Localized recession: why it happensFix the cause. Then repair.
Localized recession is often treated as a tissue problem. It is usually a stability problem. Something keeps placing pressure on this one site. Within the Structural Decision Framework (SDF), the question is what keeps pushing this one site toward breakdown. If you do not correct the cause, grafting can help but the pattern often returns.
Quick answer
Localized recession usually comes from one or more causes: thin bone support, a tooth sitting outside the envelope, repeated overload, brushing trauma, frenum pull, or inflammation. The best treatment is identifying the cause, correcting it, and then deciding whether tissue augmentation adds long-term value.
Tissue is the visible part. The cause is the reason it keeps moving.
- Position is corrected when neededA tooth outside the envelope is repositioned into safer bone.
- Force is reduced or redistributedOverload zones are identified and stabilized.
- Inflammation is controlledGums become stable and predictable.
- Then tissue is rebuiltAugmentation becomes more durable after stability exists.
- Overload continuesForce keeps testing the same site.
- Tooth remains outside the envelopeThin bone limits remain unchanged.
- Brushing pattern remains traumaticThe same mechanical cause repeats.
- Repeat procedures become more likelyThe pattern returns over time.
If the cause remains, recession tends to keep moving. If the cause is corrected, outcomes become much quieter.
- Less progression
- Better graft durability
- More stable aesthetics
- Some drift possible
- Monitoring matters
- May need staged intervention
- Repeat sensitivity
- More root exposure
- Higher retreatment likelihood
The right plan depends on what is driving the recession in this exact site.
- Prominent roots
- Thin bone housing
- Progressive localized recession
- Longer sequence
- Requires follow-through
- Grafting without correcting position and expecting permanence
- Wear patterns
- Bruxism risk
- Localized recession with bite imbalance
- Does not remove chewing forces
- Requires maintenance
- Assuming a night guard alone fixes the whole force system
- High sensitivity with stable causes
- Short-term constraints
- Higher recurrence risk if causes remain
- Recession continuing after grafting
Recession is a stability decision filtered through four dimensions.
Stay inside the same decision space. Compare one nearby scenario and one adjacent hub.
The next step is simple. We examine structure, force, and timing in person. You do not need to decide everything today.