READERS' FORUM
Letters to the editor*
Orthodontics and the repair of gingival
recessions
W e congratulate the authors for their notable work
in the area of orthodontic force application,
gingival recession, and its repair, which is one of the un-
touched 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:
1. What was the etiology of the gingival recession?
Displacement of the tooth alone does not produce
the recession of gingiva and soft tissue defect. The
displacement might produce dehiscence and/or
fenestration, which are true bony defects, but not
all the patients present with soft tissue defect such
as gingival recession. Although, with dehiscence
and fenestration, the chances of gingival recession
are consistently higher.2
2. All the subjects were in the age range of 22-41 years
(mean age, 28 years). If mere displacement was the
reason for the gingival recession, why were adoles-
cents not included in the study?
3. Was there any history of previous orthodontic treat-
ment or recent oral intervention for improvement of
gingival health because all the patients had excel-
lent oral hygiene and good occlusion?
4. According to the Material and Methods section,
“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 his-
tory of periodontitis.” Is that “none of the other
teeth” or “none of the patients?”
5. Furthermore, in the Results section, the authors
mentioned the Class III and Class IV gingival reces-
sions and their improvement to either Class II or
Class I after torquing. According to Miller,3 Class
III and IV gingival recessions do have interdental
bone loss, which is in contrast to the author's obser-
vation.3
6. As a clinical trial that was conducted on humans,
ethical clearance was not mentioned.
* The viewpoints expressed are solely those of the author(s) and do not reflect
those of the editor(s), publisher(s), or Association.
7. When the aim of the study was “to quantify the
changes of gingival recessions following ortho-
dontic displacement of exposed roots toward
the center of the alveolar bony envelope,” it
might have been better to mention the changes
in measurement scale. Furthermore, comparative
statistics could have provided better insight, if
applied.
8. To classify the Class III and Class IV categories,
there were no diagnostic aids used or
radiographs mentioned. Before the beginning of
the treatment and even after improvement,
changes in the interdental bone were
not evaluated properly. Without such evaluation,
justifying the improvement from Class IV
category to Class I would be improper and
unsatisfactory.
9. According to Miller's3 classification for gingival
recession, Class IV describes “Marginal tissue
recession extends to or beyond the mucogingival
junction, with severe bone and soft tissue loss in
the interdental area and or severe malposition of
teeth.” Thus, with only labiolingual root
movement of only 1 incisor, it is quite
confusing to understand how it is possible that
the interdental bone, which is apical to the
soft tissue level, improved to Class I, which is
just a soft tissue recession, without any
interdental bone loss. Moreover, no radiographs
have been included by the authors to support
such changes.
Venkatachalapathy Anusuya
Jitendra Sharan
Ashok Kumar Jena
Bhubaneswar, Odisha, India
Am J Orthod Dentofacial Orthop 2020;158:4
0889-5406/$36.00
Ó 2020 by the American Association of Orthodontists. All rights reserved.
https://doi.org/10.1016/j.ajodo.2020.03.011
REFERENCES
1. Laursen MG, Rylev M, Melsen B. The role of orthodontics in the
repair of gingival recessions. Am J Orthod Dentofacial Orthop
2020;157:29-34.
2. Jati AS, Furquim LZ, Consolaro A. Gingival recession: its causes and
types, and the importance of orthodontic treatment. Dental Press J
Orthod 2016;21:18-29.
3. Miller PD Jr. A classification of marginal tissue recession. Int J Peri-
odontics Restorative Dent 1985;5:8-13.