Gum recession: 5 treatment options for advanced cases

In short: Advanced gingival recession may require periodontal treatment, connective tissue grafting, mucogingival surgery, orthodontic treatment or restorative treatment. The choice depends on the cause of the recession, the available tissues and the degree of root exposure.

Gingival recession can range from a subtle change in the gum line to the exposure of a significant portion of the tooth root. In advanced cases, it may be associated with tooth sensitivity, aesthetic changes and damage to the root surface.

Treatment is not the same for every patient. The choice of treatment depends on the cause of the recession, the extent of the defect, the condition of the gingival tissues and the position of the tooth. Gingival recession is considered more complex when the exposed root surface is extensive or when there is also loss of interdental tissue, factors which can influence the treatment prognosis.

Gingival retraction is the movement of the gingival margin towards the root of the tooth, resulting in the exposure of a surface that is normally covered by the gums.

Retraction may be limited to a single tooth or may affect several areas. Extensive forms may expose a larger root surface and may be associated with dentine sensitivity, aesthetic changes, non-carious cervical lesions or root caries.

The extent of recession must be assessed clinically. The dentist also examines the loss of interdental attachment, as the type of defect influences treatment options and the possibility of root coverage.

Gingival recession does not have a single cause. Its onset and progression can be influenced by inflammation, tissue anatomy, tooth position, oral hygiene practices and other local or systemic factors. Identifying these factors is important for choosing the appropriate treatment and reducing the risk of the condition worsening.

The relationship between gingival recession, gingivitis and periodontitis

Persistent gingival inflammation and the loss of supporting tissues associated with periodontitis can contribute to the onset or worsening of recession.

However, gingival recession can also occur in the absence of active periodontal disease. Therefore, identifying the cause is important before selecting a treatment.

Gingival phenotype and tooth position

Thin gingiva may be more prone to recession than thicker gingival tissue.

The position of the tooth in the dental arch also matters. A tooth situated in an unfavourable relationship with the bone and supporting tissues may be at greater risk of gingival recession.

Brushing technique and oral hygiene

Both the build-up of bacterial plaque and repeated trauma to the gums caused by overly aggressive brushing can contribute to the onset or progression of recession.

Brushing technique and hygiene tools must be adapted to allow for plaque control without damaging the tissues.

Can orthodontic treatment influence gingival recession?

In certain situations, yes.

The initial position of the tooth, the direction of orthodontic movement and the thickness of the gingival tissues can all influence gum health. Patients with risk factors may benefit from a periodontal assessment before and during orthodontic treatment.

Other factors that may contribute to gum recession

The following may also contribute:

• unfavourable frenum attachments;
• restorations or prosthetic margins that irritate the tissues;
• smoking;
• persistent periodontal inflammation;
• individual anatomical characteristics. 

• The root of the tooth becomes visible – One of the signs is the appearance of a ‘longer tooth’, caused by a change in the gum line. The difference may become more apparent when compared with neighbouring teeth.
• Tooth sensitivity – Exposure of the root surface can cause sensitivity to cold, heat, touch or when brushing.
• Aesthetic changes – Gum recession can cause asymmetry in the gum line and expose the roots, altering the appearance of the smile.
• Lesions at the tooth root – Exposed root surfaces may present with non-carious cervical lesions or root caries and may be associated with persistent sensitivity. 

Before deciding on a course of treatment, the periodontist assesses several factors:

• the depth of recession;
• the level of interdental attachment;
• gingival phenotype;
• the amount of keratinised tissue;
• the position of the tooth;
• condition of the root surface;
• any cervical lesions;
• position of the frenum;
• the presence of an isolated retraction or several adjacent retractions.

These factors influence the prognosis and the choice of appropriate treatment. 

These options are not mutually exclusive. In certain situations, the treatment plan may combine several approaches, depending on the specific details of the case.

Treatment for advanced gum recession does not necessarily begin with surgery.

Treatment of existing periodontal conditions

When a patient is diagnosed with gingivitis or periodontitis, the first aim is to control inflammation and bacterial plaque and stabilise periodontal health.

Correcting habits that may affect the gums

It may be necessary to adjust brushing technique, choose suitable hygiene tools, give up smoking and undergo regular check-ups.

Managing tooth sensitivity

Sensitivity can be managed using specialised products and by protecting the root surface. If there are cervical lesions, these must be assessed separately.

A connective tissue graft is one of the procedures used to increase the thickness of soft tissues and, where appropriate, to cover exposed root surfaces.

What does a connective tissue graft involve?

The procedure involves harvesting the tissue, positioning it in the area of recession and allowing the graft to integrate gradually during the healing period.

When might it be recommended?

It may be considered when there is:

• an indication for root coverage;
• a thin gingival phenotype;
• sensitivity;
• aesthetic indications;
• a need to increase tissue thickness.

In appropriately selected cases, connective tissue grafting may be combined with other surgical techniques to achieve root coverage. 

Advanced coronal flap

This technique involves repositioning the gingival tissue towards the exposed root surface and may be combined with a connective tissue graft.

The tunnel technique

The tunnel technique represents another approach to soft tissues and can be used in certain isolated or multiple retractions, including in combination with a graft.

Why do results vary from one patient to another?

The outcome depends on:

• the type of recession;
• loss of interdental attachment;
• the position of the tooth;
• local anatomy;
• the size of the defect;
• the quality and quantity of available tissue. 

Orthodontic treatment is not a universal solution for gingival recession.

However, it can form part of a multidisciplinary treatment plan when the position of the tooth contributes to the development or persistence of the condition.

When might tooth repositioning be considered?

When a tooth is positioned unfavourably in relation to the supporting tissues, orthodontic repositioning may be considered as part of the treatment plan.

Orthodontic treatment before or after periodontal surgery?

The sequence of stages is determined on a case-by-case basis, depending on the gingival phenotype, the position of the tooth, the extent of recession and the joint plan established by the orthodontist and the periodontist.

In advanced cases of recession, the exposed root surface may also be affected.

Restoration of cervical lesions

Non-carious cervical lesions, root caries or changes in the shape of the tooth surface may require restorative treatment.

When might a combination of periodontal and restorative treatment be necessary?

A combined approach may be necessary when:

• the root surface is affected;
• there are cervical lesions;
• the anatomy of the tooth surface is altered;
• the objective is both functional and aesthetic. 

The laser should not be regarded as a standalone method of ‘gum restoration’.

In certain periodontal or surgical protocols, it may play an adjunctive role, but its indication depends on the procedure performed and the specific details of the case.

The primary treatment for gum recession must be determined following a comprehensive periodontal assessment.

Not all cases automatically require surgery.

Receding gums cannot be treated in exactly the same way in all cases. Sometimes it is sufficient to manage the contributing factors, whilst other situations require mucogingival surgery. 

Personalised oral hygiene

Correct brushing technique, interdental cleaning and control of bacterial plaque help to maintain gum health.

Regular periodontal check-ups

Monitoring allows for the assessment of gum recession and the early identification of inflammation or changes in the gums.

Management of risk factors

It is important to manage factors such as:

• smoking;
• periodontal disease;
• repeated mechanical trauma;
• unfavourable tooth position;
• orthodontic treatments requiring periodontal monitoring. 

If you notice gum recession, tooth sensitivity, or changes in the gum contour, you can schedule a periodontics consultation.