Gingival Recession:Cause,Classification & Treatment

 Cervical lesions, which have been found to be present in 85% of the population, represent a major problem for dentists to restore with composite resin materials due to the varying adhesive properties of the tooth structure, the biomechanical aspects of the cervical area, and difficulties in accessing and isolating the area to be restored.^1,2 The incidence also may be higher in individuals retaining their permanent teeth, as the aging population is increasing.1 Additionally, at a time when people are maintaining their natural teeth longer, the likelihood of developing caries in Class V areas also increases.³

When Class V cervical lesions are noncarious in nature, they are classified as abfractions, with an appearance characterized by a loss of hard dental structure near the cement-enamel junction. The lesions’ shape may resemble a wedge with an inward-pointing apex.1 The cause of abfractions is thought to be occlusal stress that produces cervical cracks and, subsequently, predisposes the tooth surface to the effects of erosion and abrasion.4 Although critical literature reviews suggest that abfraction is a hypothetical component of cervical wear, it is important to determine causative factors for noncarious lesions, as treatments range from eliminating the aggravating agents to specific restorative procedures.^4,5

Gingival Recession
Typically involving at least one tooth surface, gingival recession can lead to root surface exposure at the gingival margin.⁶ This not only causes aesthetic impairment, but the fear of tooth loss, an increased susceptibility to root caries, and hypersensitivity of the dentin.6 As gingival recession is the displacement of the soft tissue margin, tooth malpositions, high muscle attachment, frenal pull, and occlusal trauma can create the conditions necessary to cause recession and root exposure.⁷ Another less obvious cause, oral jewelry, also has been linked to gingival recession.⁸ Studies have shown that piercings in the lip and tongue lead to localized gingival recession as an adverse consequence.8 In one study, individuals with tongue piercings presented an 11-times greater risk of developing gingival recession over the control group