Etiology of Gingival Recessions

  • Khadija Amine
  • Wafa El Kholti
  • Jamila Kissa


According to a systematic review conducted by Zweers et al. [1], three gingival biotypes can be clinically distinguished: Normal, thin scalloped, and thick flat according to the differences in the shape, position, and thickness of the marginal periodontal tissues [2]. The authors reported that the dental, gingival, and bony dimensions represent a weak to moderate association. Uniform positive associations were found only between gingival thickness, keratinized tissue, and bone morphotype. Hence, the thin gingival biotype is characterized by a scalloped gingival outline, relatively thin with a narrow band of keratinized tissue. It confirms the finding of the in vivo study by Cook et al. [3] who found that thin gingival biotype was associated with narrow band of keratinized tissue, thin underlying buccal bone, and a big distance from cementoenamel junction to the bone crest (Figs. 2.1 and 2.2).


  1. 1.
    Sato N. Periodontal surgery. A clinical atlas. Tokyo: Quintessence; 2000.Google Scholar
  2. 2.
    Zuhr O, Hurzeler M. Plastic-esthetic periodontal and implant surgery. A microsurgical approach. London: Quintessence; 2012.Google Scholar
  3. 3.
    Cook DR, Mealey BL, Verrett RG, et al. Relationship between clinical periodontal biotype and labial plate thickness: an in vivo study. Int J Periodontics Restorative Dent. 2011;31:345–54.PubMedGoogle Scholar
  4. 4.
    Agudio G, Cortellini P, Buti J, Pini Prato GP. Periodontal conditions of sites treated with gingival-augmentation surgery compared to untreated contralateral homologous sites: a 18- to 37-year long-term study. J Periodontol. 2016;87(12):1371–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Kissa J, El Kholti W, Laalou Y, El Farouki M. Augmentation of keratinized gingiva around dental implants. J Stomatol Oral Maxillofac Surg. 2017;118(3):156–60.CrossRefPubMedGoogle Scholar
  6. 6.
    Lang NP, Loe H. The relationship between the width of keratinized gingiva and gingival health. J Periodontol. 1972;43:623–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Miyasato M, Crigger M, Egelberg J. Gingival condition in areas of minimal and appreciable width of keratinized gingiva. J Clin Periodontol. 1977;4:200–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Wennström J, Lindhe J. Role of attached gingiva for maintenance of periodontal health. Healing following excisional and grafting procedures in dogs. J Clin Periodontol. 1983;10:206–21.CrossRefPubMedGoogle Scholar
  9. 9.
    Ericsson I, Lindhe J. Recession in sites with inadequate width of the keratinized ginngiva. J Clin Periodontol. 1984;11:95–103.CrossRefPubMedGoogle Scholar
  10. 10.
    Schoo WH, Van Der Velden U. Marginal soft tissue recessions with and without attached gingiva. J Periodontol Res. 1985;20:209–11.CrossRefGoogle Scholar
  11. 11.
    Stetler KJ, Bissada NF. Significance of the width of keratinized gingiva on the periodontal status of teeth with submarginal restorations. J Periodontol. 1987;58:696–700.CrossRefPubMedGoogle Scholar
  12. 12.
    Wennstrom JL. Lack of association between width of attached gingiva and development of soft tissue recession. A 5-year longitudinal study. J Clin Periodontol. 1987;14:181–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Olsson M, Lindhe J. Periodontal characteristics in individuals with varying form of the upper central incisors. J Clin Periodontol. 1991;18:78–82.CrossRefPubMedGoogle Scholar
  14. 14.
    Freedman AL, Green K, Salkin LM, Stein MD, Mellado JR. An 18-year longitudinal study of untreated mucogingival defects. J Periodontol. 1999;70:1174–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Agudio G, Nieri M, Rotundo R, Franceschi D, Cortellini P, Pini Prato GP. Periodontal conditions of sites treated with gingival-augmentation surgery compared to untreated contralateral homologous sites: a 10- to 27-year long-term study. J Periodontol. 2009;80:1399–405.CrossRefPubMedGoogle Scholar
  16. 16.
    Mehta P, Peng LL. The width of the attached gingiva—much ado about nothing? J Dent. 2010;38:517–25.CrossRefPubMedGoogle Scholar
  17. 17.
    Kim D, Neiva R. Periodontal soft tissue non–root coverage procedures: a systematic review from the AAP regeneration workshop. J Periodontol. 2015;86(Suppl):S56–72.CrossRefPubMedGoogle Scholar
  18. 18.
    Zweers J, Thomas RZ, Slot DE, Weisgold AS, Van der Weijden GA. Characteristics of periodontal biotype, its dimensions, associations and prevalence: a systematic review. J Clin Periodontol. 2014;41:958–71.CrossRefPubMedGoogle Scholar
  19. 19.
    El Kholti W, Kissa J. Frenectomy: when it is necessary? Rev Odont Stomat. 2016;45:118–29.Google Scholar
  20. 20.
    Fowler E, Breault LG. Early creeping attachment after frenectomy: a case report. Gen Dent. 2000;48:591–3.PubMedGoogle Scholar
  21. 21.
    Powell RN, et McEniery TM. Disparities in gingival height in the mandibular central incisor region of children aged 6-12 years. Community Dent Oral Epidemiol. 1981;9:32–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Loe H, Anerud A, Boysen H. The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession. J Periodontol. 1992;63:489–95.CrossRefPubMedGoogle Scholar
  23. 23.
    Albandar JM, Kingman A. Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol. 1999;70(1):30–43.CrossRefPubMedGoogle Scholar
  24. 24.
    Susin C, Haas AN, Oppermann RV, Hangerjirden O, Albanadar JM. Gingival recession: epidemiology and risk indicators in a representative urban Brazilian population. J Peridontol. 2004;75(10):1377–86.CrossRefGoogle Scholar
  25. 25.
    Mythri S, Arunkumar SM, Hegde S, Rajesh SK, Munaz M, Ashwin D. Etiology and occurrence of gingival recession - an epidemiological study. J Indian Soc Periodontol. 2015;19:671–5.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    van Palenstein Helderman WH, Lembariti BS, van der Weijden GA, van’t Hof MA. Gingival recession and its association with calculus in subjects deprived of prophylactic dental care. J Clin Periodontol. 1998;25:106–11.CrossRefPubMedGoogle Scholar
  27. 27.
    Khocht A, Simon G, Person P, Denepitiya JL. Gingival recession in relation to history of hard toothbrush use. J Periodontol. 1993;64:900–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Van der Weijden FA, Campbell SL, Dörfer CE, González-Cabezas C, Slot DE. Safety of oscillating-rotating powered brushes compared to manual toothbrushes: a systematic review. J Periodontol. 2011;82(1):5–24. Scholar
  29. 29.
    Rajapakse PS, McCracken GI, Gwynnett E, Steen ND, Guentsch A, Heasman PA. Does tooth brushing influence the development and progression of non-inflammatory gingival recession? A systematic review. J Clin Periodontol. 2007;34:1046–61.CrossRefPubMedGoogle Scholar
  30. 30.
    Sanz M, Bäumer A, Buduneli N, Dommisch H, Farina R, Kononen E, Linden G, Meyle J, Preshaw PM, Quirynen M, Roldan S, Sanchez N, Sculean A, Slot DE, Trombelli L, West N, Winkel E. Effect of professional mechanical plaque removal on secondary prevention of periodontitis and the complications of gingival and periodontal preventive measures–consensus report of group 4 of the 11th European workshop on periodontology on effective prevention of periodontal and peri-implant diseases. J Clin Periodontol. 2015;42(Suppl. 16):S214–20.CrossRefPubMedGoogle Scholar
  31. 31.
    Heasman PA, Holliday R, Bryant A, Preshaw PM. Evidence for the occurrence of gingival recession and non-carious cervical lesions as a consequence of traumatic toothbrushing. J Clin Periodontol. 2015;42(Suppl. 16):S237–55.CrossRefPubMedGoogle Scholar
  32. 32.
    Gillette W, Van House R. Ill effects of improper oral hygiene procedure. J Am Dent Assoc. 1980;101:476–80.CrossRefPubMedGoogle Scholar
  33. 33.
    Hallmon W, Waldrop T, Houston G, Hawkins B. Flossing clefts. Clinical and histologic observations. J Periodontol. 1986;57:501–4.CrossRefPubMedGoogle Scholar
  34. 34.
    Zucchelli G, Mounssif I. Periodontal plastic surgery. J Periodontol. 2015;68:333–68.CrossRefGoogle Scholar
  35. 35.
    Joss-Vassalli I, Grebenstein C, Topouzelis N, Sculean A, Katsaros C. Orthodontic therapy and gingival recession: a systematic review. Orthod Craniofac Res. 2010;13:127–41.CrossRefPubMedGoogle Scholar
  36. 36.
    Bollen A, Cunha-Cruz J, Bakko D, Huang G, Hujoel P. The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence. J Am Dent Assoc. 2008;139(4):413–22.CrossRefPubMedGoogle Scholar
  37. 37.
    Aziz T, Flores-Mir C. A systematic review of the association between appliance-induced labial movement of mandibular incisors and gingival recession. Aust Orthod J. 2011;27(1):33–9.PubMedGoogle Scholar
  38. 38.
    Johal A, Katsaros C, Zachrisson B. State of the science on controversial topics: orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting). Prog Orthod. 2013;14:16.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Gunay H, Seeger A, Tschernitschek H, Geurtsen W. Placement of the preparation line and periodontal health-a prospective 2-year clinical study. Int J Periodontics Restorative Dent. 2000;20:171–81.PubMedGoogle Scholar
  40. 40.
    Maynard JG Jr, Wilson RD. Physiologic dimensions of the periodontium significant to the restorative dentist. J Periodontol. 1979;50:170–4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Khadija Amine
    • 1
  • Wafa El Kholti
    • 1
  • Jamila Kissa
    • 1
  1. 1.Periodontics DepartmentUniversity of Hassan IICasablancaMorocco

Personalised recommendations