Gingival recession: A narrative review of current evidence
DOI:
https://doi.org/10.33448/rsd-v14i10.49659Keywords:
Recession, Gingival, Periodontics.Abstract
Gingival Recession (GR) is characterized by the loss of gingival tissue around the teeth, which can compromise aesthetics, favor dentin hypersensitivity, increase the risk of root caries, and hinder biofilm control. It is a common finding in daily clinical practice. Objective: to verify, through a narrative review, the current evidence related to the risk factors, etiology, and treatment of GR. Methodology: cross-sectional studies, longitudinal studies, and systematic reviews indexed in the MEDLINE and PubMed databases, in Portuguese or English, were selected using the terms “gingival recession and etiology,” “gingival recession and epidemiology,” and “gingival recession and surgery,” or simply “gingival recession.” Discussion: Epidemiological surveys and longitudinal studies report that GR is highly prevalent in the adult population, with more than 50% of individuals presenting one or more sites with gingival recession of 1 mm or more. Its etiology is multifactorial, with different related factors that may act in association, such as bacterial biofilm, traumatic toothbrushing, local plaque-retentive factors, smoking, and orthodontic movement. Connective tissue grafting remains the most predictable clinical approach for root coverage in GR. Conclusion: The mechanism by which GR occurs is still not well understood. It is a common condition reported in most populations, frequently perceived by patients, leading them to seek professional guidance and treatment.
References
Abdel-Fatah, R, & Saleh, W. (2024). Efficacy of amniotic membrane with coronally advanced flap in the treatment of gingival recession: an updated systematic review and meta-analysis. BMC Oral Health. 2024;24(1),133.
Ahmedbeyli, C., Cakar, B., Ipci, S. D., Kuru, B. E., & Yumaz, S. (2014). Clinical evaluation of coronally advanced flap with or without acellular dermal matrix graft on complete defects coverage for the treatment of multiple gingival recessions with thin tissue biotype. Journal of Periodontology, 2014; 41(3), 303–310.
Agudio, G, Chambrone, L, Selvaggi, F, & Pini-Prato, G P. (2019). Effect of gingival augmentation procedure (free gingival graft) on reducing the risk of non-carious cervical lesions, a 25- to 30-year follow-up study. J Periodontol. 2019; 90, 1235-1243.
Benic, G I, Elmasry, M, & Hammerle, C H. (2015). Novel digital imaging techniques to assess the outcome in oral rehabilitation with dental implants, a narrative review. Clin Oral Implants Res. 2015; 26(Suppl 11), 86-96.
Bernardo, W M, Nobre, M R C, & Jatene, F B. (2004). A prática clínica baseada em evidências. Parte II: buscando as evidências em fontes de informação. Rev Assoc Med Bras. 2004; 50(1),1-9.
Bittencourt, S, Del Peloso Ribeiro, E, Sallum, E A, Nociti, F H Jr, & Casati, M Z. (2012). Surgical microscope may enhance root coverage with subepithelial connective tissue graft: a randomized-controlled clinical trial. J Periodontol. 2012 Jun;83(6),721-30.
Cairo, F., Nieri, M., Cincinelli, S., Mervelt, J., & Pagliaro, U. (2011). 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), 661-666.
Cairo F, Couso-Queiruga, E, Barbato, L, Rupe, C, Stuhr, S, Chambrone, L, & Avila-Ortiz, G. (2000). Clinician- and patient-reported outcomes following the surgical treatment of single gingival recession defects: A systematic review. Periodontol 2000. 2025 Jul 22. doi: 10.1111/prd.12641. Epub ahead of print. PMID: 40693671.
Caero, F. (2000). Periodontal plastic surgery of gingival recessions at single and multiple teeth. Periodontology 2000, 75(1), 296–316.
Cheng, G. L., Fu, E., Tu, Y.-K., Shen, E.-C., Huang, R.-Y., Yuh, D.-Y., et al. (2014). Root coverage by coronally advanced flap with connective tissue graft and/or enamel matrix derivative: A meta-analysis. Journal of Periodontal Research, 2014; 49(2), 145–160.
Cortellini, P, & Bissada, N F. (2018). Mucogingival conditions in the natural dentition, narrative review, case definitions, and diagnostic considerations. J Periodontol. 2018; 89(Suppl 1): S204-S213.
Fageeh, H I, Fageeh, H N, Bhati, A K, Thubab, A Y, Sharrahi, H M H, Aljabri, Y S, & Alotaibi, F I. (2024). Assessing the Reliability of Miller's Classification and Cairo's Classification in Classifying Gingival Recession Defects: A Comparison Study. Medicina (Kaunas). 2024 Jan 25;60(2), 205. doi: 10.3390/medicina60020205. PMID: 38399493; PMCID: PMC10890451.
Gunpinar, S, Sevinc, A S, Akgül, Z, Tasmektepligil, A A, & Gunpinar, E. (2025). Patient-specific gingival recession system based on periodontal disease prediction. Int J Comput Dent. 2025 Apr 3;28(1), 35-45. doi: 10.3290/j.ijcd.b4784721. PMID: 38112604.
Guttiganur, N, Aspalli, S, Sanikop, M V, Desai, A, Gaddale, R, & Devanoorkar, A. (2018). Classification systems for gingival recession and suggestion of a new classification system. Indian J Dent Res. 2018 Mar-Apr;29(2), 233-237. doi: 10.4103/ijdr.IJDR_207_17. PMID: 29652020.
Hammam, I. F., Fageedh, H. N., Bhati, A. K., Thubab, A. Y., Sharrahi, H. M. H., et al. (2024). Assessing the reliability of Miller’s classification and Cairo’s classification in classifying gingival recession defects: A comparison study. Medicina (Kaunas), 2024; 60(2), 1–10. Disponível em: https://pubmed.ncbi.nlm.nih.gov/38399493/
Imber, J C, & Kasaj, A. (2021). Treatment of Gingival Recession: When and How? Int Dent J. 2021 Jun;71(3), 178-187. doi: 10.1111/idj.12617. Epub 2021 Jan 29. PMID: 34024328; PMCID: PMC9275303.
Jepsen, S , Caton, J G , Albandar, J M , et al. (2018). Manifestações periodontais de doenças sistêmicas e condições de desenvolvimento e adquiridas: relatório de consenso do grupo de trabalho 3 do Workshop Mundial de 2017 sobre a Classificação de Doenças e Condições Periodontais e Peri-Implantares . J Clin Periodontal . 2018 ; 45 : S219 - S229 .
Kalimeri, E, Roccuzzo, A, Stähli, A, Oikonomou, I, Berchtold, A, Sculean, A, & Kloukos, D. (2024). Adjunctive use of hyaluronic acid in the treatment of gingival recessions: a systematic review and meta-analysis. Clin Oral Investig. 2024 May 21;28(6), 329. doi: 10.1007/s00784-024-05701-7. PMID: 38771388; PMCID: PMC11108902.]
Kassab, M M, & Cohen, R E. (2003). The etiology and prevalence of gingival recession. J Am Dent Assoc. 2003 Feb;134(2), 220-5. doi: 10.14219/jada.archive.2003.0137. PMID: 12636127.
Kasaj, A., et al. (2016). Gingival recession coverage: Do we still need autogenous grafts? Quintessence International, 2016; 47(9), 775–783.
Kumar, S, Gopalkrishna P, Syed, A K, & Sathiyabalan, A. (2025). The Impact of Toothbrushing on Oral Health, Gingival Recession, and Tooth Wear-A Narrative Review. Healthcare (Basel). 2025 May 14;13(10), 1138. doi: 10.3390/healthcare13101138. PMID: 40427974; PMCID: PMC12111729.
Malpartida-Carrillo, V., Tinedo-Lopez, A., Amaya-Pajares, S. P., Rosing, C. K., Ozcan, M., & Guerrero, M. E. (2020). Periodontal phenotype: A review of historical and current classifications evaluating different methods and characteristics. Journal of Esthetic and Restorative Dentistry, 2020, 32(6), 1–14.
Marschner, F, Lechte, C, Kanzow, P, Hraský, V, & Pfister, W. (2025). Systematic review and meta-analysis on prevalence and risk factors for gingival recession. J Dent. 2025 Apr;155, 105645. doi: 10.1016/j.jdent.2025.105645. Epub 2025 Feb 21. PMID: 39988303.
Mascardo, K C, Tomack, J, Chen, C Y, Mancini, L, Kim, D M, Friedland, B, Barootchi, S, & Tavelli, L. (2024). Risk indicators for gingival recession in the esthetic zone: A cross-sectional clinical, tomographic, and ultrasonographic study. J Periodontol. 2024 May;95(5), 432-443. doi: 10.1002/JPER.23-0357. Epub 2024 Jan 9. PMID: 38196327.
Mazzotti, C, Mounssif, I, Rendón, A, Mele, M, Sangiorgi, M, Stefanini, M, & Zucchelli, G. (2023). Complications and treatment errors in root coverage procedures. Periodontol 2000. 2023 Jun;92(1), 62-89. doi: 10.1111/prd.12468. Epub 2023 Jan 3. PMID: 36594482.
Niemczyk, W, Niemczyk, S, Prokurat, M, Grudnik, K, Migas, M, Wągrowska, K, Lau, K, & Kasperczyk, J. (2024). Etiology of gingival recession - a literature review. Wiad Lek. 2024;77(5), 1080-1085. doi: 10.36740/WLek202405131. PMID: 39008601.
Pereira, A. S. (2018). Metodologia da pesquisa científica. [free ebook]. Santa Maria. Editora da UFSM. 2018.
Rother, E. T. (2007). Revisão sistemática x revisão narrativa. Acta Paulista de Enfermagem. 2007; 20(2), 5-6.
Sanz, M., & Simon, M. (2013). Surgical techniques on periodontal plastic surgery and soft tissue regeneration: Consensus report of Group 3 of the 10th European Workshop of Periodontology. Journal of Periodontology, 2013; 41(Suppl. 15), 92–97.
Sanz Martin, E., Rojo, E., Maldonado, E., Stroppa, G., Nart, J., & Sanz, M. (2018). Structural and histological differences between connective tissue grafts harvested from the lateral palatal mucosa and from the tuberosity area. Springer Science Reviews, 2018; 6(1), 1–9.
Sculean, A., & Allen, E. P. (2018). The laterally closed tunnel for the treatment of deep isolated mandibular recessions: Surgical technique and a report of 24 cases. Quintessence International, 2018, 38(5), 479–487.
Sonnenschein, S K, Ziegler, P, & Kim, T S. (2025). Long-term changes in gingival recessions and their impact on oral health-related quality of life in patients under supportive periodontal therapy: a bidirectional cohort study. Quintessence Int. 2025 Mar 18;56(3), 186-196. doi: 10.3290/j.qi.b5933592. PMID: 39820294.
Sullivan, H C, & Atkins, J H. (1968). Free autogenous gingival grafts. 3. Utilization of grafts in the treatment of gingival recession. Periodontics 1968; 6, 152–160,
Susin, C et al. (2004). Gingival recession: epidemiology and risk indicators in a representative urban Brazilian population. J Periodontol, 75(10, 1377–1386, 2004.
Tavelli, L, Majzoub, J, Kauffmann, F, et al. (2023). Coronally advanced flap versus tunnel technique for the treatment of peri-implant soft tissue dehiscences with the connective tissue graft, a randomized, controlled clinical trial. J Clin Periodontol. 2023; 50(7): 980-995.
Tonetti, M S, Cortellini, P, Pellegrini, G, Nieri, M, Bonaccini ,D, Allegri, M, Bouchard, P, Cairo, F, Conforti, G, Fourmousis, I, Graziani, F, Guerrero, A, Halben J, Malet, J, Rasperini, G, Topoll, H, Wachtel, H, Wallkamm, B, Zabalegui, I, & Zuhr, O. (2018). Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non-inferiority in root coverage and superiority in oral health-related quality of life. J Clin Periodontol. 2018 Jan;45(1), 78-88
Vitor, G. P. (2019). Recessão gengival: uma revisão narrativa. Revista Brasileira Multidisciplinar, 2019; 22(2), 178-185. https://doi.org/10.25061/2527-2675/ReBraM/2019.v22i2.600
Wagner, T P, Costa, R S, Rios, F S, et al. (2016). Gingival recession and oral health-related quality of life, a population-based cross-sectional study in Brazil. Community Dent Oral Epidemiol. 2016; 44, 390-399.
Wan, W., Zhong, H., & Wang, J. (2020). Creeping attachment: A literature review. Journal of Esthetic and Restorative Dentistry. 2020; 32(7), 1–7.
Yadav, V S, Gumber, B, Makker, K, Gupta, V, Tewari, N, Khanduja, P, & Yadav, R. (2022). Global prevalence of gingival recession: A systematic review and meta-analysis. Oral Dis. 2023 Nov;29(8), 2993-3002. doi: 10.1111/odi.14289. Epub 2022 Jul 6. PMID: 35735236.
Zucchelli, G., & Mounssif, I. (2000). Periodontal plastic surgery. Periodontology 2000, 68(1), 333–368.
Zucchelli, G, Tavelli, L, & McGuire, MK, et al. (2020). Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction. J Periodontol. 2020; 2015; 91, 9-16.
Zuhr, O., Akalpo, D., Eickholz, P., Vach, K., Hürzeler, M. B., Petsos, H., et al. (2021). Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: 5-year results of an RCT using 3D measurement. Journal of Periodontology, 2021; 48(6), 949–961.
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Copyright (c) 2025 Samuel Vinícius de Jesus Castro, Amanda Gonçalves Franco, Maria Luiza Albuquerque Ferreira de Paula, Mateus Carazza Ferreira, Glayson Pereira Vitor, Alexandre Godinho Pereira, Bernardo de Carvalho Dutra
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