Mucogingival Deformities and Conditions Around Teeth - Ch 7

Mucogingival Deformities and Conditions

• Any defect associated with deviation from normal anatomic/morphologic relationship between gingiva and alveolar mucosa​

• All age groups susceptible​

• Can affect any tooth or implant and can occur in presence or absence of periodontal disease​

Normal Mucogingival Condition

• Lack of keratinized tissue​

  • Commonly observed in absence of underlying disease state​

  • May occur due to congenital or developmental reasons​

Thin-Scalloped Gingival Biotype

• Slender, triangular-shaped crown​

• Thin, delicate, friable soft tissue with thin alveolar bone​

• Narrow zone of keratinized tissue​

• Accentuated scalloped gingival margin contour​

• Greater tendency for onset, progression of mucogingival deformity​

Thick-Scalloped Gingival Biotype

• Slender, triangular-shaped crown​

• Thick, fibrotic gingiva​

• Narrow-to-moderate zone of keratinized tissue​

• Accentuated scalloped gingival margin contour​

• Prone to development of mucogingival deformity​

Thick-Flat Gingival Biotype

• Wide, square-shaped crown​

• Thick, dense, and fibrotic tissue​

• Wide band of keratinized tissue​

• Flat gingival margin contour​

• More resilient and less susceptible to inflammation and trauma than thin- and thick-scalloped biotypes​

Recession of Gingival Margin

• Movement of gingival margin to point apical to cementoenamel junction ​

• Most common mucogingival deformity​

• Can affect any age group​

• Corresponds to attachment loss that exposes root surface to oral environment​

Risk factors for Gingival Recession

• Thin tissue biotype​

• Narrow band (or zone) of keratinized tissue

• Reduced thickness of alveolar bone during abnormal tooth position in dental arch​

• Mechanical trauma​

• Orthodontics​

Miller Classification System for Recession of GM

• Class I

  • Marginal tissue that does not extend to mucogingival junction (MGJ)​

• Class II

  • Marginal tissue recession that extends to or beyond MGJ with no periodontal loss in interdental area​

• Class III

  • Marginal tissue recession that extends to or beyond MGJ with interdental bone or soft-tissue loss and/or malpositioning of teeth​

• Class IV

  • Marginal tissue recession that extends beyond MGJ with severe loss of interdental bone to level corresponding to most apical extent of marginal tissue recession​

Criticism of Miller Classification System

• Sometimes difficult to identify exact location of apical extent of recession defect with respect of MGJ

• Does not clearly define amount of interproximal soft/hard tissue loss needed to differentiate Class III from Class IV

• Reliability unavailable; never tested in clinical setting

Cairo Classification System for Recession of GM

• Uses objective identifiable criterion (clinical attachment level) to classify extent and severity of soft tissue recession​

• More reliable; can be used in clinical practice​

• Identifies three gingival recession types

Recession Type 1 (RT1)

Gingival recession with no loss of interproximal attachment​

Recession Type 2 (RT2)

• Gingival recession with loss of interproximal attachment​

• Amount of interproximal attachment loss less than or equal to buccal attachment loss​

Recession Type 3 (RT3)

• Gingival recession with loss of interproximal attachment​

• Amount of interproximal attachment loss greater than buccal attachment loss​

Surgical Intervention

• Esthetic impairment

• Dentin hypersensitivity

• Increased root caries activity

• Severe plaque induced gingival inflammation