ), and the change of the labial gingival margin was defined as the change of the distance from the CEJ to the gingival margin. Additionally, the jaw, tooth position, tooth inclination, tooth rotation, and history of orthognathic surgery were investigated to determine the various factors that could have affected anterior periodontal tissue changes. Results: The mean IGT and IBT were 0.77±0.29 mm and 0.77±0.32 mm, respectively. The mean gingival recession was 0.14±0.57 mm. Tooth inclination had a significant association with gingival recession, and as tooth inclination increased labially, gingival recession increased by approximately 0.2 mm per 1°. Conclusions: In conclusion, the IGT, IBT, tooth position, tooth rotation, and history of orthognathic surgery did not affect labial gingival recession. However, tooth inclination showed a significant association with labial gingival recession of the anterior teeth after orthodontic treatment.

• Journal of Korean Dental Science
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• v.16 no.2
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• pp.218-226
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• 2023

Treatment of multiple gingival recession defects is usually more challenging than that of single gingival recession. Various techniques for the treatment of multiple gingival recession have been established. Recently, vestibular incision subperiosteal tunnel access (VISTA) technique has been considered to exhibit high predictive ability. Connective tissue graft (CTG) has also been considered a gold standard technique owing to its high predictability of root coverage. However, this technique requires a suitable donor site and has clinical disadvantages, such as additional pain. Thus, in this case presentation, platelet-rich fibrin (PRF) was used as an alternative material for CTG along with VISTA. We herein report cases of two patients with Miller's class I and III multiple gingival recession defects, respectively. These patients underwent VISTA along with the use of a PRF membrane. They were followed up for 12 months postoperatively, and their clinical parameters, including probing depth, depth of gingival recession, clinical attachment level, and width of attached gingiva at baseline and at 2, 6, and 12 months postoperatively, were assessed. The patient with class 1 recession defects exhibited a significant amount of root coverage, which remained stable during the follow-up period. Whereas the patient with class 3 recession defects had lesser amount of coverage compared to class 1 patient. The partial coverage observed may be attributed to not only anatomical factors but also the technique-sensitive nature of the procedure. Considering these results, the use of VISTA along with PRF is a viable option for treating gingival recession, as it does not cause discomfort to patients. However, various factors need to be considered during the surgical procedure.

• Journal of Periodontal and Implant Science
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• v.31 no.1
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• pp.243-258
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• 2001

Gingival recession is exposure of the root surface with apical shift in the position of gingiva. The incidence of gingival recession is 8% in children and 100% after the age of 50. Recession tends to be found in patients with healthy gingiva, but more frequentely found in patients with periodontal disease, and it often causes mucogingival defects. Buccal surface of premolar is the area not only for severe gingival recession and cervical abrasion, but also the area of numbers of buccal frenum and less keratinized gingiva. Threrfore, the goal of this study was to observe the patients with periodontitis and examine whether there are clinical relations between gingival recession and cervical abrasion of premolar and other factors related with the condition of periodontal health. Generally healthy 218 patients who had periodontitis, aged between 18 and 78, were examined for depth of periodontal poket, width of attached gingival, gingival recession, cervical abrasion, and frenum of mid-buccal surface of premolar at the Department of Periodontics in Dankook University Dental Hospital and following is the result. 1. The average gingival recession and cervical abrasion of premolar with periodontal disease was 0.76mm and 0.29mm and each has 43% and 14% of incidence. Also the width of attached gingiva of mid-buccal surface was 1.77mm. the average periodontal pocket depth is 2.0mm and 47% of frequently seen was narrow single shaped frenum, and the interdistance of the frenum was mostly over 4mm. 2. With statistical significance(P<0.05), the incidence of gingival recession increased with age and was related much more with female than male, the first premolar than the second premolar, and with narrow attached gingiva and frenum. 3. With statistical significance(p<0.05), the incidence of cervical abrasion increased with age and was related with the area of the first premolar and narrow attached gingiva, but the sexual and frenum differences were not statistically significant (p>0.05). 4. The severity of gingival recession increased with age and was more related with female than male, the first premolar than the second premolar. And the area of narrow attached gingiva and frenum showed more gingival recession and the distance of frenum was more highly related than shape, and they were statistically significant (p<0.05). 5. With statistical significance(p<0.05), the severity of cervical abrasion increase with age and was observed at the first premolar and narrow attached gingiva. But the sexual and frenum differences were not statistically significant (p>0.05).

• Journal of the korean academy of Pediatric Dentistry
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• v.23 no.4
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• pp.893-898
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• 1996

The occlusal disharmonies resulted from labially protruded or malpositioned teeth can damage the periodontium and induce the non-inflammatory gingival recession. For these cases, a conservative approach was performed by improving oral hygiene and correcting the axial and positional status of the gingivally recessed teeth and removing the prematurely contacted areas. In some cases, rapid remission of tooth mobility and gradual decrease of gingival recession was observed just after start of treatment. In cases of gingival recession in permanent lower incisors of the children with mixed dentition, the treatment of choice is non-surgical conservative approaches. In cases when the gingival inflammation can be controlled through reinforcing the oral hygiene, when attached gingiva have a potential to increase in width through growth (not more than 1 year after eruption or not yet arrived at adult level), and when the recession can be corrected by moving the teeth from labial cortical plate through orthodontic treatment, the conservative measures would be the first choice. On the contrary, when recession has exceeded beyond the level of CEJ, when the gingival inflammation existed with the cause of poor oral hygiene, when the attached gingiva have little potential to increase (for example, more than 8 years after eruption), and when the conservative measures yielded no benefit after 4-8 weeks of treatment, the surgical approaches should be sought.