Surgical management of gingival recession: A clinical update

Expression of wound healing markers in gingival crevicular fluid following root-coverage procedures: A systematic review of randomized clinical trials

OBJECTIVE

Although several surgical techniques have been developed for treatment of gingival recession (GR), the underlying wound healing process remains relatively unexplored. This systematic review aimed to investigate the expression of wound healing markers in gingival crevicular fluid (GCF) before and after surgical treatment of GR.

DESIGN

Randomized clinical trials (RCTs) reporting changes in the expression of GCF markers following any root coverage surgical procedure were identified from 4 electronic databases and manual searches followed by data extraction and result synthesis. The risk of bias (RoB) was assessed using Cochrane RoB 2.0 tool. Overall certainty of evidence was summarized using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool.

RESULTS

Four RCTs comprising 100 patients and investigating 15 biomarkers were included. Post-surgery, GCF levels of cytokines and inflammatory proteins were raised during the first 2-10 days of healing. MMP-8 levels increased during the first week followed by a gradual decline. RoB was found to be high for all studies and the overall certainty of evidence was very low.

CONCLUSION

A limited number of studies with large methodological variations precluded reliable conclusions. Well-designed studies powered for GCF markers' levels that follow a standardized protocol for GCF sampling and processing are needed to draw conclusive evidence.

Biofabrication Strategies for Oral Soft Tissue Regeneration

Gingival recession, a prevalent condition affecting the gum tissues, is characterized by the exposure of tooth root surfaces due to the displacement of the gingival margin. This review explores conventional treatments, highlighting their limitations and the quest for innovative alternatives. Importantly, it emphasizes the critical considerations in gingival tissue engineering leveraging on cells, biomaterials, and signaling factors. Successful tissue-engineered gingival constructs hinge on strategic choices such as cell sources, scaffold design, mechanical properties, and growth factor delivery. Unveiling advancements in recent biofabrication technologies like 3D bioprinting, electrospinning, and microfluidic organ-on-chip systems, this review elucidates their precise control over cell arrangement, biomaterials, and signaling cues. These technologies empower the recapitulation of microphysiological features, enabling the development of gingival constructs that closely emulate the anatomical, physiological, and functional characteristics of native gingival tissues. The review explores diverse engineering strategies aiming at the biofabrication of realistic tissue-engineered gingival grafts. Further, the parallels between the skin and gingival tissues are highlighted, exploring the potential transfer of biofabrication approaches from skin tissue regeneration to gingival tissue engineering. To conclude, the exploration of innovative biofabrication technologies for gingival tissues and inspiration drawn from skin tissue engineering look forward to a transformative era in regenerative dentistry with improved clinical outcomes.

Donor site wound healing following free gingival graft surgery using platelet rich fibrin: A randomized controlled trial

BACKGROUND

The primary purpose of this two-arm, parallel design, randomized controlled study is to compare healing of the palatal tissue donor site when platelet-rich fibrin (PRF) is used as a wound dressing compared to the use of a hemostatic agent. Secondary outcomes of patient pain perception and analgesic intake were also evaluated.

METHODS

Seventy-four patients receiving free gingival grafts were randomized to receive either PRF (test) or hemostatic agent (control) as a palatal wound dressing by patients selecting a sealed envelope containing their group assignment (initially 37 envelopes for PRF group and 37 for hemostatic agent group). Patient pain assessment and analgesic consumption were documented using a 21-point numerical scale (NMRS-21) at 24, 48, and 72 hours post-surgery. At 1-, 2-, 3-, and 4-week follow-up appointments palatal early healing index (PEHI) scores including wound color, epithelialization, presence or absence of swelling, granulation tissue, and bleeding on gentle palpation were generated by direct intraoral examination by a blinded examiner unaware of the patients' treatment group.

RESULTS

NMRS-21 pain scores showed a significant reduction in pain over time in both groups, with no significant difference between groups at any time point. No significant between-group difference was found in the amount of analgesics taken by patients at 24, 48, and 72 hours. There was significant improvement in PEHI scores over the 4-week time period in both groups, but there was no significant difference in PEHI score at each time point (1, 2, 3, 4 weeks) between groups.  CONCLUSIONS: Study findings suggest that there is no difference in early palatal wound healing, patient pain perception, or analgesic consumption between use of PRF or a hemostatic agent as donor-site wound dressings.

A randomized controlled trial evaluating the effect of epithelial removal on free soft tissue autograft healing

BACKGROUND

The purpose of this study is to determine if there is a difference in dimensional change of a free soft tissue autograft (FSTA) with epithelium compared to without epithelium. The secondary aim is to determine the patient and professional evaluation of color match and graft texture between the two groups.

METHODS

Patients with ≤2 mm keratinized tissue indicated for a FSTA were randomly assigned to control group (FSTA with epithelium) or test group (de-epithelialized FSTA). The vertical and horizontal measurements of the grafts were taken at surgery, and 1, 3, and 6 months postoperatively. Patients were asked to evaluate the color match at each postoperative time point on a 21-step Numeric Rating Scale (NRS-21). Professional assessment of color match and graft texture were evaluated on images at the same time points.

RESULTS

Forty-six patients and 55 grafts were included in the study. For change in graft height, width, and area, there were no significant differences between the treatment groups at any time point. Graft height and area in both groups decreased significantly from baseline to month 1 (p < .001), but no other difference was significant over time. When patients and professionals used the NRS-21 for evaluation of color match between the graft site and the surrounding soft tissue, there was no significant difference between the treatment groups. Similarly, evaluation of texture match on color images and black-and-white images revealed no significant differences between or within groups.

CONCLUSION

De-epithelialized FSTA showed no difference in dimensional change or color and texture match compared to FSTA with epithelium.

Evaluation of the effectiveness of Lactuca Sativa syrup in controlling pain after periodontal flap surgery: a split-mouth, randomized, double-blind placebo-controlled trial

OBJECTIVES

Effective pain control after oral surgeries including periodontal flap surgery is one of the biggest problems in the periodontology field. The use of Nonsteroidal Anti-inflammatory Drugs (NSAIDs) to reduce pain after periodontal flap surgery is common, but these have some adverse side effects such as impaired platelet function and causing digestive problems. Today, the tendency to use omedicinal plants is more than synthetic drugs due to their safety. Therefore, we designed a split-mouth randomized controlled clinical trial to evaluate the effects of Lactuca Sativa (L. Sativa) syrup as an adjunct therapy in reducing pain after periodontal flap surgery.

METHODS

This split-mouth, randomized, double-blind, placebo-controlled trial was performed on 26 subjects. Patients were assigned for two surgery. Primary surgery was performed on the right maxilla and after 30 days, secondary surgery was performed on the left maxilla. In primary surgery, patients consumed L. Sativa syrup (3 times a day for 72 h) and in secondary surgery, patients consumed placebo syrup (3 times a day for 72 h). Pain intensity was measured at 6, 12, 24, 48, and 72 h after a periodontal flap surgery in both surgeries using the Visual Analogue Scale (VAS). All patients received their routine drugs, including analgesics. The number of analgesics used after surgery was recorded. Statistical analysis of t-test was used to compare the results of the two surgery.

RESULTS

The results showed that the mean pain based on VAS score at 6, 12, 24, 48 and 72 h after primary periodontal flap surgery was significantly reduced compared to the secondary periodontal flap surgery (p<0.001). The results also showed that the use of analgesics after 72 h of surgery was significantly reduced in the primary periodontal flap surgery compared to the secondary periodontal flap surgery (p<0.001).

CONCLUSIONS

According to the results of this study, L.Sativa syrup can be effective as adjuvant therapy in reducing pain after periodontal flap surgery.

A Modified Approach in Lip Repositioning Surgery for Excessive Gingival Display to Minimize Post-Surgical Relapse: A Randomized Controlled Clinical Trial

Lip repositioning surgeries are performed to treat patients with excessive GD (EGD). This study aimed to explore and compare the long-term clinical results and stability following the modified lip repositioning surgical technique (MLRS) with the addition of periosteal sutures compared to the conventional lip repositioning surgery (LipStaT^®) in order to address EGD. A controlled clinical trial with female participants (n = 200) intended to improve their gummy smile were divided into control (n = 100) and test (n = 100) groups. The gingival display (GD), maxillary lip length at rest (MLLR), and maxillary lip length at maximum smile (MLLS) were measured at four time intervals (Baseline; 1 Month; 6 Months, and 1 Year) in millimeters (mm). Data were analyzed by t-tests, Bonferroni-test, and regression analysis using SPSS software. At the one-year follow-up, GD for the control and test groups were 3.77 + 1.76 mm and 2.48 + 0.86 mm, respectively, and their comparisons showed that GD was considerably lower (p = 0.000) in the test group compared to the control group. The MLLS measurements taken at baseline, one-month, six-month, and one-year follow-up showed no significant differences (p > 0.05) between the control and test groups. At baseline, one-month, and six-month follow-up, the mean and standard deviation for the MLLR were almost similar, with no statistically significant difference (p = 0.675). The MLRS is a successful and viable treatment option for the treatment of patients with EGD. The current study showed stable results and no recurrence with MLRS until the one-year follow-up compared to LipStaT^®. With the MLRS, a 2 to 3 mm decline in EGD is usually to be expected.

Comparison between Rolled and Nonrolled U-Shaped Flap in the Second Stage of Dental Implant Surgery: A Randomized Clinical Trial

Background. The presence of black triangles around the dental implant-supported prosthesis and the failure to construct adequate papillae around them bothers dental implantologists. Peri-implant surgical soft tissue management will improve esthetics, function, and implant survival. Aim. To compare the effects of rolled and nonrolled U-shaped flaps combined with a temporary crown in enhancing the soft tissue around dental implants. Materials and Methods. Forty patients were included in this study; all patients were operated on by the same maxillofacial surgeon at Al-Iraq specialized dental clinics from January 2019 to January 2020. Patients were divided randomly into two groups: group A: at the second stage of implant surgery, a U-shaped flap without rolling was used in conjunction with temporary crown placement; group B: at the second stage of implant surgery, a U-shaped flap with rolling was used in conjunction with temporary crown placement. Then, the temporary crown was fabricated for both groups and kept in place for one month. Two independent maxillofacial surgeons evaluated all patients two weeks after the cementation of the final zirconia crown for the implant soft tissue esthetic score. Results. The highest possible score assigned to the mesial papilla (2 scores) was present in 92.5% of the group A patients and only 77.5% of the group B patients. Moreover, we have found that alveolar bone contour is achieved perfectly (2 scores) in 70% of group A patients but only in 32.5% of group B patients. Conclusion. The U-shaped flap without rolling with a temporary crown is a simple technique. It has good results, especially when there is no severe resorption of the labial bone plate (in canine and premolar areas).

Peripheral Blood Mesenchymal Stem Cells and Platelet Rich Fibrin Matrix in the Management of Class II Gingival Recession: A Case Report

The treatment of gingival recession is a frequent demand due to aesthetic concern, root caries, and /or root hypersensitivity. The purpose of this case study was to evaluate the success and predictability of coronally advanced flap (CAF) in combination with peripheral blood mesenchymal stem cells (PBMSCs) and platelet rich fibrin matrix(PRFM) for the management of Miller's Class II gingival recession. CAF followed by placement of PBMSCs and PRFM was performed on a male patient, aged 25 years having Miller’s Class II gingival recession of 5-6 mm on the upper left canine, premolars and molars. The patient was followed up for 3 months. Root coverage of 60.0% and clinical attachment gain of 3 mm were evident following 3 months of follow-up. This novel technique showed an effective way to increase the width of attached gingiva and treat gingival recession.

Lateral osteoperiosteal flap versus lateral pedicle flap in the treatment of class III gingival recession: A single-center, open-label trial

AIMS

The aim of this study was to compare outcomes of lateral osteoperiosteal flap (OPF) and lateral pedicle flap (LPF) in the treatment of Miller's Class III gingival recession.

MATERIALS AND METHODS

Twenty-two anterior maxillary and mandibular sites from 16 participants requiring mucogingival surgery for Miller's Class III gingival recession were included in the study. Eleven sites each were assigned to two groups. OPF: sites treated with lateral OPF and LPF: sites treated with LPF. Recession depth (RD) and bone level (BL) were the primary outcome variables, and probing pocket depth, clinical attachment level (CAL), and keratinized tissue width (KTW) were the secondary variables. All the variables were recorded at baseline (on the day of surgery), 3 months, and 6 months postsurgery.

RESULTS

OPF and LPF resulted in similar reduction in RD at the end of the study period (P ≤ 0.001). There was no statistically significant difference in RD between OPF and LPF at 6 months (P = 0.862). OPF-treated sites showed greater gain in BL at 3 months (P = 0.0004) and 6 months (P = 0.0002). No significant differences were seen between OPF and LPF in measures of PD, CAL, and KTW.

CONCLUSION

Data from this 6-month trial seem to suggest that OPF can be used as an alternative procedure for treating Miller's class III recessions with adjacent edentulous sites or wide interproximal spaces. Long-term effects of OPF on the stability of root coverage outcomes are an exciting direction for future research.

Re-invigoration of Pink Esthetics by a Novel Minimally Invasive Technique: A Report of Two Cases

The importance of pink esthetics as well as increased patient comfort has been gaining its pace in dentistry. Moreover, when it comes to the treatment of gingival recession, the ideologies of the periodontists have changed over time, i.e., from “extension to prevention;” it has now become “conserve to preserve.” Utilizing this same principle, pinhole technique was introduced comprising sutureless surgery with minimal surgical intervention, thus providing maximum comfort to the patient while undergoing treatment and postoperatively. This article presents a case report of two cases who were treated with a minimally invasive pinhole surgical technique, with complete root coverage and minimal complications.

Long-term predictability of allogenic dermal matrix for root coverage: Three years observation period on 15 consecutive cases

Gingival recession is an apical migration of gingival margin that is a common finding on patients with meticulous oral hygiene and periodontitis patients. Several surgical treatment techniques of gingival recession have been described. The most challenging situation is the presence of multiple adjacent recession defects. 15 patients with total of 53 recession defects have been treated with Acellular Dermal Matrix (ADM). The following clinical parameters were evaluated recession depth (RD), probing depth (PD); and the width of the keratinized tissue (KT). Upon completion of the study; there was statistically significant (P-value = 0.00) reduction in recession depth from baseline, one and three years after the surgery (2.6 mm, 0.32 mm, and 0.17 mm, respectively). There was statistically significant (P-value = 0.00) increase in the width of keratinized tissue from baseline to one year and three years (3.47 mm, 5.02 mm, and 5.40 mm, respectively). Based on this study the use of ADM with the coronally advanced flap resulted in a significant increase in keratinized tissue and percentage of root surface coverage.

Comparative evaluation of clinical efficacy of coronally advanced flap alone and in combination with placental membrane and demineralized freeze-dried bone allograft in the treatment of gingival recession

Background:

Guided tissue regeneration is a very commonly employed technique for treating recession defects. However, achieving the required space beneath the membrane is often difficult.

Aim and Objectives:

The purpose of the present study was to compare and evaluate the clinical efficacy of coronally advanced flap (CAF) alone or in combination with amnion membrane (AM) or chorion membrane (CM) and demineralized freeze-dried bone allografts (DFDBAs) in the management of gingival recession (GR) defects.

Materials and Methods:

The sample size (Miller's Class I and Class II GR-type defects) consisted of thirty patients which were stratified into three groups randomly (ten for each group). Group A patients were treated with only CAF and Group B patients were treated by CAF in combination with CM and DFDBA. Similarly, Group C patients were treated by CAF in combination with AM and DFDBA. Clinical parameters such as gingival index, GR depth, GR width, relative attachment level, and width of keratinized tissue were assessed at baseline and 3 months postoperatively.

Results:

Inter- and intragroup data were analyzed by paired t-test. The percentage of root coverage obtained in the study groups was 60%, 78%, and 63%, respectively, for Groups A, B, and C. Statistically significant difference was obtained in the clinical parameters of Group B which was treated with CM and DFDBA.

Conclusions:

Combination of DFDBA and placental membrane (chorion/amnion) in CAF procedure provided an additional benefit over CAF alone in the treatment of Class I and II GR defects.

Sub-epithelial connective tissue graft for the management of Miller's class I and class II isolated gingival recession defect: A systematic review of the factors influencing the outcome

The aim of the present systematic review was to analyze the factors that affect the outcome of subepithelial connective tissue graft (SCTG) for managing Miller's class I and class II isolated gingival recession defect. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews were used. Quality assessments of selected articles were performed. Data on root surface condition, recession type defect, flap thickness, different flap designs, different harvesting techniques, presence/absence of the epithelial collar, graft thickness, flap tension, suturing techniques, and smoking-related outcomes on root coverage were assessed. The SCTG procedure provides the best root coverage outcomes for Miller's class I and class II recession. The critical threshold of flap thickness was found to be 1 mm. Maximum root coverage was achieved by envelope and modified tunnel technique. SCTG with the epithelial collar does not provide additional gains than SCTG without the epithelial collar. The thickness of SCTG for root coverage was found to be 1.5-2 mm. Greater flap tension and smoking adversely affect root coverage outcomes. Analysis of the factors discussed would be of key importance for technique selection, and a combined approach involving factors favoring outcomes of SCTG could be of clinical relevance in recession coverage.

Ascertaining the regenerative potential of the "gold standard" grafts: Achieving 100% root coverage in Miller's Class III recession with periosteal pedicle graft and autogenous bone

Recession of the gingiva is defined as the stripping of a portion of the dental root surface as a result of gingival margin shifting apically. Various techniques have been advocated for root coverage. The practice of utilizing periosteal pedicle graft for covering gingival recession defects is a contemporary development. Utilizing bone grafts for hard tissue regeneration has also been implemented. This case report assesses the effectiveness of the surgical approach utilizing autogenous bone and periosteum for recession coverage. A participant with Miller's Class III gingival recession in #23 and #24 was treated using this technique. The loss of periodontal attachment was recorded to be 8 mm and 5 mm on the mid-buccal surface of the upper left canine and first premolar, respectively. Clinical parameters were recorded at 1, 3, 6, 9, and 12 months postoperatively. Complete root coverage was achieved when evaluated from baseline till 12 months, with clinical attachment level and keratinized tissue gain. The results of esthetics in terms of color match and tissue contours were satisfactory to the patient as well as to the clinicians.

"United Pedicle Flap" for management of multiple gingival recessions

Numerous surgical procedures have evolved and are being modified with time to treat gingival recession by manipulating gingival or mucosal tissues in various ways. However, the decision to choose the most appropriate technique for a given recession site still remains a challenging task for clinicians. Mucogingival deformities such as shallow vestibule, frenal pull, or inadequate attached gingiva complicate the decision and limit the treatment options to an invasive procedure involving soft tissue grafts. The situation is further comprised if there is a nonavailability of adequate donor tissue and patients' unwillingness for procedures involving a second surgical site. In such situations, the recession either remains untreated or has poor treatment outcomes. This case report presents a modified pedicle graft technique for treatment of multiple gingival recessions with shallow vestibule and inadequate attached gingiva. The technique is a promising therapeutic alternative to invasive surgical procedures such as soft tissue grafts for treatment of multiple gingival recessions.

Esthetic dentistry for multiple gingival recession cases: Coronally advanced flap with bracket application

Treatment of gingival recession is essential to rectify the esthetic and functional deficiencies of the patient and to combat further periodontal destruction. However, treating multiple recession cases is quite challenging, and therefore requires constant modifications of the prevalent treatment strategies as per the severity of the condition. The objective of this case report was to evaluate the effectiveness of coronally advanced flap (CAF) technique without vertical incisions using CAF brackets (CAF+B) for treating a patient presenting with class II gingival recession defects in relation to maxillary anteriors. Complete root coverage was observed, and the results were consistent even after 6 months. The current case report demonstrates good outcomes of the CAF + B technique without the use of any additional soft tissue grafts or vertical incisions, therefore, endorsing the promising potential of the CAF + B technique in multiple gingival recession cases.

Root coverage using a coronally advanced flap with or without acellular dermal matrix: a meta-analysis

Purpose

Gingival recession is a major esthetic concern and may lead to root sensitivity during periodontal treatment. Coronally advanced flaps (CAFs) with and without acellular dermal matrix (ADM) are widely used in root coverage procedures. The aim of this study was to analyze the efficacy of CAF in combination with ADM in the treatment of gingival recession.

Methods

PubMed, The Cochrane Library, and Embase were used to identify relevant articles. The articles were screened, data were extracted, and the quality of the studies was assessed by three reviewers with expertise in clinical practice, trials, statistics, and biomedical editing. The clinical endpoints of interest included changes in recession, probing depth (PD), clinical attachment level (CAL), and keratinized tissue (KT).

Results

Ten randomized controlled trials were identified, including six studies that compared CAFs with ADM and CAFs using connective tissue grafting (CTG) and four studies that compared CAFs with or without ADM. No statistically significant differences were found between the use of ADM and CTG, whereas statistically significant differences were found between groups in which ADM and CAF were combined and groups that underwent CAF alone with regard to recession coverage, CAL, and KT. The combination of CAF with an ADM allograft achieved more favorable recession coverage and recovery of CAL and KT than CAF alone.

Conclusions

The results from the ADM and CTG groups suggest that both procedures may be equally effective in clinical practice. Given the limitations of this study, further investigation is needed to clarify the effectiveness of ADM and CAF in clinical practice.

Gingival biotype in relation to incisors' inclination and position

OBJECTIVES

To study the association between gingival biotypes and inclination and position of the maxillary and mandibular incisors.

METHODS

This cross-sectional study included 142 consecutive orthodontic patients (64 males and 78 females) who were seeking orthodontic treatment at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia from February 2013 to January 2014. Gingival biotype was assessed independently for the maxillary and mandibular central incisors using the transparency of periodontal probe method. Maxillary and mandibular incisors' inclination and position were measured using cephalometric analysis.

RESULTS

The mean age was 23.56 (±2.55) years. The prevalence of thin gingival biotype was 43% for the maxillary and 52.1% for the mandibular incisors. Females were 4 times more likely to have thin gingiva for the maxillary incisors and 5 times more likely for the mandibular incisors. A significant association was found between mandibular incisor inclination and position and thin gingival biotype, while there was no association between the maxillary incisor inclination and position and gingival biotypes.

CONCLUSION

Mandibular incisor proclination and protrusion is associated with thin gingival biotype while no association is found in the maxilla. The evaluation of the gingival biotype is essential during diagnosis and treatment planning for potential orthodontic patients. 

Interest and satisfaction of dentists in practicing periodontics: A survey based on treatment of gingival recession

BACKGROUND

Gingival recession is a common occurrence and patients often report to dental clinic with associated problems such as root surface hypersensitivity, esthetic concerns, cervical root abrasions, and root caries that make it a concern for patients. Based upon the fact that gingival recession is an enigma for clinicians because of multitude of etiological factors and plethora of treatment modalities present for its treatment, a survey was conducted to assess knowledge as well as opinion about most common etiology, classification, and preferred treatment of gingival recession and to evaluate the interest and satisfaction of dentists in practicing periodontics.

MATERIALS AND METHODS

Study design consisted of a cross-sectional online survey, conducted among dentists practicing in state of Punjab, India, in the month of April 2011. A structured online questionnaire consisting of 17 questions evaluating the interest of dentists in periodontics based on knowledge about gingival recession (most of them giving the possibility of multiple choices of answers) was sent to about 300 dentists. Pearson Chi-Square and Mann-Whitney U tests were used for statistical analysis of data collected. P ≤ 0.05 was considered as statistically significant and P ≤ 0.01 considered as highly significant.

RESULTS

A greater proportion of periodontists had better knowledge about etiology (P = 0.07), classification (P = 0.000), and treatment of gingival recession (P = 0.000). A greater number of periodontists opted for the surgical modalities to correct the defects produced by gingival recession as compared to non-periodontists and had better interest (P = 0.000) and satisfaction (P = 0.000) in practicing periodontics.

CONCLUSION

The results elucidated that periodontists had better interest and satisfaction in practicing periodontics, and were more inclined towards surgical correction of gingival recession as compared to non-periodontists.

Aetiology and severity of gingival recession in an adult population sample in Greece

BACKGROUND

Gingival recession is the most common and undesirable condition of the gingiva. The aim of study was to investigate the aetiology and severity of gingival recession in a Greek adult population sample.

METHODS

The study was performed on 165 males and 179 females, 18-68 years old who sought dental treatment in a private dental practice and showed gingival recession. All subjects were clinically examined and answered questions regarding their oral hygiene habits such as the type of toothbrush, frequency of brushing and method of brushing. The association between gingival recession and the following parameters was assessed: plaque score, gingival score and tooth position. Statistical analysis of the results was accomplished using chi-square test (α = 0.05).

RESULTS

The majority (79.4%) of the patients showed grade I gingival recession and 15.3% showed grade II gingival recession. The maxillary 1(st) and 2(nd) molars (35.3%) and the mandibular 1(st) and 2(nd) molars (28.7%) were the teeth most frequently affected by root surface exposure. Patients with sub-gingival calculus, bacterial plaque and gingival inflammation (P <60; 0.05), malpositioned teeth (P <60; 0.001), horizontal brushing method, medium type of toothbrush (P <60; 0.001) and brushing once daily (P <60; 0.001) appeared to be the most common precipitating aetiological factor for gingival recession.

CONCLUSION

According to the results of the present study, gingival recession was the result of more than one factor acting together. Horizontal brushing method, usage of medium type toothbrush and tooth brushing once daily were found to be more associated with gingival recession.