RomanianJournalofOralRehabilitation Vol.6,No.3,JulyͲSeptember2014

GINGIVAL RECESSION, DIAGNOSTIC METHODS Viorica Chetru܈*, I. Roman “Nicolae TestemiĠanu" State University of Medicine and Pharmacy - Chiúinău, Rep. Moldova, Faculty of Dentistry, Department of Stomatological Therapy

*Corresponding author: Viorica Chetruú, DMD “Nicolae TestemiĠanu" State University of Medicine and Pharmacy - Chiúinău, Rep. Moldova; e-mail: [email protected]

ABSTRACT Aim of the study To study and analyze the most effective methods in clinical and paraclinic as early diagnosis of gingival recession. The study is based on a group of 191 patients, of whom 122 (63.8%) female, 69 (36%) males, aged between 14-35 years - 87 (45.5 %) and 36-50 years of age - 104 (54.3%) who have been subjected for some methods of diagnosis of gingival recession according to the survey which was composed of the main indices and diagnostic methods to obtain exact information about the status of periodontal tissues. After examination of each patient were obtained fairly truthful results and demonstration for doctor and patient that the patient motivated to start treatment as early as possible. The early and correct diagnosis of gingival recession, parodotolog doctor must carefully collect history, pay attention intraoral clinical examination to know the classification of gingival recession, to know the methods of clinical measurement recessions following three basic parametric tests: gingival fistoon and the coloring.

Keywords: gingival recession, methods of diagnosis, investigation, , test, gingival festoon, coloring

INTRODUCTION inflammation. Across from cosmetic defect It is already known for now not amaze gingival recession is accompanied by a anyone with a restoration, endodontic hypersensitive dental packages,[2, 3, 4, 6], treatment or perfect orthopedic work. But all which are most often cause of presence of these successes can in no way cover the patient to the doctor. multitude of issues that require further studies Usually gingival recession is accompanied in dentistry. Among these problems is graded by inflammation and a huge percentage it and gingival recession, either alone or in appears in region with fenestration in combination with cuneiform defects, dental the vestibular cortical plate of the alveolar erosion cavities package. process and a smaller percentage in the region Many authors define different gingival of in tooth with root perforations. In some recession, in his opinion KH Reteischak, cases, the recession in the form of even if the 1986 [12] - gingival recession is limited fissura Stillman, which may be of different tissue atrophy of periodontal tissue with sizes. Stillman described the recession as a decrease of the height of the gum wedge or result of trauma, although sometimes may oval from the vestibular and less nakedness appear even if the fissura Stillman can appear from oral dental root in the absence of in erosive inflammatory processes of

38 RomanianJournalofOralRehabilitation Vol.6,No.3,JulyͲSeptember2014 marginal gingiva. [2, 6, 10, 13]. state of periodontal tissues) In other cases gingival recession in the 1. General and specific dental anamnesis form of an indurated formations "festoon 2. Clinical examination of the oral cavity gingival" literature described as "festoon gingival inflammation Makkola", which most often occurs on the a) Inflammation of gingiva surfaces of canines and premolars buccal b) The presence of tartar and plaque region. Originally region festooned is c) The presence of periodontal pockets healthy, and later debris accumulation occurs d) The presence of gingival recession after inflammation [2, 6, 7, 11]. (class after Miller fig.1, 2, 3, 4). Making an analysis of the literature on recession, I noticed that recessions are very little studied, virtually no information about this disease in our Republic of Moldova and the former republics of the Soviet Union, while in European countries and the U.S., recessions are studied many years and Figure 1. First class by Miller multilateral. [5, 8, 9] But from these studies a lot of problems remained unstudied full such as non- systematization cases; action risk factors, conditions favouring disease process progresses, the impossibility diagnosis prenozologice and processing of primary Figure 2. Second class by Miller prevention of gingival recession. Therefore, the purpose of this study we wanted: to study and analyse the most effective clinical and laboratory methods in the early diagnosis and correct gingival recession. Figure 3. Third class by Miller MATERIAL AND METHODS The study is based on a group of 191 patients, who addressed of healthcare problems at the Dental Clinic USMF "Nicolae TestemiĠanu". All patients were divided by age and sex. After sex addressed 122 (63.8%) women and 69 (36.0%) men. Figure 4. Fourth class by Miller After age patients were divided into 2 groups: - Inflammatory etiology (microbian) 14-35 years, 87 (45.5%) patients, and 36-50 - Noninflammatory etiology years 104 (54.3%) patients. (nonmicrobian) Both groups of patients were subjected to 3. Measurement of recession after the 3 thorough clinical examination and laboratory basic parameters with calibrated periodontal as required under investigation, which was probe. performed for each patient. a. The vertical dimension of the recession - Investigation: (All information about the

39 RomanianJournalofOralRehabilitation Vol.6,No.3,JulyͲSeptember2014 measured with graduated periodontal probe fig. 5). from enamel-cement border up to the gingival b. The width is measured with periodontal margin. If the recession is accompanied by probe of recession in the widest part recession cuneiform defect or cavity of the package, the from enamel-cement border region (fig. 6). measurement will be done at the apical point c. The width of the is against which will remain unchanged in the determined with periodontal probe at enamel- near future (this is necessary for determining cement border region [1] (fig. 7). the closure of gingival recession after surgery

Figure 7. The width of the Figure 5. Gingival probing Figure 6. The width is measured interdental papilla 4. For predicting the development of a a) probing the (after potential complications methods were used: which determine and bleeding gums and gingival biotype touch fig. 8).

Figure 8. Probing the gingival sulcus Figure 9. Test "festoon gingival"

Figure 10. Coloring test Figure 11. PET-Diagnostic-Set

40 RomanianJournalofOralRehabilitation Vol.6,No.3,JulyͲSeptember2014

b) Test "festoon gingival" which is out biochemical tests and thyroid hormones, determined by periodontal probe presses on thyroid ultrasound, 8 patients were collected the mobile mucous membrane (This test at the level of bacterial DNA samples demonstrates the presence or absence of (Sample PET), and 22 patients took CT gingival fixed charge resistance and not computer. moving fig. 9). After conducting investigation and c) Test the coloring-gums and oral mucosa laboratory tests (as indication for each stained with Lugol solution, free-lining patient) were obtained true results and membrane containing glycogen will turn demonstration as both for the doctor and brown, while fixed gums will remain patient, and the patient is motivated to follow colorless [1] (fig.10). further surgical treatment is to stop the 5. The presence clamps and deeply recession early or prophylaxis if they present inserted frens to clips mucosal and deeply inserted 6. Determination by degrees frenurilor lips or gum recession closing in 7. Determination of the degree of mobility case of detection of a class of recession after 8. Radiological data (OPG) Miller, bone resorption and bone fenestration. 9. Photo 10. Bacterial DNA-PET-Diagnostic (by CONCLUSIONS indication) Biochemical (calcium and ionized To establish an early diagnosis and correct calcium, blood glucose (by indication) gingival recession periodontist doctor must fig.11). carefully collect anamnesis, clinical 11. Analysis hormone (TSH, parathyroid examination of the mouth, to know: hormone, T-3, T-4, indication) 1. Methods of clinical measurement of 12. Computed tomography (as indication) gingival recession following three basic 13. Ultrasonography of the thyroid gland parameters and (as indication) 2. Classification of gingival recession by 14. Oclusion supracontact points Miller. determination thith contact paper and wax. And for predicting the development of possible complications periodontist doctor RESULTS should know how to: All 191 patients were investigated a) probing the gingival sulcus, according to our investigation, which takes b) test "gingival festoon" only a few minutes. Following investigation c) coloring test. of 132 patients were diagnosed based on After the doctor will decide the results of collection history, clinical examination, the laboratory investigations will require each measurements by three basic parameters, test, patient either hormone analysis, biochemical ,, gingival festoon "and the coloring. In 29 analysis, microbiological seeding or making a patients for diagnostic tests have been carried panoramic radiography or CT scans.

REFERENCES 1 ȼɨɥɶɮ Ƚ.Ɏ., Ɋɚɬɟɣɰɯɚɤ ɗ.Ɇ., Ɋɚɬɟɣɰɯɚk Ʉ.// ɉɚɪɨɞɨɧɬɨɥɨɝɢɹ, Ɇɨɫɤɜɚ 2008, 175-176. 2 Ainamo J.,Influence of age on the location of the maxillary // J. Periodontal Res. –1978- Vol.13.-P.-189-193. 3 Cohen E.S. Atlas of cosmetic and reconstructive . – Ed.2.-Baltimare,- 1994,-P.84- 98.

41 RomanianJournalofOralRehabilitation Vol.6,No.3,JulyͲSeptember2014

4 Hammi Blue A.Periodontal plastic procedures in esthetic dentistry// Texas Dent.-2001.- Vol.118, ʋ10.-P.972-976. 5 Harris R.J. Clinical evoluation of 3 techniques to augment keratinized tissue without root coverage. J. Periodontal 2001; 72: 932-938. 6 Kassab M.M., Cohen R.E. The etiology and prevalence of gingival recession// J.American Dent.Ass.-2003.-Vol.134,ʋ2.-P.225. 7 Loe H.The structure and physiology of the dentogingival junction // Structural and chemical organization of teeth. – New York : Academic Press, 1967. 8 Maijnard J.G., Ochseinbein C. Mucogingival problems: Prevalence and therapy in children. J. Periodontal 1975:46:543. 9 Miller P.D., Jr A classification of marginal tissue recession. Int J.Periodont Rest Dent 1985;5(2):9. 10 Meitner S.W., Zander H., Iker H.P. et. al. Identification of inflamed gingival surfaces// J.Clin. Periodontal.- 1979.- Vol.6.- P.93. 11 Sangnes G. Traumatisation of teeth and gingive related to habitual tooth cleaning procedures// J.Clin.Periodontal.-1976.-Vol.3.-P.94-103. 12 Rateischak K., Products designed to regenerate periodontal tissues: Acceptance program guidelines. The American Dental Association. -1997.-July.-P.1-7. 13 Tal H., Mases O., Zohar R. ey al. Root coverage of advanced gingival recession: Comparative study between acellular dermal matrix allograft and subepithelial connective tissue grafts// J. Periodontal.- 2002.- Vol. 73, ʋ12.- P. 1405-1411.

42