The role of orthodontics in the repair of gingival recessions

  • Morten Godtfredsen Laursen
    Correspondence
    Address correspondence to: Morten Godtfredsen Laursen, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, Aarhus C DK-8000 Denmark.
    Affiliations
    Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark

    Private practice, Aarhus, Denmark
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  • Mette Rylev
    Affiliations
    Private practice, Aarhus, Denmark
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  • Birte Melsen
    Affiliations
    Formerly, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; currently, Medizinische Hochschule, Hannover, Germany

    Private practice, Lübeck, Germany
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      Highlights

      • Orthodontic root movement into the alveolar bone consistently reduced gingival recessions.
      • The recession depth decreased with 23%, the width with 38%, and the recession area with 63%.
      • All cases improved in Miller's classification from Class III and IV to Class I or II.

      Introduction

      The goal of this research was to assess the impact of orthodontic root movement on gingival recessions.

      Methods

      Twelve consecutive adult patients with a mandibular incisor presenting buccal or lingual gingival recession and with the root positioned outside the alveolar bone were enrolled. The roots were moved toward the center of the alveolar process with a goal oriented segmented appliance. The following variables were measured at baseline and after orthodontic treatment: (1) recession depth, (2) recession width, and (3) recession area. In addition, pocket probing depth, keratinized tissue height, and changes in Miller's classification were registered.

      Results

      The depth, width, and area of the gingival recessions were reduced in all patients without increased pocket probing depth. On average, the recession depth decreased with 23%, the width with 38%, and the recession area with 63% of the baseline value. All patients improved in Miller's classification from Class III and IV to Class I or II.

      Conclusions

      Orthodontic correction of the root toward the center of the alveolar envelope consistently reduced gingival recessions. The changes in Miller's classification indicated improved prognosis for full root coverage with mucogingival surgery.
      Tooth displacement outside the alveolar bone constitutes a risk for the development of a bony dehiscence that may be accompanied by a recession of the gingiva.
      • Karring T.
      • Nyman S.
      • Thilander B.
      • Magnusson I.
      Bone regeneration in orthodontically produced alveolar bone dehiscences.
      • Pazera P.
      • Fudalej P.
      • Katsaros C.
      Severe complication of a bonded mandibular lingual retainer.
      • Steiner G.G.
      • Pearson J.K.
      • Ainamo J.
      Changes of the marginal periodontium as a result of labial tooth movement in monkeys.
      • Thilander B.
      • Nyman S.
      • Karring T.
      • Magnusson I.
      Bone regeneration in alveolar bone dehiscences related to orthodontic tooth movements.
      • Wainwright W.M.
      Faciolingual tooth movement: its influence on the root and cortical plate.
      • Wennström J.L.
      • Lindhe J.
      • Sinclair F.
      • Thilander B.
      Some periodontal tissue reactions to orthodontic tooth movement in monkeys.
      Conversely, redirection of a root into the alveolar process can be complemented by improved marginal bone level
      • Karring T.
      • Nyman S.
      • Thilander B.
      • Magnusson I.
      Bone regeneration in orthodontically produced alveolar bone dehiscences.
      • Thilander B.
      • Nyman S.
      • Karring T.
      • Magnusson I.
      Bone regeneration in alveolar bone dehiscences related to orthodontic tooth movements.
      • Wainwright W.M.
      Faciolingual tooth movement: its influence on the root and cortical plate.
      • Engelking G.
      • Zachrisson B.U.
      Effects of incisor repositioning on monkey periodontium after expansion through the cortical plate.
      • Nyman S.
      • Karring T.
      • Bergenholtz G.
      Bone regeneration in alveolar bone dehiscences produced by jiggling forces.
      and spontaneous improvement of gingival recession.
      • Farret M.M.
      • Farret M.M.
      • da Luz Vieira G.
      • Assaf J.H.
      • de Lima E.M.
      Orthodontic treatment of a mandibular incisor fenestration resulting from a broken retainer.
      • Laursen M.G.
      • Rylev M.
      • Melsen B.
      Treatment of complications after unintentional tooth displacement by active bonded retainers.
      • Machado A.W.
      • MacGinnis M.
      • Damis L.
      • Moon W.
      Spontaneous improvement of gingival recession after correction of tooth positioning.
      • Wennström J.L.
      Mucogingival considerations in orthodontic treatment.
      According to several authors, the prognosis for a complete root coverage of gingival recessions by a mucogingival surgical intervention is correlated to both the severity of the recession
      • Miller Jr., P.D.
      A classification of marginal tissue recession.
      • Holbrook T.
      • Ochsenbein C.
      Complete coverage of the denuded root surface with a one-stage gingival graft.
      • Pini Prato G.
      • Tinti C.
      • Vincenzi G.
      • Magnani C.
      • Cortellini P.
      • Clauser C.
      Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession.
      • Trombelli L.
      • Schincaglia G.P.
      • Scapoli C.
      • Calura G.
      Healing response of human buccal gingival recessions treated with expanded polytetrafluoroethylene membranes. A retrospective report.
      • Cortellini P.
      • Bissada N.F.
      Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations.
      and the position of the recessed tooth.
      • Miller Jr., P.D.
      A classification of marginal tissue recession.
      Consequently, it is advocated to position the roots within the alveolar envelope reducing root prominence and allowing creeping of the attachment thereby providing a more optimal surgical site.
      • Johal A.
      • Katsaros C.
      • Kiliaridis S.
      • Leitao P.
      • Rosa M.
      • Sculean A.
      • et al.
      State of the science on controversial topics: orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting).
      Movement of the exposed roots toward the center of the alveolus may thus lead to improvement of the gingival recession and to reduction of the bony dehiscence before periodontal plastic surgery.
      • Wennström J.L.
      Mucogingival considerations in orthodontic treatment.
      However, the association between orthodontic correction of tooth position and “spontaneous” repair of gingival recession has not previously been systematically investigated in a clinical study.
      The aim of this study was to quantify the changes of gingival recessions following orthodontic displacement of exposed roots toward the center of the alveolar bony envelope.

      Material and methods

      Twelve consecutive adult patients (9 females and 3 males), mean age of 28 years and age range 22-41 years, with 1 mandibular incisor presenting either buccal or lingual gingival recession and the root clearly positioned outside the alveolar bone were enrolled for orthodontic root correction before mucogingival surgery. Apart from the gingival recession of the displaced incisor, none of the patients exhibited periodontal inflammation, radiological signs, or clinically detectable defects, which would indicate a past history of periodontitis. Informed consent to participate in the study was obtained. The orthodontic root corrections were performed with a segmented appliance consisting of a torque arch made of 0.019 × 0.025-inch titanium-molybdenum alloy delivering a desired torque equal to the force applied to hook the arch onto the base arch anteriorly to the molar multiplied by the sagittal distance between the displaced tooth and the point of force application. The undesired vertical force was neutralized by a steel base arch resting on the displaced tooth (Fig 1, Fig 2, Fig 3). The base arch also prevented undesired proclination during lingual root torque and undesired retroclination during buccal root torque. As a consequence, only the torque needed for the root movement was expressed, and the center of rotation was at the bracket without side effects on the adjacent teeth. In some patients, finishing corrections were performed with a continuous wire (Fig 3, C). All patients were treated by the same orthodontist. After orthodontic treatment, the patients were referred to the periodontist for mucogingival surgery (Fig 3, D).
      Figure thumbnail gr1
      Fig 1A and B, Root of the mandibular left central incisor (tooth 31) positioned outside the alveolar housing exhibiting gingival recession. C, Beginning of treatment. The force system, generating lingual root torque of the incisor, without side-effect on adjacent teeth, was obtained by a 0.019 × 0.025-inch titanium-molybdenum alloy torque arch inserted into the bracket of the malpositioned tooth and hooked onto a 0.020-inch SS base arch that controlled the vertical position of the incisor and the arch perimeter. D, During lingual root torque of tooth 31. The root of 31 is moving into the alveolar bone. E, One week after orthodontic treatment. The root position is corrected, and the recession is reduced in depth and width. SS, stainless steel.
      Figure thumbnail gr2
      Fig 2The appliance with the torque arch deactivated. The terminal ends of the torque arch are hooked onto the base arch for lingual root torque of the incisor. The base arch is activated for intrusion of the incisor to counteract extrusion. The tendency to displace the incisor labially during lingual root torque is controlled by cinching back the base arch distal to the molars.
      Figure thumbnail gr3
      Fig 3A, Root of the mandibular right central incisor (tooth 41) positioned outside the alveolar housing and with gingival recession. B, The appliance delivers lingual root torque to tooth 41 with a torque arch inserted into the bracket of the displaced tooth and hooked onto a base arch that controlled the vertical position of the incisor and the arch length. C, Before referral back to the periodontist after finishing in a continuous arch wire. D, Five months after mucogingival surgery with a coronally advanced flap combined with enamel matrix proteins.
      At baseline and after orthodontic treatment, the following variables were measured clinically with a calibrated periodontal probe (University of North Carolina-15 probe) and on standardized intraoral photographs: (1) recession depth from the free gingival margin to the cemento-enamel junction, (2) recession width at the cemento–enamel junction, (3) recession area (on photographs), and (4) keratinized tissue height at the midbuccal or midlingual aspect of the exposed root. Furthermore, pocket probing depth was measured using the same calibrated periodontal probe also at the midbuccal or midlingual aspect, and the recessions were classified according to Miller's classification.
      • Miller Jr., P.D.
      A classification of marginal tissue recession.
      The measurements were performed by the referring periodontist and the orthodontist treating the patients. The reported measurements of recession width and depth were made to the nearest 0.25 mm on magnified (factor 10) intraoral photographs of good quality and calibrated to the true value using the clinically assessed widths of maxillary and mandibular incisors as reference. The area of the recession was calculated on the clinical photographs with an open source image processing software (ImageJ, version 2.0.0; National Institutes of Health, Bethesda, MD). Measurements on the photos were repeated after a minimum of 15 days on 12 patients for calculation of the error of the method.

       Statistical analysis

      The mean and range of the intraindividual changes in recession depth, width, and area were calculated. Intraexaminer reproducibility was assessed by interclass correlation coefficient. Bland-Altman plots were inspected for the systematic error and the Dahlberg's formula was used for the calculation of the random error. The analysis was performed using Stata software version 14.1 (StataCorp, College Station, Tex).

      Results

      Excellent reliability was shown when comparing 2 complete sets of measurements with an interclass correlation coefficient ranging from 0.993 to 0.999. Bland-Altman plots revealed no systematic errors for any of the performed measurements of recession depth, width, and area. The random error calculated by the Dahlberg's formula was 0.07 mm for the recession depth and 0.08 mm for recession width and 0.15 mm2 for the area.
      The width, depth, and area of the gingival recessions were reduced in all patients. The changes in the individual patients are illustrated graphically (Fig 4, A-C). As a consequence, all patients showed improvement in Miller's classification from Class III and IV to Class I or II. Four patients improved from Miller's Class IV to II, 1 patient from Class IV to I, 6 patients from Class III to II, and 1 patient from Class III to I. On average, the recession depth decreased with 23% (range 4.35%-43.75%), the recession width with 38% (range 27%-67%) and the recession area with 63% (range 36%-93%) of the baseline value. In 2 patients (Fig 4, A, series 9 and 11) the depth was reduced with <10%, but the overall reduction in width lead to more than 50% reduction in recession area in these 2 patients. The height of the keratinized tissue was at baseline ≤1 mm in all patients. After orthodontic treatment, 7 patients did not show a measurable increase in the height of keratinized tissue and 5 patients demonstrated an increase of ≤0.75 mm, although not corresponding to the amount of reduction in recession depth in any case. Pocket probing depth was unchanged with measurements ≤1 mm in all patients both before and after orthodontic treatment.
      Figure thumbnail gr4
      Fig 4A, Reduction in recession depth illustrated for each of the 12 patients. The points on the left indicate the values before treatment and the points on the right indicate the posttreatment value. All patients presented with a reduction in recession depth. Patients 2 and 5 have the same values and are represented by series 5. B, Reduction in recession width. All patients obtained a reduction in recession width. Patients 7, 9, and 12 have the same values and are represented by series 12. Patients 5 and 8 have the same values and are represented by series 8. Patients 2 and 11 have the same values and are represented by series 11. C, Reduction in recession area varied considerably, but all patients exhibited an improvement.

      Discussion

      Gingival recessions of mandibular incisors may be related to displacement of the root outside the boundary of the alveolar envelope. This report evaluates the effect of orthodontic repositioning on the extension of the gingival recession.
      The appliance used generated a large torque moment with small forces omitting side effects on the adjacent teeth because these were not included in the appliance during the correction. The vertical forces acting on the molars were of a magnitude that was neutralized by occlusal forces.
      After orthodontic treatment, all patients had improvement of the recession depth, width, and area leading to an improved Miller's classification. However, the depth was reduced <10% in 2 patients. This may be explained by a thick lip frenulum attaching close to the recession in these patients. Reduction in the width nevertheless resulted in a reduced recession area also in these patients. The recession width was measured at the cemento-enamel junction, but the width decreased in the entire extension of the recessions and often more in the apical part of the recession, which is also seen in Figures 1, A-E and 3, A-C.
      The reduction of recessions following root movement toward the center of the alveolar process confirmed the findings of previous animal studies
      • Engelking G.
      • Zachrisson B.U.
      Effects of incisor repositioning on monkey periodontium after expansion through the cortical plate.
      and human case reports.
      • Pazera P.
      • Fudalej P.
      • Katsaros C.
      Severe complication of a bonded mandibular lingual retainer.
      • Farret M.M.
      • Farret M.M.
      • da Luz Vieira G.
      • Assaf J.H.
      • de Lima E.M.
      Orthodontic treatment of a mandibular incisor fenestration resulting from a broken retainer.
      • Laursen M.G.
      • Rylev M.
      • Melsen B.
      Treatment of complications after unintentional tooth displacement by active bonded retainers.
      • Machado A.W.
      • MacGinnis M.
      • Damis L.
      • Moon W.
      Spontaneous improvement of gingival recession after correction of tooth positioning.
      For ethical reasons, regeneration of the marginal bone level could not be assessed in this study, but an improvement was observed by the periodontist in 1 patient, where a periodontal flap was raised both before and after the orthodontic root correction. This finding is supported by the findings of animal studies
      • Karring T.
      • Nyman S.
      • Thilander B.
      • Magnusson I.
      Bone regeneration in orthodontically produced alveolar bone dehiscences.
      • Thilander B.
      • Nyman S.
      • Karring T.
      • Magnusson I.
      Bone regeneration in alveolar bone dehiscences related to orthodontic tooth movements.
      • Wainwright W.M.
      Faciolingual tooth movement: its influence on the root and cortical plate.
      • Engelking G.
      • Zachrisson B.U.
      Effects of incisor repositioning on monkey periodontium after expansion through the cortical plate.
      • Nyman S.
      • Karring T.
      • Bergenholtz G.
      Bone regeneration in alveolar bone dehiscences produced by jiggling forces.
      and a human case report by Pazera et al,
      • Pazera P.
      • Fudalej P.
      • Katsaros C.
      Severe complication of a bonded mandibular lingual retainer.
      where the correction of a root displaced out of the alveolar housing resulted in the regeneration of bone. A cone beam computed tomography (CBCT) evaluation of changes in the marginal bone level was not performed because the thickness of the alveolar bone plate could be expected to be below the imaging spatial resolution of the CBCT scanning. Therefore, a CBCT evaluation would expectably lead to false findings
      • Leung C.C.
      • Palomo L.
      • Griffith R.
      • Hans M.G.
      Accuracy and reliability of cone-beam computed tomography for measuring alveolar bone height and detecting bony dehiscences and fenestrations.
      • Patcas R.
      • Müller L.
      • Ullrich O.
      • Peltomäki T.
      Accuracy of cone-beam computed tomography at different resolutions assessed on the bony covering of the mandibular anterior teeth.
      and thus not indicated or ethical. A control group was not included because of the risk of progression of recessions when left untreated.
      • Chambrone L.
      • Tatakis D.N.
      Long-term outcomes of untreated buccal gingival recessions: A systematic review and meta-analysis.
      The prognosis for a complete root coverage by periodontal plastic surgery has been reported to be correlated to the severity of the recession.
      • Miller Jr., P.D.
      A classification of marginal tissue recession.
      • Holbrook T.
      • Ochsenbein C.
      Complete coverage of the denuded root surface with a one-stage gingival graft.
      • Pini Prato G.
      • Tinti C.
      • Vincenzi G.
      • Magnani C.
      • Cortellini P.
      • Clauser C.
      Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession.
      • Trombelli L.
      • Schincaglia G.P.
      • Scapoli C.
      • Calura G.
      Healing response of human buccal gingival recessions treated with expanded polytetrafluoroethylene membranes. A retrospective report.
      • Cortellini P.
      • Bissada N.F.
      Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations.
      According to the classification by Miller,
      • Miller Jr., P.D.
      A classification of marginal tissue recession.
      the Class III defects have the gingival margin located at or beyond the mucogingival junction with interproximal bone loss and/or tooth malpositioning. The Miller Class IV defects are defined by serious interproximal bone loss and/or severe tooth malpositioning.
      • Miller Jr., P.D.
      A classification of marginal tissue recession.
      • Cairo F.
      Periodontal plastic surgery of gingival recessions at single and multiple teeth.
       Defects classified as Class III or IV cannot, according to Miller,
      • Miller Jr., P.D.
      A classification of marginal tissue recession.
      be treated to complete root coverage by mucogingival surgery. However, Class I and II recessions can be fully covered with mucogingival surgery. In this study, the recessions classified as Miller Class III and IV because of tooth malposition beyond the bony alveolar housing. The orthodontic treatment directed the roots to the center of the alveolar process and converted the Miller classification of the recessions to Class I or II, and thus a more favorable starting point for periodontal plastic surgery.
      All cases in the present study exhibited a “spontaneous” improvement of the connective tissue coverage, and some patients might not even need surgical intervention following orthodontic correction with “spontaneous” repair of the recession. However, the reduction in recession depth did not result in increased height of the keratinized tissue in most patients, which can be related to a modest reduction in recessions depth. The pocket probing depth was ≤1 mm both before and after orthodontic treatment, which possibly can suggest that the periodontal ligament migrates coronally leading to an improvement of the clinical attachment level.
      The results demonstrate the potential synergy of an interdisciplinary orthodontic and periodontal treatment of patients with gingival recessions related to roots positioned outside the alveolar bony housing. Moving the roots first to an ideal position within the alveolar process can reduce the recession and improve the prognosis for following mucogingival surgical intervention. The measurements of recession dimensions were performed on magnified intraoral photos. A possible limitation of this method could be the orientation of the photos. However, the photos were standardized, and the applied method has been evaluated in a previous study
      • Allais D.
      • Melsen B.
      Does labial movement of lower incisors influence the level of the gingival margin? A case-control study of adult orthodontic patients.
      demonstrating that measurements of gingival recessions are reliable on clinical photographs. Clinical measurements of recession dimensions are not reported because there was no assessment of repeatability and reproducibility for those, but the clinical measurements in the sample generally reflected the measurements performed on photographs. If clinical measurements of recessions should be considered the “gold standard,” indeed, the validity and reproducibility of using photographs and ImageJ to evaluate the percentage of root coverage have been assessed by Kerner et al,
      • Kerner S.
      • Etienne D.
      • Malet J.
      • Mora F.
      • Monnet-Corti V.
      • Bouchard P.
      Root coverage assessment: validity and reproducibility of an image analysis system.
      who found the method highly correlated with clinical measurements. The sample size was limited owing to the inclusion criteria, and only mandibular incisors were investigated in the current study. Presumably, the results can be applied to other tooth types as reported by other authors.
      • Pazera P.
      • Fudalej P.
      • Katsaros C.
      Severe complication of a bonded mandibular lingual retainer.
      • Engelking G.
      • Zachrisson B.U.
      Effects of incisor repositioning on monkey periodontium after expansion through the cortical plate.
      Applicability of the findings can be discussed since baseline recession dimension and incisors displacement varied, and individuals tend to have different responses to the same treatment. Nevertheless, the reaction shared by all patients was a reduction of the recession width, depth, and area following orthodontic movement of the root toward the center of the alveolar process. The amount of orthodontic displacement into the alveolar process can sometimes be limited by the buccolingual thickness of the alveolar process, and care should then be taken not to displace the root out of the bone on the opposite side of the recession.

      Conclusions

      The findings of this study indicate that orthodontic correction of roots positioned outside the alveolar process has important clinical impact. The obtained root position within the alveolar process was followed by reduced gingival recessions in all patients and provided a more favorable surgical site for a periodontal plastic surgery to fully cover the recession.

      References

        • Karring T.
        • Nyman S.
        • Thilander B.
        • Magnusson I.
        Bone regeneration in orthodontically produced alveolar bone dehiscences.
        J Periodont Res. 1982; 17: 309-315
        • Pazera P.
        • Fudalej P.
        • Katsaros C.
        Severe complication of a bonded mandibular lingual retainer.
        Am J Orthod Dentofacial Orthop. 2012; 142: 406-409
        • Steiner G.G.
        • Pearson J.K.
        • Ainamo J.
        Changes of the marginal periodontium as a result of labial tooth movement in monkeys.
        J Periodontol. 1981; 52: 314-320
        • Thilander B.
        • Nyman S.
        • Karring T.
        • Magnusson I.
        Bone regeneration in alveolar bone dehiscences related to orthodontic tooth movements.
        Eur J Orthod. 1983; 5: 105-114
        • Wainwright W.M.
        Faciolingual tooth movement: its influence on the root and cortical plate.
        Am J Orthod. 1973; 64: 278-302
        • Wennström J.L.
        • Lindhe J.
        • Sinclair F.
        • Thilander B.
        Some periodontal tissue reactions to orthodontic tooth movement in monkeys.
        J Clin Periodontol. 1987; 14: 121-129
        • Engelking G.
        • Zachrisson B.U.
        Effects of incisor repositioning on monkey periodontium after expansion through the cortical plate.
        Am J Orthod. 1982; 82: 23-32
        • Nyman S.
        • Karring T.
        • Bergenholtz G.
        Bone regeneration in alveolar bone dehiscences produced by jiggling forces.
        J Periodont Res. 1982; 17: 316-322
        • Farret M.M.
        • Farret M.M.
        • da Luz Vieira G.
        • Assaf J.H.
        • de Lima E.M.
        Orthodontic treatment of a mandibular incisor fenestration resulting from a broken retainer.
        Am J Orthod Dentofacial Orthop. 2015; 148: 332-337
        • Laursen M.G.
        • Rylev M.
        • Melsen B.
        Treatment of complications after unintentional tooth displacement by active bonded retainers.
        J Clin Orthod. 2016; 50: 290-297
        • Machado A.W.
        • MacGinnis M.
        • Damis L.
        • Moon W.
        Spontaneous improvement of gingival recession after correction of tooth positioning.
        Am J Orthod Dentofacial Orthop. 2014; 145: 828-835
        • Wennström J.L.
        Mucogingival considerations in orthodontic treatment.
        Semin Orthod. 1996; 2: 46-54
        • Miller Jr., P.D.
        A classification of marginal tissue recession.
        Int J Periodontics Restorative Dent. 1985; 5: 8-13
        • Holbrook T.
        • Ochsenbein C.
        Complete coverage of the denuded root surface with a one-stage gingival graft.
        Int J Periodontics Restorative Dent. 1983; 3: 8-27
        • Pini Prato G.
        • Tinti C.
        • Vincenzi G.
        • Magnani C.
        • Cortellini P.
        • Clauser C.
        Guided tissue regeneration versus mucogingival surgery in the treatment of human buccal gingival recession.
        J Periodontol. 1992; 63: 919-928
        • Trombelli L.
        • Schincaglia G.P.
        • Scapoli C.
        • Calura G.
        Healing response of human buccal gingival recessions treated with expanded polytetrafluoroethylene membranes. A retrospective report.
        J Periodontol. 1995; 66: 14-22
        • Cortellini P.
        • Bissada N.F.
        Mucogingival conditions in the natural dentition: narrative review, case definitions, and diagnostic considerations.
        J Clin Periodontol. 2018; 45: S190-S198
        • Johal A.
        • Katsaros C.
        • Kiliaridis S.
        • Leitao P.
        • Rosa M.
        • Sculean A.
        • et al.
        State of the science on controversial topics: orthodontic therapy and gingival recession (a report of the Angle Society of Europe 2013 meeting).
        Prog Orthod. 2013; 14: 16
        • Leung C.C.
        • Palomo L.
        • Griffith R.
        • Hans M.G.
        Accuracy and reliability of cone-beam computed tomography for measuring alveolar bone height and detecting bony dehiscences and fenestrations.
        Am J Orthod Dentofacial Orthop. 2010; 137: S109-S119
        • Patcas R.
        • Müller L.
        • Ullrich O.
        • Peltomäki T.
        Accuracy of cone-beam computed tomography at different resolutions assessed on the bony covering of the mandibular anterior teeth.
        Am J Orthod Dentofacial Orthop. 2012; 141: 41-50
        • Chambrone L.
        • Tatakis D.N.
        Long-term outcomes of untreated buccal gingival recessions: A systematic review and meta-analysis.
        J Periodontol. 2016; 87: 796-808
        • Cairo F.
        Periodontal plastic surgery of gingival recessions at single and multiple teeth.
        Periodontol 2000. 2017; 75: 296-316
        • Allais D.
        • Melsen B.
        Does labial movement of lower incisors influence the level of the gingival margin? A case-control study of adult orthodontic patients.
        Eur J Orthod. 2003; 25: 343-352
        • Kerner S.
        • Etienne D.
        • Malet J.
        • Mora F.
        • Monnet-Corti V.
        • Bouchard P.
        Root coverage assessment: validity and reproducibility of an image analysis system.
        J Clin Periodontol. 2007; 34: 969-976

      Linked Article

      • Orthodontics and the repair of gingival recessions
        American Journal of Orthodontics and Dentofacial OrthopedicsVol. 158Issue 1
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          We congratulate the authors for their notable work in the area of orthodontic force application, gingival recession, and its repair, which is one of the untouched aspects of the interdisciplinary approach.1 The research question of the study was clear in producing a better clinical impact. The following are concerns that, if clarified, might improve the clinical approach and outcome:
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