Gingival recession, commonly known as receding gums, occurs when the margin of the gum tissue surrounding the teeth pulls back, exposing more of the tooth’s surface or its root. This exposure can lead to increased tooth sensitivity, aesthetic concerns, and a higher risk of root decay. This article explores the biological reality of gum tissue loss and outlines the professional treatments available to achieve root coverage and restore health.
Understanding Gingival Recession
Recession is typically the result of several factors working together over time. One common cause is mechanical trauma, often from aggressive or incorrect brushing techniques using a hard-bristled toothbrush. This repeated physical force gradually wears down the delicate gum tissue adjacent to the tooth.
A significant contributor is periodontal disease, a bacterial infection where plaque and tartar buildup cause inflammation that destroys supporting gum tissue and bone. As the infection progresses, the tissues detach and migrate downward, exposing the root surface. Genetic predisposition also plays a role, as some individuals naturally have thinner or less resilient gum tissue, making them more susceptible to recession. Misaligned teeth or malocclusion can place uneven forces on the gums, contributing to localized tissue loss.
The Possibility of Natural Reversal
Once specialized gum tissue, or gingiva, is lost, it does not spontaneously regrow; natural reversal is not possible. Unlike skin, the specialized tissue that forms the tight seal around the tooth cannot biologically regenerate the lost margin on its own. The lost tissue volume will not return to its original position above the cementoenamel junction.
While the tissue itself cannot regrow, treatment can stop the progression of recession and restore the appearance and function of the gums. When recession is caused by active periodontal disease, a procedure like deep cleaning (scaling and root planing) can halt the destructive process and allow inflamed tissues to tighten around the tooth. This non-surgical approach only stabilizes the condition and does not result in the regeneration of the physically lost tissue margin. Therefore, professional intervention focuses on achieving predictable “root coverage” through surgical correction.
Surgical Solutions for Root Coverage
Surgical procedures are the most reliable method for achieving root coverage and correcting the recession defect.
Connective Tissue Graft (CTG)
The Connective Tissue Graft (CTG) is often considered the gold standard for covering exposed roots. This procedure involves taking sub-epithelial connective tissue from beneath the top layer of the palate and transplanting it to the recession site. It is often placed under a repositioned flap of existing gum tissue. This technique is highly valued for its predictable root coverage, excellent aesthetic integration, and good color matching.
Free Gingival Graft (FGG)
The Free Gingival Graft (FGG) involves harvesting a full-thickness section of tissue, including the outer layer, directly from the palate. While it provides coverage, the FGG is primarily used to increase the overall width and thickness of the firm, keratinized tissue around the tooth. This is essential for long-term stability in areas with thin gums. Because tissue is removed from the palate, both CTG and FGG procedures create two surgical sites, which can lead to temporary post-operative discomfort in the donor area.
Pedicle Grafts
Pedicle grafts, such as the Coronally Advanced Flap, move gum tissue from an adjacent area while maintaining its original blood supply. This technique promotes faster healing. This approach is effective for certain types of recession defects and can yield excellent aesthetic outcomes.
Pinhole Surgical Technique (PST)
The Pinhole Surgical Technique (PST) is a less invasive alternative that avoids the need for a secondary donor site on the palate. This method creates a tiny, pinhole-sized entry point in the gum tissue. Specialized instruments are used to gently loosen and slide the existing tissue over the exposed root surface. Collagen strips are often inserted to stabilize the repositioned tissue, promoting healing and minimizing discomfort due to the lack of large incisions or sutures. PST is generally a viable option for mild to moderate recession and is favored by patients seeking quicker recovery times.
Preventing Further Tissue Loss
Preventing further tissue loss requires consistent non-surgical management, regardless of whether surgery is performed. The most significant adjustment involves correcting traumatic oral hygiene habits. Patients should switch to a soft-bristled toothbrush and use gentle, circular motions at a 45-degree angle toward the gumline to clean effectively. Daily flossing is equally important, as it removes plaque and debris, reducing inflammation and the risk of infection-related recession.
Lifestyle factors must also be addressed to maintain long-term gum health. Quitting tobacco use is strongly recommended, as smoking and chewing tobacco restrict blood flow and impair the body’s ability to heal and fight infection. For individuals who grind or clench their teeth (bruxism), a custom-fitted nightguard can alleviate excessive pressure on the teeth and supporting structure. Regular professional dental check-ups and cleanings remain foundational, ensuring that any early signs of disease or progression are immediately identified and managed. For patients experiencing sensitivity from exposed roots, specialized desensitizing toothpastes or professional fluoride varnish application can help reduce discomfort.