Gingival Recession:Cause,Classification & Treatment

[Drsumitra]

 Noncarious Class V Lesions

As the health and appearance of gingival tissue is important to the aesthetics of a smile, many with noncarious Class V lesions and/or exposed tooth structure from gingival recession wish to have their conditions treated without the cost or inconvenience of invasive methods.²⁰ Used to treat noncarious Class V legions, glass ionomer cements, compomers, and composite resins work alone or in combination to correct the aesthetic issues and prevent further damage.¹ When unaesthetic Class V lesions display caries, a combination of glass ionomer materials for the internal aspects of the restoration and a resin-based composite material for the surface has been advocated.3 This treatment method is believed to provide aesthetic results while increasing the potential for caries reduction.³

The physical properties of resin-based composites allow a bond to tooth structure, with highly aesthetic results, so many practitioners feel that they are the best materials to use when restoring cervical defects.⁵ In a recent study, resin composite restorations that were placed to treat noncarious cervical lesions exhibited no secondary caries and far less deficiencies in marginal adaptation than compomer restorations after 3 years.²¹ There are, however, some challenges in using resin-based composites for Class V lesions.²

When placing resin-based composite restorations in the aesthetic zone, it is good to have an understanding of the composites being utilized, especially with regard to their respective optical and physical characteristics.^22,23 When used and placed properly, the polychromatic effects seen in natural teeth can be replicated.^22,23 More importantly, producing outstanding composite resin restorations is achieved thorough comprehension of natural tooth morphology and how each component of tooth structure affects aesthetics.^24,25



Resin-Based Composites and Gingival Health

In past studies, resin-based composites showed promising results for treating Class V lesions and masking the effects of gingival recession.²⁶ Through observations of composites, it was found that they do not adversely affect gingival health, and that there is typically less inflammatory response to well-finished and contoured composite resins than carious lesions that are left untreated.²⁶Another study, comparing plaque buildup around newer composite resins and conventional composites, found that there was no significant difference in plaque formation of the 2 materials.²⁷ 

Unfortunately, when composite resins are applied to teeth presenting with gingival recession, the resulting tooth-colored restorations tend to make the teeth appear very long, leading to an unaesthetic appearance.²⁷ To correct this issue, the need for resins that are gingival-colored has increased.²⁷ Manufacturers have met this demand, creating products that demonstrate the aesthetics of natural gingival tissue.²⁷ Aside from the aesthetic value of these new materials, the composites also allow for minimally invasive procedures to cover the roots and exposed tooth structure caused by the gingival recession.²⁷ 

These new resin-based composites correct the aesthetic deficits of gingival recession by framing the tooth or teeth with material in a similar pink color to the gingival tissue.²⁰ These gingival-colored composites tend to demonstrate greater color stability and resistance to wear.20 When used in collaboration with the new generation of bonding agents, which enable bonding to metal, porcelain, enamel, and dentin, gingival-colored composites have been proven to enhance the smiles of patients with gingival recession.²⁰ More importantly, this treatment option provides a clinical solution for patients that is aesthetic, economical, and practical.²⁷ 



Aesthetic Gingival Composite Resins

An aesthetic gingiva-shaded light-cured composite resin (Amaris Gingiva [VOCO America]) was recently introduced, providing practitioners with the option of correcting gingival recession with a minimally invasive and less costly procedure. This pink-colored composite (available in one translucent gingival color and 3 pink flowable opaquers that can be mixed together to better match an individual’s gingival shade) was specifically developed for indications in the cervical area, including composite restorations in gingival colors, V-shaped defects, exposed cervical areas, aesthetic corrections of the gingiva area, primary splinting, and the correction of red/white aesthetics. This restorative material also gives the clinician the ability to mask exposed crown margins to improve aesthetics and patient satisfaction.