Therapy of gingival recessions
The reduction of possible influencing factors and the optimisation of oral hygiene at home are the first step in the therapy of gingival recessions. Further, the denuded tooth roots can be covered again with tooth neck fillings or surgical measures.
Reduction of the influencing factors
In a first step, possible influencing factors are reduced. In counselling sessions, the optimisation of oral hygiene at home is aimed at and, if necessary, the renunciation of tobacco products is implemented.
During professional tooth cleaning, the dentist or dental hygienist systematically cleans all tooth surfaces. Particularly important in periodontitis is the cleaning and smoothing of the bacteria-populated root surfaces under the gum line.
Likewise, all obstacles that can impede optimal oral hygiene at home are removed. These include, in particular, tartar deposits above the gumline, as well as protruding crown or filling margins.
An initial professional dental cleaning can rarely be performed in one session. For patients with advanced periodontitis, several appointments are scheduled for professional tooth cleaning.
Professional teeth cleaning
In order for a gingival recession to be treated further, all plaque and tartar must first be removed from the tooth surfaces in a professional dental cleaning.
During professional tooth cleaning, the dentist, dental hygienist or prophylaxis assistant systematically clean all tooth surfaces. Particularly important in gingival recession is the cleaning and smoothing of the bacteria-populated denuded root surfaces.
Likewise, during professional tooth cleaning, all obstacles are removed that can impede optimal oral hygiene at home. These include, in particular, tartar deposits above the gum line, as well as protruding crown or filling margins.
Optimising oral hygiene at home
The denuded root surfaces must be cleaned regularly and optimally so that gingivitis and further gingival recession can be avoided there.
Performing regular oral hygiene at home in the best possible way is a great challenge. For the conscientious cleaning of the interdental spaces, a little more time is also needed. Furthermore, the special cleaning of the gingival recessions is not always easy. There are special oral hygiene aids for these areas, so-called single tuft brushes. These are selected individually for each situation in the dentition and their correct use is instructed by the dentist, the dental hygienist or the prophylaxis assistant.
For more information on oral hygiene instruction, see also http://www.mundhygiene-instruktion.ch.
Three to four weeks after the professional teeth cleaning, the interim result is reviewed and a decision is made on how to plan the further procedure.
A few weeks after professional teeth cleaning, the overall situation is checked again. In this follow-up check, it is especially checked whether patients can clean their teeth well through their home oral hygiene.
In the course of the gum treatment, patients learn an oral hygiene technique adapted to their situation. Good cooperation with optimal oral hygiene at home determines the overall success of the treatment.
Following the pre-treatment, exposed tooth roots can be covered up again with a surgical procedure. This measure is only carried out if the jawbone has not receded.
In order to successfully correct gingival recession and cover the exposed root surface, a surgical procedure is required. During this treatment under local anaesthesia, the patient’s own gums are reattached to their original position using suitable incision guides and suturing techniques. In this process, a tissue graft from the patient’s own palate can help to widen the thickness of the gum while improving the stability of the tissue.
The attached sutures must be left in place for a few weeks to heal and must be regularly rechecked. During this time, the wound area must not be cleaned mechanically with oral hygiene aids. An appropriate mouth rinse with chlorhexidine twice a day can bridge this period well.
After complete healing of the new gum line, the teeth there must first be cleaned carefully and then with the correct oral hygiene technique.
Root surfaces that have been denuded and any abrasions that may be present there can be covered up and filled with tooth neck fillings.
As long as existing gingival recessions are not perceived as aesthetically disturbing, but the affected teeth show hypersensitivity, therapy with tooth neck fillings may be indicated. The respective teeth will still be aesthetically the same length afterwards. However, the sensitivity to colder temperatures is significantly reduced and the missing tooth substance is replaced.
In the case of caries on the denuded root surface, the removal of the caries is followed by covering the root with filling material.
Professional long-term care (recall)
Following gingival recession treatment, long-term professional care is planned with the dental hygienist or prophylaxis assistant.
Following gum treatment, long-term success over several years is only guaranteed if patients maintain optimal oral hygiene at home, successfully preventing their gums from suffering gingival recession.
For optimal long-term success, it is also important to maintain ongoing professional long-term care in the dental practice so that any recurring problems can be detected and corrected in time.
Who can perform periodontal treatment?
The initial assessment can be carried out in any dental practice. However, in the case of extensive gingival recession, referral to a specialist in periodontology is recommended.
During his studies, the Swiss dentist is trained and examined theoretically and practically for the examination and treatment of gingival recession. With this training, he is able to treat not too advanced cases himself. In continuing education courses and other events offered by universities, the Swiss Society of Periodontology (SSP) and other institutions, this basic knowledge can be deepened.
The treatment of difficult cases – these include in particular more advanced gingival recessions in adolescents and adults – requires specialist knowledge and an infrastructure that guarantees seamless long-term periodontal care. Such patients can be referred to a periodontist by the private dentist (family dentist).
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