Dişeti Çekilmelerinde Güncel Tedavi Yaklaşımları
Özet
Dişeti çekilmeleri, yumuşak doku kenarının mine-sement sınırının altına doğru hareket ederek kök yüzeyinin bir kısmının açığa çıkması durumunu ifade eder. Sıklıkla travmatik diş fırçalama ve yetersiz ağız hijyeni gibi faktörlerle ilişkilendirilen toplumda yaygın bir durumdur. Estetik kaygıların yanı sıra diş hassasiyeti, kök çürükleri ve fonksiyon kaybı gibi sorunlara yol açabilir. Başarılı bir tedavi için öncelikle dişeti çekilmelerine neden olan hazırlayıcı ve hızlandırıcı faktörlerin belirlenmesi gereklidir. Hazırlayıcı faktörler arasında dişeti kalınlığı, anormal frenulum ataşmanı ve anatomik faktörler yer alırken, hızlandırıcı faktörler arasında periodontal hastalık, travmatik diş fırçalama, ortodontik tedavi, uyumsuz restorasyonlar ve sigara bulunur. Tedavi endikasyonları arasında estetik nedenler, hassasiyet ya da koruyucu amaç gibi nedenler yer alır. Dişeti çekilmelerinin tedavisi plağın kontrolü, uygunsuz restorasyonların çıkarılması gibi cerrahi olmayan yaklaşımların yanı sıra koronal pozisyonlandırılan flep, tünel tekniği, gibi çeşitli cerrahi yaklaşımlar kullanılmakla birlikte yeni yaklaşımlar doğmaya devam etmektedir. Hangi durumda hangi tedavi yönteminin seçileceği hakkında literatürde kesin bir bilgi olmasa da dişeti çekilmesinin şiddeti, hastanın beklentisi ya da anatomik faktörlerin değerlendirilmesi sonucunda kullanılacak yönteme karar verilebilir.
Gingival recession refers to the exposure of a portion of the root surface as the soft tissue margin moves below to the cementoenamel line. It is a common condition often associated with factors like traumatic tooth brushing and poor oral hygiene. In addition to aesthetic concerns, it can lead to issues such as tooth sensitivity, root decay, and loss of function. Successful treatment requires identifying predisposing and precipitating factors. Predisposing factors include gum tissue thickness, abnormal frenulum attachment, and anatomical factors, while precipitating factors include periodontal disease, traumatic tooth brushing, orthodontic treatment, inappropiate restorations, and smoking. Treatment indications include aesthetic reasons, sensitivity, or preventive purposes. In addition to non-surgical approaches such as treatment of gingival recession, control of plaque, removal of inappropriate restorations, various surgical approaches such as coronally positioned flap and tunnel technique are used, and new approaches continue to emerge. Although there is no definitive information in the literature about which treatment method to choose in which case, the method to be used can be decided as a result of the severity of gingival recession, the patient's expectation or evaluation of anatomical factors.
Referanslar
Cairo F. Periodontal plastic surgery of gingival recession at single and multiple teeth. Periodontology 2000. 2017;75(1):296-316. doi:10.1111/prd.12186
Zucchelli G MI. Periodontal plastic surgery. Periodontology 2000. 2015(68):333-68. doi:10.1111/prd.12059
Löe H, Anerud, A., & Boysen, H. The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession. Journal of periodontology. 1992;63(6):489-95.
Kassab MM CR. The etiology and prevalence of gingival recession. Journal of American Dental Association. 2003;134(2):220-5. doi:10.14219/jada.archive.2003.0137
Olsson M LJ. Periodontal characteristics in individuals with varying form of the upper central incisors. Journal of Clinical Periodontology. 1991;18(1):78-82.
Litonjua LA, Andreana S, Bush PJ et al. Toothbrushing and gingival recession. International Dental Journal. 2003;53(2):67-72. doi:10.1111/j.1875-595x.2003.tb00661.x
Serino G, Wennström, JL., Lindhe, J. et al. The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene. Journal of clinical periodontology. 1994;21(1):57-63.
Wagner TP, Costa RS, Rios FS et al. Gingival recession and oral health-related quality of life: a population-based cross-sectional study in Brazil. Community Dent Oral Epidemiol. 2016;44(4):390-9. doi:10.1111/cdoe.12226
Sullivan HC, Atkins JH. Free autogenous gingival grafts. 3. Utilization of grafts in the treatment of gingival recession. Periodontics. 1968;6(4):152-60.
Mlinek A, Smukler H, Buchner A. The use of free gingival grafts for the coverage of denuded roots. Journal of Periodontology. 1973;44(4):248-54. doi:10.1902/jop.1973.44.4.248
Miller PD, Jr. A classification of marginal tissue recession. International Journal of Periodontics & Restorative Dentistry. 1985;5(2):8-13.
Pini-Prato GP CF, Nieri M, Franceschi D. et. al. Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up. Jorunal of Clinical Periodontology. 2010;37(7):644-50. doi:10.1111/j.1600-051X.2010.01559.x
Clauser C, Nieri M, Franceschi D. et al Evidence-based mucogingival therapy. Part 2: Ordinary and individual patient data meta-analyses of surgical treatment of recession using complete root coverage as the outcome variable. Jorunal of Periodontology. 2003;74(5):741-56. doi:10.1902/jop.2003.74.5.741
Saletta D, Pini Prato G, Pagliaro U. et al. Coronally advanced flap procedure: is the interdental papilla a prognostic factor for root coverage? Journal of Periodontology. 2001;72(6):760-6. doi:10.1902/jop.2001.72.6.760
Müller HP, Eger T, Schorb A. Gingival dimensions after root coverage with free connective tissue grafts. Journal of Clinical Periodontology. 1998;25(5):424-30. doi:10.1111/j.1600-051x.1998.tb02466.x
Pini-Prato G. The Miller classification of gingival recession: limits and drawbacks. Journal of Clinical Periodontology. 2011;38(3):243-5. doi:10.1111/j.1600-051X.2010.01655.x
Miller PD. Miller Classification of Marginal Tissue Recession Revisited After 35 Years. Compendium of Continuing Education in Dentistry. 2018;39(8):514-20.
Cairo F, Nieri M., Cincinelli S. et al. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. Journal of Clinical Periodontology. 2011;38(7):661-6. doi:10.1111/j.1600-051X.2011.01732.x
Jepsen S, Caton JG, Albandar JM et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Clinical Periodontology. 2018;45 Suppl 20:S219-s29. doi:10.1111/jcpe.12951
Kasaj A. Etiology and Prevalence of Gingival Recession. In: Kasaj A, editor. Gingival Recession Management: A Clinical Manual. Cham: Springer International Publishing; 2018. p. 19-31.
Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. Journal of Periodontology. 1972;43(10):623-7. doi:10.1902/jop.1972.43.10.623
Wennström J, Lindhe J. Role of attached gingiva for maintenance of periodontal health. Healing following excisional and grafting procedures in dogs. Journal of Clinical Periodontology. 1983;10(2):206-21. doi:10.1111/j.1600-051x.1983.tb02208.x
Wennström J, Lindhe J. Plaque-induced gingival inflammation in the absence of attached gingiva in dogs. Journal of Clinical Periodontology. 1983;10(3):266-76. doi:10.1111/j.1600-051x.1983.tb01275.x
Schoo WH, van der Velden U. Marginal soft tissue recessions with and without attached gingiva. A five year longitudinal study. Journal of Periodontal Research. 1985;20(2):209-11. doi:10.1111/j.1600-0765.1985.tb00427.x
Wennström JL, Lindhe J, Sinclair F et al. Some periodontal tissue reactions to orthodontic tooth movement in monkeys. Journal Clinical Periodontology. 1987;14(3):121-9. doi:10.1111/j.1600-051x.1987.tb00954.x
Maroso FB, Gaio EJ, Rösing CK. et al. Correlation between gingival thickness and gingival recession in humans. Acta Odontologica Latinoamericana. 2015;28(2):162-6. doi:10.1590/s1852-48342015000200011
Baker DL, Seymour GJ. The possible pathogenesis of gingival recession. A histological study of induced recession in the rat. Journal of Clinical Periodontology. 1976;3(4):208-19. doi:10.1111/j.1600-051x.1976.tb00040.x
Löst C. Depth of alveolar bone dehiscences in relation to gingival recessions. Journal of Clinical Periodontology. 1984;11(9):583-9. doi:10.1111/j.1600-051x.1984.tb00911.x
Bernimoulin J, Curilovié Z. Gingival recession and tooth mobility. Journal of Clinical Periodontology. 1977;4(2):107-14. doi:10.1111/j.1600-051x.1977.tb01890.x
Beck JD, Koch GG. Characteristics of older adults experiencing periodontal attachment loss as gingival recession or probing depth. Journal of Periodontal Research. 1994;29(4):290-8. doi:10.1111/j.1600-0765.1994.tb01224.x
Padbury A, Jr., Eber R, Wang HL. Interactions between the gingiva and the margin of restorations. Journal of Clinical Periodontology. 2003;30(5):379-85. doi:10.1034/j.1600-051x.2003.01277.x
Tugnait A, Clerehugh V. Gingival recession-its significance and management. Journal of Dentistry. 2001;29(6):381-94. doi:10.1016/s0300-5712(01)00035-5
Yeung AL, Lo EC, Chow TW et al. Oral health status of patients 5-6 years after placement of cobalt-chromium removable partial dentures. Journal of Oral Rehabilitation. 2000;27(3):183-9. doi:10.1046/j.1365-2842.2000.00512.x
Heasman PA, Holliday R, Bryant A et al. Evidence for the occurrence of gingival recession and non-carious cervical lesions as a consequence of traumatic toothbrushing. Journal of Clinical Periodontology. 2015;42 Suppl 16:S237-55. doi:10.1111/jcpe.12330
Lang NP, Lindhe J. Clinical Periodontology and Implant Dentistry. Sixth edition ed: John Wiley & Sons, Ltd, Chichester, West Sussex, 2015; 2015.
Loos BG, Van Dyke TE. The role of inflammation and genetics in periodontal disease. Periodontology 2000. 2020;83(1):26-39. doi:10.1111/prd.12297
Müller HP, Stadermann S, Heinecke A. Gingival recession in smokers and non-smokers with minimal periodontal disease. Journal Clinical Periodontology. 2002;29(2):129-36. doi:10.1034/j.1600-051x.2002.290207.x
Bollen AM, Cunha-Cruz J, Bakko DW et al. The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence. Journal of American Dental Association. 2008;139(4):413-22. doi:10.14219/jada.archive.2008.0184
Wennström JL. Mucogingival considerations in orthodontic treatment. Seminars of Orthodontics. 1996;2(1):46-54. doi:10.1016/s1073-8746(96)80039-9
Steiner GG, Pearson JK, Ainamo J. Changes of the marginal periodontium as a result of labial tooth movement in monkeys. Journal of Periodontology. 1981;52(6):314-20. doi:10.1902/jop.1981.52.6.314
Ristic M, Vlahovic Svabic M, Sasic M et al. Effects of fixed orthodontic appliances on subgingival microflora. International Journal of Dental Hygiene. 2008;6(2):129-36. doi:10.1111/j.1601-5037.2008.00283.x
Guo R, Lin Y, Zheng Y, Li W. The microbial changes in subgingival plaques of orthodontic patients: a systematic review and meta-analysis of clinical trials. BMC Oral Health. 2017;17(1):90. doi:10.1186/s12903-017-0378-1
Crego-Ruiz M, Jorba-García A. Assessment of the periodontal health status and gingival recession during orthodontic treatment with clear aligners and fixed appliances: A systematic review and meta-analysis. Medicina Oral, Patologia Oral y Cirugia Bucal. 2023;28(4):e330-e40. doi:10.4317/medoral.25760
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Zucchelli G MI. Periodontal plastic surgery. Periodontology 2000. 2015(68):333-68. doi:10.1111/prd.12059
Löe H, Anerud, A., & Boysen, H. The natural history of periodontal disease in man: prevalence, severity, and extent of gingival recession. Journal of periodontology. 1992;63(6):489-95.
Kassab MM CR. The etiology and prevalence of gingival recession. Journal of American Dental Association. 2003;134(2):220-5. doi:10.14219/jada.archive.2003.0137
Olsson M LJ. Periodontal characteristics in individuals with varying form of the upper central incisors. Journal of Clinical Periodontology. 1991;18(1):78-82.
Litonjua LA, Andreana S, Bush PJ et al. Toothbrushing and gingival recession. International Dental Journal. 2003;53(2):67-72. doi:10.1111/j.1875-595x.2003.tb00661.x
Serino G, Wennström, JL., Lindhe, J. et al. The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene. Journal of clinical periodontology. 1994;21(1):57-63.
Wagner TP, Costa RS, Rios FS et al. Gingival recession and oral health-related quality of life: a population-based cross-sectional study in Brazil. Community Dent Oral Epidemiol. 2016;44(4):390-9. doi:10.1111/cdoe.12226
Sullivan HC, Atkins JH. Free autogenous gingival grafts. 3. Utilization of grafts in the treatment of gingival recession. Periodontics. 1968;6(4):152-60.
Mlinek A, Smukler H, Buchner A. The use of free gingival grafts for the coverage of denuded roots. Journal of Periodontology. 1973;44(4):248-54. doi:10.1902/jop.1973.44.4.248
Miller PD, Jr. A classification of marginal tissue recession. International Journal of Periodontics & Restorative Dentistry. 1985;5(2):8-13.
Pini-Prato GP CF, Nieri M, Franceschi D. et. al. Coronally advanced flap versus connective tissue graft in the treatment of multiple gingival recessions: a split-mouth study with a 5-year follow-up. Jorunal of Clinical Periodontology. 2010;37(7):644-50. doi:10.1111/j.1600-051X.2010.01559.x
Clauser C, Nieri M, Franceschi D. et al Evidence-based mucogingival therapy. Part 2: Ordinary and individual patient data meta-analyses of surgical treatment of recession using complete root coverage as the outcome variable. Jorunal of Periodontology. 2003;74(5):741-56. doi:10.1902/jop.2003.74.5.741
Saletta D, Pini Prato G, Pagliaro U. et al. Coronally advanced flap procedure: is the interdental papilla a prognostic factor for root coverage? Journal of Periodontology. 2001;72(6):760-6. doi:10.1902/jop.2001.72.6.760
Müller HP, Eger T, Schorb A. Gingival dimensions after root coverage with free connective tissue grafts. Journal of Clinical Periodontology. 1998;25(5):424-30. doi:10.1111/j.1600-051x.1998.tb02466.x
Pini-Prato G. The Miller classification of gingival recession: limits and drawbacks. Journal of Clinical Periodontology. 2011;38(3):243-5. doi:10.1111/j.1600-051X.2010.01655.x
Miller PD. Miller Classification of Marginal Tissue Recession Revisited After 35 Years. Compendium of Continuing Education in Dentistry. 2018;39(8):514-20.
Cairo F, Nieri M., Cincinelli S. et al. The interproximal clinical attachment level to classify gingival recessions and predict root coverage outcomes: an explorative and reliability study. Journal of Clinical Periodontology. 2011;38(7):661-6. doi:10.1111/j.1600-051X.2011.01732.x
Jepsen S, Caton JG, Albandar JM et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Clinical Periodontology. 2018;45 Suppl 20:S219-s29. doi:10.1111/jcpe.12951
Kasaj A. Etiology and Prevalence of Gingival Recession. In: Kasaj A, editor. Gingival Recession Management: A Clinical Manual. Cham: Springer International Publishing; 2018. p. 19-31.
Lang NP, Löe H. The relationship between the width of keratinized gingiva and gingival health. Journal of Periodontology. 1972;43(10):623-7. doi:10.1902/jop.1972.43.10.623
Wennström J, Lindhe J. Role of attached gingiva for maintenance of periodontal health. Healing following excisional and grafting procedures in dogs. Journal of Clinical Periodontology. 1983;10(2):206-21. doi:10.1111/j.1600-051x.1983.tb02208.x
Wennström J, Lindhe J. Plaque-induced gingival inflammation in the absence of attached gingiva in dogs. Journal of Clinical Periodontology. 1983;10(3):266-76. doi:10.1111/j.1600-051x.1983.tb01275.x
Schoo WH, van der Velden U. Marginal soft tissue recessions with and without attached gingiva. A five year longitudinal study. Journal of Periodontal Research. 1985;20(2):209-11. doi:10.1111/j.1600-0765.1985.tb00427.x
Wennström JL, Lindhe J, Sinclair F et al. Some periodontal tissue reactions to orthodontic tooth movement in monkeys. Journal Clinical Periodontology. 1987;14(3):121-9. doi:10.1111/j.1600-051x.1987.tb00954.x
Maroso FB, Gaio EJ, Rösing CK. et al. Correlation between gingival thickness and gingival recession in humans. Acta Odontologica Latinoamericana. 2015;28(2):162-6. doi:10.1590/s1852-48342015000200011
Baker DL, Seymour GJ. The possible pathogenesis of gingival recession. A histological study of induced recession in the rat. Journal of Clinical Periodontology. 1976;3(4):208-19. doi:10.1111/j.1600-051x.1976.tb00040.x
Löst C. Depth of alveolar bone dehiscences in relation to gingival recessions. Journal of Clinical Periodontology. 1984;11(9):583-9. doi:10.1111/j.1600-051x.1984.tb00911.x
Bernimoulin J, Curilovié Z. Gingival recession and tooth mobility. Journal of Clinical Periodontology. 1977;4(2):107-14. doi:10.1111/j.1600-051x.1977.tb01890.x
Beck JD, Koch GG. Characteristics of older adults experiencing periodontal attachment loss as gingival recession or probing depth. Journal of Periodontal Research. 1994;29(4):290-8. doi:10.1111/j.1600-0765.1994.tb01224.x
Padbury A, Jr., Eber R, Wang HL. Interactions between the gingiva and the margin of restorations. Journal of Clinical Periodontology. 2003;30(5):379-85. doi:10.1034/j.1600-051x.2003.01277.x
Tugnait A, Clerehugh V. Gingival recession-its significance and management. Journal of Dentistry. 2001;29(6):381-94. doi:10.1016/s0300-5712(01)00035-5
Yeung AL, Lo EC, Chow TW et al. Oral health status of patients 5-6 years after placement of cobalt-chromium removable partial dentures. Journal of Oral Rehabilitation. 2000;27(3):183-9. doi:10.1046/j.1365-2842.2000.00512.x
Heasman PA, Holliday R, Bryant A et al. Evidence for the occurrence of gingival recession and non-carious cervical lesions as a consequence of traumatic toothbrushing. Journal of Clinical Periodontology. 2015;42 Suppl 16:S237-55. doi:10.1111/jcpe.12330
Lang NP, Lindhe J. Clinical Periodontology and Implant Dentistry. Sixth edition ed: John Wiley & Sons, Ltd, Chichester, West Sussex, 2015; 2015.
Loos BG, Van Dyke TE. The role of inflammation and genetics in periodontal disease. Periodontology 2000. 2020;83(1):26-39. doi:10.1111/prd.12297
Müller HP, Stadermann S, Heinecke A. Gingival recession in smokers and non-smokers with minimal periodontal disease. Journal Clinical Periodontology. 2002;29(2):129-36. doi:10.1034/j.1600-051x.2002.290207.x
Bollen AM, Cunha-Cruz J, Bakko DW et al. The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence. Journal of American Dental Association. 2008;139(4):413-22. doi:10.14219/jada.archive.2008.0184
Wennström JL. Mucogingival considerations in orthodontic treatment. Seminars of Orthodontics. 1996;2(1):46-54. doi:10.1016/s1073-8746(96)80039-9
Steiner GG, Pearson JK, Ainamo J. Changes of the marginal periodontium as a result of labial tooth movement in monkeys. Journal of Periodontology. 1981;52(6):314-20. doi:10.1902/jop.1981.52.6.314
Ristic M, Vlahovic Svabic M, Sasic M et al. Effects of fixed orthodontic appliances on subgingival microflora. International Journal of Dental Hygiene. 2008;6(2):129-36. doi:10.1111/j.1601-5037.2008.00283.x
Guo R, Lin Y, Zheng Y, Li W. The microbial changes in subgingival plaques of orthodontic patients: a systematic review and meta-analysis of clinical trials. BMC Oral Health. 2017;17(1):90. doi:10.1186/s12903-017-0378-1
Crego-Ruiz M, Jorba-García A. Assessment of the periodontal health status and gingival recession during orthodontic treatment with clear aligners and fixed appliances: A systematic review and meta-analysis. Medicina Oral, Patologia Oral y Cirugia Bucal. 2023;28(4):e330-e40. doi:10.4317/medoral.25760
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Sayfalar
107-124
Gelecek
16 Nisan 2024
Telif Hakkı (c) 2024 Akademisyen Yayınevi Kitap Portalı
Lisans
LisansNasıl Atıf Yapılır
1.
Tayan E. Dişeti Çekilmelerinde Güncel Tedavi Yaklaşımları. Içinde: Kesim S, editör. Güncel Periodontoloji Çalışmaları III (Bahar) [Internet]. Türkiye: Akademisyen Yayınevi Kitap DOI Portalı; 2024 [a.yer 13 Temmuz 2026]. ss. 107-24. Erişim adresi: https://www.omp35.books.akademisyen.net/index.php/akya/catalog/book/3052/chapter/13775
