Gingival recession, commonly known as receding gums, occurs when the margin of the gum tissue pulls away from the tooth, exposing the root surface. This condition can cause sensitivity, aesthetic issues, and an increased risk of root decay. Braces can be used with this condition, but only under strict periodontal control and with specialized orthodontic planning. Successfully moving teeth requires a coordinated approach between the orthodontist and a gum specialist (periodontist).
The Relationship Between Orthodontics and Gum Health
Orthodontic tooth movement relies on bone remodeling, where pressure causes bone to break down and tension stimulates new bone growth. When existing gum recession is present or the gum tissue is thin, the risk of worsening the condition increases significantly during movement. This is particularly true if the teeth are moved toward the cheek or lip (buccal movement).
The primary concern is that orthodontic forces can push the tooth root outside the boundaries of the surrounding bone. This movement can create defects in the alveolar bone, specifically a “dehiscence” (loss of bone at the marginal edge) or a “fenestration” (a window-like defect). When the bone supporting the gum tissue is lost, the soft tissue often follows, resulting in an apical shift of the gum line and greater root exposure. The risk is directly tied to the biomechanics and the pre-existing bone and tissue structure.
Assessing and Stabilizing Gum Recession Before Treatment
Before any orthodontic appliance is placed, the patient must achieve complete periodontal clearance. A gum specialist must confirm the gums are healthy and stable. Any active inflammation, such as periodontitis, must be completely resolved. Tooth movement in the presence of active gum disease can lead to rapid and severe bone loss. The goal is to ensure the gums are free of infection and inflammation, creating a foundation for safe tooth movement.
A major factor in stability is the thickness and quality of the gum tissue, known as the biotype. If the tissue is thin or if there is inadequate “attached gingiva,” the risk of recession during treatment is high. In such cases, a soft tissue graft may be required before starting braces to thicken the protective gum tissue. This pre-treatment grafting creates a more robust buffer, expanding the scope of safe tooth movement and protecting against future recession.
Specialized Orthodontic Techniques for Compromised Gums
When treating a patient with a history of recession, the method of tooth movement must be adapted to minimize stress on the compromised tissues. The magnitude of force applied is significantly reduced compared to standard treatment, often to a range of 5 to 15 grams per tooth. These ultra-light, continuous forces respect the biological limits of the reduced periodontal support.
Specialized biomechanical techniques ensure the tooth moves as a whole unit (bodily movement), rather than simply tipping the crown. Achieving bodily movement helps keep the tooth root centered within the bone, preventing the root from pushing through the thin outer bone plate. In some instances, the orthodontist may use braces to deliberately move the tooth therapeutically, such as using intrusion to push an extruded tooth deeper into the socket. This controlled movement can sometimes lead to an improvement in the surrounding bone level and soft tissue health. Clear aligners may also be preferred because they allow for precise, broad-surface pressure application and are removable, which facilitates better oral hygiene maintenance.
Managing and Treating Gum Recession During and After Braces
Even with careful planning, new or worsened recession may occur, necessitating corrective procedures. These are often scheduled between phases of orthodontic treatment or immediately following the removal of braces. The definitive treatment for repairing exposed root surfaces is a soft tissue grafting procedure. A common method is the connective tissue graft, where a small piece of tissue is taken from the palate and placed over the exposed root to cover the recession site.
The timing of this corrective surgery is a coordinated decision, often waiting until the teeth have been moved to their final, stable position, allowing the periodontist to graft the tissue only once. Rigorous oral hygiene is paramount throughout the entire process to prevent any recurrence of inflammation that could threaten the stability of the gum line. Maintaining a meticulous cleaning routine is the patient’s primary responsibility for ensuring the long-term success of both the periodontal and orthodontic treatment.