Gum Recession After Tooth Extraction: Causes, Prevention & Treatment

Adjacent gum recession post-extraction is a known sequela, especially with difficult extractions or thin biotype.

Mechanisms

• Bone loss: Bundle bone (lamina dura) resorbs after tooth removal → gingival margin follows bone (1–1.5 mm typical).
• Surgical trauma: Flap reflection, rotary instrumentation, excessive force thin the buccal plate.
• Loss of contact point: Adjacent tooth loses interproximal support → papilla flattens, recession.
• Inflammation: Post-op plaque accumulation → gingivitis → recession.

Prevention (Atraumatic Extraction + Socket Preservation)

• Periotomes / Physics Forceps: Minimize buccal plate fracture.
• Socket graft (xenograft/allograft + membrane): Preserves ridge dimension 2–3 mm more than natural healing.
• Immediate implant (if indicated): Maintains bone via functional loading.
• Primary closure vs. open healing: Graft + membrane + suture stabilizes margin.

Treatment for Established Recession

Approach	Indication	Success
Connective Tissue Graft (CTG)	Recession >2 mm, esthetic zone	90%+ root coverage
Tunnel Technique / VISTA	Multiple adjacent recessions	High, less morbidity
Pinhole Surgical Technique (PST)	Mild-moderate, multiple teeth	Good, no palate harvest
Orthodontic Extrusion	Pre-restorative, move margin coronally	Slow, requires retention

When to Refer

Periodontist for grafting; prosthodontist if restorative planning needed. Early intervention preserves options.