Mucogingival considerations for the orthodontic patient

Recession of the gingival margin during or subsequent to orthodontic therapy may occur as either pseudorecession or true recession. Assessment of both predisposing and possible precipitating factors will assist in evaluating the need for surgical intervention. Unfortunately, several parameters cannot be evaluated by objective measures. The clinician must address both objective and subjective criteria. Factors predisposing a site to recession are elucidated by evaluating the anatomy of the area, including the width of keratinized and attached gingiva, the facial-to-lingual dimension of both soft tissue and alveolus, and the position and angulation of the teeth in question. Marginal inflammation must be controlled to define the mucogingival junction necessary for these anatomic evaluations. Precipitating factors relate to the amount of trauma imposed on the marginal tissues. A definition of trauma would vary from direct trauma such as laceration to plaque-derived inflammation. Treatment that affects either trauma or the anatomy could enhance or reduce the potential for recession. Because the situation is dynamic, multiple evaluations are needed. If an area is to be observed, the presence of adequate donor and recipient sites for root coverage grafting techniques should be assessed to determine the potential for successful grafting in the event recession occurs.