When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. As gum tissue recedes due to inadequate hard gum tissue around the teeth, bone that was under the gum tissue and enclosing the bone is also lost. Factors that predispose people to recession of their gum tissue include genetics (people with fair and delicate skin are more prone to gum recession), use of medium or hard toothbrushes, clenching and bruxing of the teeth, and a history of orthodontics.
When there is only minor recession, some healthy gingiva often remains and protects the teeth, so that no treatment other than modifying home care is necessary. The first line of defense against penetration is the keratinized hard tissue around teeth. However, when there is not enough tissue (usually 2 to 3 mm are needed for health), recession will continue because the remaining mucosa is not strong enough to prevent further recession and bone loss even with careful brushing and chewing. In addition, gum recession often results in root sensitivity to hot and cold foods as well as unsightly appearance of the gum and tooth. Exposure of the root surface, which is softer than enamel, can lead to root caries and abrasion of the root from normal tooth brushing.
A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth and may be placed in such a way as to cover the exposed portion of the root. This procedure is highly predictable and results in a stable healthy band of attached tissue around the tooth. However, if recession is allowed to continue, complete coverage of the root may not be possible because of the bone loss caused by gum recession.
This patient initially presented in 2001 with severe recession on her lower 3 front teeth (1) and gum grafts were placed. In 2004, the patient returned with great results on lower 3 teeth and gum grafts were recommended on the lower canines (2). She did not move forward with the gum grafts and returned in 2014 (3). Combined with depression, lack of oral hygiene and her predisposing factors, her recession is so severe on her lower canines that the predictability of the procedure drops tremendously.
Notice the original graft placed in 2001 remains stable 13 years later even in the presence of inflammation. This case highlights the importance of treating recession early enough not only to increase predictability but also to increase the band of thick gum tissue to prevent further recession.