European Group on Periodontal Research (ERGOPerio, CH); private practice, Florence, Italy.
Department of Periodontics, Case Western Reserve University, School of Dental Medicine, Cleveland, OH, USA.
J Periodontol. 2018 Jun;89 Suppl 1:S204-S213. doi: 10.1002/JPER.16-0671.
Mucogingival deformities, and gingival recession in particular, are a group of conditions that affect a large number of patients. Since life expectancy is rising and people are retaining more teeth both gingival recession and the related damages to the root surface are likely to become more frequent. It is therefore important to define anatomic/morphologic characteristics of mucogingival lesions and other predisposing conditions or treatments that are likely to be associated with occurrence of gingival recession.
Mucogingival defects including gingival recession occur frequently in adults, have a tendency to increase with age, and occur in populations with both high and low standards of oral hygiene. The root surface exposure is frequently associated with impaired esthetics, dentinal hypersensitivity and carious and non-carious cervical lesions. The objectives of this review are as follows (1) to propose a clinically oriented classification of the main mucogingival conditions, recession in particular; (2) to define the impact of these conditions in the areas of esthetics, dentin hypersensitivity and root surface alterations at the cervical area; and (3) to discuss the impact of the clinical signs and symptoms associated with the development of gingival recessions on future periodontal health status.
An extensive literature search revealed the following findings: 1) periodontal health can be maintained in most patients with optimal home care; 2) thin periodontal biotypes are at greater risk for developing gingival recession; 3) inadequate oral hygiene, orthodontic treatment, and cervical restorations might increase the risk for the development of gingival recession; 4) in the absence of pathosis, monitoring specific sites seems to be the proper approach; 5) surgical intervention, either to change the biotype and/or to cover roots, might be indicated when the risk for the development or progression of pathosis and associated root damages is increased and to satisfy the esthetic requirements of the patients.
The clinical impact and the prevalence of conditions like root surface lesions, hypersensitivity, and patient esthetic concern associated with gingival recessions indicate the need to modify the 1999 classification. The new classification includes additional information, such as recession severity, dimension of the gingiva (gingival biotype), presence/absence of caries and non-carious cervical lesions, esthetic concern of the patient, and presence/absence of dentin hypersensitivity.
黏膜炎性和牙龈退缩等黏膜-牙周畸形是一组影响大量患者的病症。随着预期寿命的延长以及人们保留更多的牙齿，牙龈退缩以及相关的牙根表面损伤可能会更加频繁。因此，确定黏膜-牙周病损的解剖/形态学特征以及可能与牙龈退缩发生相关的其他诱发因素或治疗方法非常重要。
成年人中经常出现黏膜炎性缺陷，包括牙龈退缩，且这种情况随着年龄的增长而有增加趋势，在口腔卫生水平高或低的人群中均会发生。牙根表面暴露通常与美观受损、牙本质过敏症以及龋病和非龋性颈病损有关。本综述的目的如下：（1）提出一种以临床为导向的主要黏膜-牙周病损，特别是牙龈退缩的分类；（2）定义这些病损在美观、牙本质过敏症和颈缘区域牙根表面改变等方面的影响；（3）讨论与牙龈退缩发展相关的临床体征和症状对未来牙周健康状况的影响。
广泛的文献检索发现以下结果：（1）通过最佳家庭护理，大多数患者的牙周健康可以得到维持；（2）牙周组织较薄的患者发生牙龈退缩的风险更高；（3）口腔卫生不佳、正畸治疗和颈部修复可能会增加发生牙龈退缩的风险；（4）在没有病变的情况下，监测特定部位似乎是恰当的方法；（5）当发生或进展为病理状态以及相关的牙根损伤的风险增加且为了满足患者的美观需求时，可能需要进行手术干预，改变生物学类型和/或覆盖牙根。
与牙龈退缩相关的牙根表面病损、过敏症和患者美观问题等情况的临床影响和流行率表明，需要对 1999 年的分类进行修改。新的分类包括了更多的信息，如退缩的严重程度、牙龈的维度（牙龈生物学类型）、是否存在龋病和非龋性颈病损、患者的美观需求以及是否存在牙本质过敏症。
