FOR DENTIST EDUCATION: Case of the Month – Not All Gum Recession Needs Covering: A Phenotype-Driven Approach to LR6
By Dr Bruno Delaunay
When it comes to managing gum recession, especially in posterior teeth like the lower first molar (LR6), not every case calls for surgical root coverage. In this Periodontal Case of the Month, our Richmond-based specialist periodontist explores a phenotype-driven approach — showing how thoughtful diagnosis, soft tissue evaluation, and minimally invasive care can lead to successful outcomes without unnecessary intervention. If you’re a dentist navigating the decision between monitoring vs. treating gingival recession, this clinical case offers practical insight rooted in evidence-based periodontology.
Referral background
This case was referred by local dentist after noticing progressive gingival recession around LR6 during routine review.
Patient profile
Age: 42
Medical history: Fit and well
Smoking: Non-smoker
Aesthetic concern: None
Patient aim: “Do what’s necessary to maintain the tooth and avoid future problems.”
Clinical findings (baseline)
- LR6 presented with a thin periodontal phenotype
- < 1 mm of keratinised tissue
- Buccally positioned tooth (unfavourable position)
Together, these factors significantly increase the risk of further recession, inflammation and long-term instability—particularly under functional load and routine oral hygiene forces.
Why this case matters
This is a classic high-risk scenario where recession may continue even in a healthy, motivated patient.
Importantly:
- Recession here is predictable, not random
- Monitoring alone often means intervening too late
- Early referral allows risk modification, not damage control
Recognising phenotype + keratinised tissue width + tooth position as a combined risk profile is key.
In plain terms: The gum is thin and there is very little tough (keratinised) gum, and the tooth sits too far towards the cheek, the area is more vulnerable than normal.
As a result:
- The gum is more likely to keep receding
- It is easier for inflammation to develop
- The gum and bone around the tooth are less stable over time
This risk is made worse by everyday forces, such as:
- Chewing and biting (functional load)
- Toothbrushing and normal oral hygiene
So even though the patient is healthy and motivated, normal daily use of the tooth can gradually cause further damage unless the tissue quality is improved.
Treatment strategy (TT option) Tissue therapy approach
Free gingival graft (FGG) to modify the phenotype around LR6.
Critical point for referrers:
👉 The aim was not root coverage.
👉 The goal was to increase tissue thickness and keratinised tissue, creating a stable, resilient peri-tooth environment.
This significantly reduces the likelihood of further recession and improves long-term maintainability.
Treatment timeline
- Baseline: Thin phenotype, <1 mm KT, buccal tooth position
- Surgery: Free gingival graft
- Review @ 3 months: Healthy maturation, increased tissue robustness
- Review @ 6 months: Stable phenotype, improved resilience and maintainability
Key learning points for referrers
- Thin phenotype + minimal keratinised tissue + buccal positioning = high recession risk
- Early referral enables preventive periodontal intervention
- Phenotype modification can be tooth-saving, even without aesthetic demand
- Not all grafting is about coverage—often it’s about long-term stability
If you notice progressive recession, limited keratinised tissue, or an unfavourable tooth position—even in asymptomatic patients—early referral can change the trajectory of the tooth.
Would you like More Case Studies?
If you’re interested in reading more real-world case studies on periodontal regeneration, implantology, and advanced surgical techniques, fill out the form below! Expert insights from specialists like Dr. Bruno Delaunay will keep you informed and enhance your clinical decision-making.
Sign up now to access exclusive case studies!
