High risk recession defects

From experience, I can assure most patients that recession is likely to progress but is unlikely to lead to tooth loss. The exception is when a horizontal (not vertical) probing depth of 3mm or more is noted in association with the recession defect. This horizontal attachment loss is indicative of bone loss compromising the width of the alveolus which in susceptible individuals with a thin alveolus or complicated root anatomy can lead to tooth loss. The progression is very similar furcation involvements.

The clinical images demonstrate a severe recession defect around lower incisors which has been progressing. Clinical assessment revealed horizontal probing depth of over 3mm in association with the recession defects. Radiographs demonstrated radiolucency around the incisors indicating a reduction in the interproximal bone volume of the alveolus.  We identified this as a high risk case of gingival recession and diagnosed it as localised severe chronic periodontitis.   Urgent treatment was planned and it consisted of de-epithelialised free gingival graft to improve the phenotype and allow for root coverage. I also added enamel matrix derivatives to encourage horizontal attachment gain and bone formation interpromixally.(Zuchelli et al 2014). The 6 month result was favourable with root coverage of 3-4mm and increase in bone density interproximally. 


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