Dişeti Çekilmeleri: Etiyolojisi ve Tedavi Yaklaşımları
Özet
Bu bölüm, dişeti çekilmelerini güncel periodontal yaklaşım doğrultusunda kapsamlı biçimde ele almaktadır. Dişeti çekilmesinin estetik etkilerinin yanı sıra dentin hipersensitivitesi, kök çürüğü riski ve servikal doku kayıpları ile ilişkisi değerlendirilmektedir. Bölümde epidemiyoloji, etiyolojik faktörler, Cairo sınıflaması, periodontal fenotip ve klinik değerlendirme ölçütleri özetlenmekte; tedavi planlamasında risk faktörlerinin kontrolü, non-cerrahi yaklaşımlar ve kök örtüsü cerrahilerinin yeri açıklanmaktadır. Ayrıca güncel cerrahi teknikler, biyolojik ajanlar, özel klinik durumlar ve uzun dönem tedavi başarısı hasta odaklı bir bakış açısıyla sunulmaktadır.
This chapter presents a contemporary overview of gingival recession in terms of its etiology, classification, clinical assessment, and treatment. Beyond esthetic concerns, gingival recession is discussed in relation to dentin hypersensitivity, root caries risk, and cervical tissue loss. The chapter summarizes epidemiologic aspects, risk factors, Cairo classification, periodontal phenotype, and clinical evaluation parameters, while also outlining the role of risk control, non-surgical management, and root coverage procedures in treatment planning. Current surgical techniques, biologic adjuncts, special clinical conditions, and long-term treatment outcomes are addressed within a patient-centered perspective.
Referanslar
Tugnait A, Clerehugh V. Gingival recession—its significance and management. Journal of Dentistry. 2001;29(6): 381–394. doi:10.1016/S0300-5712(01)00034-5
Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontology 2000. 2015;68: 333–368. doi:10.1111/prd.12059
Imber JC, Kasaj A. Treatment of gingival recession: When and how?. International Dental Journal. 2021;71: 178–187. doi:10.1111/idj.12617
Cairo F, Couso-Queiruga E, Barbato L, et al. Clinician- and patient-reported outcomes following surgical treatment of single gingival recession defects: a systematic review. Periodontology 2000. 2025;00: 1–14. doi:10.1111/prd.12641
Tonetti MS, Cairo F, Herrera D, et al. Aesthetics and patient-reported outcomes in periodontology and implant dentistry: Consensus report. Journal of Clinical Periodontology. 2025;52(9): 1222–1244. doi:10.1111/jcpe.14182
Yadav VS, Gumber B, Makker K, et al. Global prevalence of gingival recession: a systematic review and meta-analysis. Oral Diseases. 2023;29: 2993–3002. doi:10.1111/odi.14289
Marschner F, Lechte C, Kanzow P, et al. Systematic review and meta-analysis on prevalence and risk factors for gingival recession. Journal of Dentistry. 2025;155: 105645. doi:10.1016/j.jdent.2025.105645
Kanarakis I, Goriuc A, Mârțu MA, et al. Gingival recessions between classification, diagnosis and prognosis. Romanian Journal of Medical and Dental Education. 2021;10(3): 72–81.
Fageeh HI, Fageeh HN, Bhati AK, et al. Assessing the reliability of Miller’s classification and Cairo’s classification in classifying gingival recession defects: A comparison study. Medicina. 2024;60: 205. doi:10.3390/medicina60020205
Pini Prato GP, Di Gianfilippo R, Pannuti CM, et al. Diagnostic reproducibility of the 2018 classification of gingival recession defects and gingival phenotype: A multicenter inter- and intra-examiner agreement study. Journal of Periodontology. 2023;94: 661–672. doi:10.1002/JPER.22-0501
Kuralt M, Gasperšič R, Fidler A. Methods and parameters for digital evaluation of gingival recession: A critical review. Journal of Dentistry. 2022;118: 103793. doi:10.1016/j.jdent.2021.103793
Zucchelli G, Tavelli L, McGuire MK, et al. Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction. Journal of Periodontology. 2020;91: 9–16. doi:10.1002/JPER.19-0350
Chan HL, Chun YH, MacEachern M, et al. Does gingival recession require surgical treatment?. Dental Clinics of North America. 2015;59(4): 981–996. doi:10.1016/j.cden.2015.06.010
De Angelis N, Mele M, Serafini S, et al. Suturing techniques and materials for the treatment of single gingival recession defects with coronally advanced flap: A systematic review. Clinical Advances in Periodontics. 2024;14: 214–226. doi:10.1002/cap.10224
Carbone AC, Joly JC, Botelho J, et al. Long-term stability of gingival margin and periodontal soft tissue phenotype achieved after mucogingival therapy: A systematic review. Journal of Clinical Periodontology. 2024;51(2): 177–195. doi:10.1111/jcpe.13900
Chambrone L, Barootchi S, Avila-Ortiz G, et al. Efficacy of biologics in root coverage and gingival augmentation therapy: An American Academy of Periodontology best evidence systematic review and network meta-analysis. Journal of Periodontology. 2022;93: 1771–1802. doi:10.1002/JPER.22-0075
Mehta V, Kaçani G, Al Moaleem MM, et al. Hyaluronic acid: A new approach for the treatment of gingival recession—A systematic review. International Journal of Environmental Research and Public Health. 2022;19(21): 14330. doi:10.3390/ijerph192114330
Miron RJ, Zucchelli G, Pikos MA, et al. Use of platelet-rich fibrin in regenerative dentistry: A systematic review. Clinical Oral Investigations. 2017;21: 1913–1927. doi:10.1007/s00784-016-2001-x
Gapski R, Parks CA, Wang HL. Acellular dermal matrix for mucogingival surgery: A meta-analysis. Journal of Periodontology. 2005;76(11): 1814–1822. doi:10.1902/jop.2005.76.11.1814
Rovai ES, Ambrosio LMB, Morillo CMR, et al. Root coverage procedures in noncarious cervical lesions with and without restoration: A systematic review and meta-analysis. The International Journal of Periodontics & Restorative Dentistry. 2020;40(3): e127–e135. doi:10.11607/prd.4284
Gil S, de la Rosa M, Mancini E, et al. Coronally advanced flap achieved higher esthetic outcomes without a connective tissue graft for the treatment of single gingival recessions: A 4-year randomized clinical trial. Clinical Oral Investigations. 2021;25: 2727–2735. doi:10.1007/s00784-020-03587-9
Liu Y, Li CX, Nie J, et al. Interactions between orthodontic treatment and gingival tissue. Chinese Journal of Dental Research. 2023;26(1): 11–18. doi:10.3290/j.cjdr.b3978667
Chelărescu S, Vaida C, Ormenisan A, et al. Gingival recession treatment: Surgery and chemical compounds. Revista de Chimie. 2020;71(6): 508–518. doi:10.37358/RC.20.6.8217
Menon GR, Malaiappan S, Pandurangan KK. The prevalence of gingival recession among different types of malocclusion. International Journal of Dentistry and Oral Science. 2021;8(6): 2868–2872. doi:10.19070/2377-8075-21000582
Chetana, Sidharthan S, Dharmarajan G, et al. Comparison of the effectiveness of gingival unit transfer and free gingival graft in the management of localized gingival recession: A systematic review. Journal of Oral Biology and Craniofacial Research. 2023;13: 130–137. doi:10.1016/j.jobcr.2022.11.007
Pourabbas R, Chitsazi MT, Kosarieh E, et al. Coronally advanced flap in combination with acellular dermal matrix with or without enamel matrix derivatives for root coverage. Indian Journal of Dental Research. 2009;20(3): 320–325. doi:10.4103/0970-9290.57374
Yan J, Zhang J, Zhang Q, et al. Effectiveness of laser adjunctive therapy for surgical treatment of gingival recession with flap graft techniques: A systematic review and meta-analysis. Lasers in Medical Science. 2018;33(4): 899–908. doi:10.1007/s10103-018-2440-x
Latkowska-Wiśniewska M, Jakubowska S, Górski B. Antibiotics in mucogingival surgery for recession treatment: A narrative review. Antibiotics. 2025;14: 769. doi:10.3390/antibiotics14080769
Sunil S, Avinash BS, Prasad D, Jagadish L. A modified double pedicle graft technique and other mucogingival interceptive surgeries for the management of impacted teeth: A case series. Indian Journal of Dental Research. 2006;17(1): 35–40.
Referanslar
Tugnait A, Clerehugh V. Gingival recession—its significance and management. Journal of Dentistry. 2001;29(6): 381–394. doi:10.1016/S0300-5712(01)00034-5
Zucchelli G, Mounssif I. Periodontal plastic surgery. Periodontology 2000. 2015;68: 333–368. doi:10.1111/prd.12059
Imber JC, Kasaj A. Treatment of gingival recession: When and how?. International Dental Journal. 2021;71: 178–187. doi:10.1111/idj.12617
Cairo F, Couso-Queiruga E, Barbato L, et al. Clinician- and patient-reported outcomes following surgical treatment of single gingival recession defects: a systematic review. Periodontology 2000. 2025;00: 1–14. doi:10.1111/prd.12641
Tonetti MS, Cairo F, Herrera D, et al. Aesthetics and patient-reported outcomes in periodontology and implant dentistry: Consensus report. Journal of Clinical Periodontology. 2025;52(9): 1222–1244. doi:10.1111/jcpe.14182
Yadav VS, Gumber B, Makker K, et al. Global prevalence of gingival recession: a systematic review and meta-analysis. Oral Diseases. 2023;29: 2993–3002. doi:10.1111/odi.14289
Marschner F, Lechte C, Kanzow P, et al. Systematic review and meta-analysis on prevalence and risk factors for gingival recession. Journal of Dentistry. 2025;155: 105645. doi:10.1016/j.jdent.2025.105645
Kanarakis I, Goriuc A, Mârțu MA, et al. Gingival recessions between classification, diagnosis and prognosis. Romanian Journal of Medical and Dental Education. 2021;10(3): 72–81.
Fageeh HI, Fageeh HN, Bhati AK, et al. Assessing the reliability of Miller’s classification and Cairo’s classification in classifying gingival recession defects: A comparison study. Medicina. 2024;60: 205. doi:10.3390/medicina60020205
Pini Prato GP, Di Gianfilippo R, Pannuti CM, et al. Diagnostic reproducibility of the 2018 classification of gingival recession defects and gingival phenotype: A multicenter inter- and intra-examiner agreement study. Journal of Periodontology. 2023;94: 661–672. doi:10.1002/JPER.22-0501
Kuralt M, Gasperšič R, Fidler A. Methods and parameters for digital evaluation of gingival recession: A critical review. Journal of Dentistry. 2022;118: 103793. doi:10.1016/j.jdent.2021.103793
Zucchelli G, Tavelli L, McGuire MK, et al. Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction. Journal of Periodontology. 2020;91: 9–16. doi:10.1002/JPER.19-0350
Chan HL, Chun YH, MacEachern M, et al. Does gingival recession require surgical treatment?. Dental Clinics of North America. 2015;59(4): 981–996. doi:10.1016/j.cden.2015.06.010
De Angelis N, Mele M, Serafini S, et al. Suturing techniques and materials for the treatment of single gingival recession defects with coronally advanced flap: A systematic review. Clinical Advances in Periodontics. 2024;14: 214–226. doi:10.1002/cap.10224
Carbone AC, Joly JC, Botelho J, et al. Long-term stability of gingival margin and periodontal soft tissue phenotype achieved after mucogingival therapy: A systematic review. Journal of Clinical Periodontology. 2024;51(2): 177–195. doi:10.1111/jcpe.13900
Chambrone L, Barootchi S, Avila-Ortiz G, et al. Efficacy of biologics in root coverage and gingival augmentation therapy: An American Academy of Periodontology best evidence systematic review and network meta-analysis. Journal of Periodontology. 2022;93: 1771–1802. doi:10.1002/JPER.22-0075
Mehta V, Kaçani G, Al Moaleem MM, et al. Hyaluronic acid: A new approach for the treatment of gingival recession—A systematic review. International Journal of Environmental Research and Public Health. 2022;19(21): 14330. doi:10.3390/ijerph192114330
Miron RJ, Zucchelli G, Pikos MA, et al. Use of platelet-rich fibrin in regenerative dentistry: A systematic review. Clinical Oral Investigations. 2017;21: 1913–1927. doi:10.1007/s00784-016-2001-x
Gapski R, Parks CA, Wang HL. Acellular dermal matrix for mucogingival surgery: A meta-analysis. Journal of Periodontology. 2005;76(11): 1814–1822. doi:10.1902/jop.2005.76.11.1814
Rovai ES, Ambrosio LMB, Morillo CMR, et al. Root coverage procedures in noncarious cervical lesions with and without restoration: A systematic review and meta-analysis. The International Journal of Periodontics & Restorative Dentistry. 2020;40(3): e127–e135. doi:10.11607/prd.4284
Gil S, de la Rosa M, Mancini E, et al. Coronally advanced flap achieved higher esthetic outcomes without a connective tissue graft for the treatment of single gingival recessions: A 4-year randomized clinical trial. Clinical Oral Investigations. 2021;25: 2727–2735. doi:10.1007/s00784-020-03587-9
Liu Y, Li CX, Nie J, et al. Interactions between orthodontic treatment and gingival tissue. Chinese Journal of Dental Research. 2023;26(1): 11–18. doi:10.3290/j.cjdr.b3978667
Chelărescu S, Vaida C, Ormenisan A, et al. Gingival recession treatment: Surgery and chemical compounds. Revista de Chimie. 2020;71(6): 508–518. doi:10.37358/RC.20.6.8217
Menon GR, Malaiappan S, Pandurangan KK. The prevalence of gingival recession among different types of malocclusion. International Journal of Dentistry and Oral Science. 2021;8(6): 2868–2872. doi:10.19070/2377-8075-21000582
Chetana, Sidharthan S, Dharmarajan G, et al. Comparison of the effectiveness of gingival unit transfer and free gingival graft in the management of localized gingival recession: A systematic review. Journal of Oral Biology and Craniofacial Research. 2023;13: 130–137. doi:10.1016/j.jobcr.2022.11.007
Pourabbas R, Chitsazi MT, Kosarieh E, et al. Coronally advanced flap in combination with acellular dermal matrix with or without enamel matrix derivatives for root coverage. Indian Journal of Dental Research. 2009;20(3): 320–325. doi:10.4103/0970-9290.57374
Yan J, Zhang J, Zhang Q, et al. Effectiveness of laser adjunctive therapy for surgical treatment of gingival recession with flap graft techniques: A systematic review and meta-analysis. Lasers in Medical Science. 2018;33(4): 899–908. doi:10.1007/s10103-018-2440-x
Latkowska-Wiśniewska M, Jakubowska S, Górski B. Antibiotics in mucogingival surgery for recession treatment: A narrative review. Antibiotics. 2025;14: 769. doi:10.3390/antibiotics14080769
Sunil S, Avinash BS, Prasad D, Jagadish L. A modified double pedicle graft technique and other mucogingival interceptive surgeries for the management of impacted teeth: A case series. Indian Journal of Dental Research. 2006;17(1): 35–40.
