11 September 2019

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Gingival recessions after orthodontic treatment: do we have any predictor?

Davide Elsido

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The development of gingival recessions has been associated with orthodontic treatment; however, a clear etiology is still unknown.

Gingival recession is defined as the displacement of the marginal tissue apical to the cemento-enamel junction.
Gingival recessions have been associated with thermal sensitivity of teeth, increased risk of root caries and constitute one of the main aesthetic complaints of persons seeking reconstructive periodontal therapy.
Gingival recessions are age-dependent and it has been reported that at 20 years, 63 per cent of Caucasian males present at least one recession. This percentage continues to increase and at 50 years, over 90 per cent of the patients have at least one recession.
Habits such as traumatic tooth brushing, piercings, parafunctional activity and occlusal injury have frequently been linked with the development of gingival recessions in non-orthodontic patients. It has also been postulated that anatomic characteristics such as preexisting lack of alveolar cortical bone due to an ectopic tooth eruption outside the dental arch and bony envelope and a small width of keratinized gingiva and thin gingival biotype are additional etiologic factors.

The development of gingival recessions has been considered a common sequel of orthodontic treatment. Suboptimal oral hygiene maintenance during treatment and chronic gingivitis in combination with an orthodontic movement may result in gingival recessions. Furthermore, buccal gingival recessions have been associated with a thin symphysis, excessive proclination of mandibular incisors (more than 10 degrees relative to the mandibular line) with displacement of the cervical region of the roots outside the alveolar cortical bone.

In the March 2019 issue of the Journal The European Journal of Orthodontics an article was published 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. In the article, on dental casts and good quality lateral cephalograms of 126 orthodontically treated patients, relevant measurements were performed and gingival recessions were assessed.
The authors found no association between the width of the alveolar bone process at the apex, at the level of the crest and at mid of the root, the width, 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 was statistically related with the onset of lingual recessions on teeth 3.2 and 4.2. 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.

For additional informations: 
Long-term evaluation of lower incisors gingival recessions after orthodontic treatment