Soft Tissue (Gum) Grafting

Gum Recession

Gingival recession (receding gums) refers to the progressive loss of gum tissue, which can eventually result in tooth root exposure if left untreated.  Gum recession is most common in adults over the age of 40, but the process can begin in the teenage years.

Gum recession can be difficult to self-diagnose in its earlier stages because the changes often occur asymptomatically and gradually.  Regular dental check-ups will help to prevent gum recession and assess risk factors.

The following symptoms may be indicative of gum recession:

  • Sensitive teeth – When the gums recede enough to expose the cementum protecting the tooth root, the dentin tubules beneath will become more susceptible to external stimuli.
  • Visible roots – This is one of the main characteristics of a more severe case of gum recession.
  • Longer-looking teeth – Individuals experiencing gingival recession often have a “toothy” smile.  The length of the teeth is perfectly normal, but the gum tissue has been lost, making the teeth appear longer.
  • Halitosis, inflammation and bleeding – These symptoms are characteristic of gingivitis or periodontal disease.  A bacterial infection causes the gums to recede from the teeth and may cause tooth loss if not treated promptly.

Causes of Gum Recession

Gum recession is an incredibly widespread problem that dentists diagnose and treat on a daily basis.  It is important to thoroughly examine the affected areas and make an accurate diagnosis of the actual underlying problem.  Once the cause of the gum recession has been determined, surgical and non surgical procedures can be performed to halt the progress of the recession, and prevent it from occurring in the future.

The most common causes of gingival recession are:

  • Over-aggressive brushing – Over brushing can almost be as dangerous to the gums as too little.  Brushing too hard or brushing with a hard-bristled toothbrush can erode the tooth enamel at the gum line, and irritate or inflame gum tissue.
  • Poor oral hygiene – When brushing and flossing are performed improperly or not at all, a plaque build up can begin to affect the teeth.  The plaque contains various bacterial toxins which can promote infection and erode the underlying jawbone.
  • Chewing tobacco – Any kind of tobacco use has devastating effects on the entire oral cavity.  Chewing tobacco in particular, aggravates the gingival lining of the mouth and causes gum recession if used continuously.
  • Periodontal disease – Periodontal disease can be a result of improper oral hygiene or caused by systemic diseases such as diabetes.  The excess sugars in the mouth and narrowed blood vessels experienced by diabetics create a perfect environment for oral bacteria.  The bacterium causes an infection which progresses deeper and deeper into the gum and bone tissue, eventually resulting in tooth loss.

Soft Tissue (Gum) Grafting

Soft tissue grafting is often necessary to combat gum recession.  Periodontal disease, trauma, aging, over brushing, and poor tooth positioning are the leading causes of gum recession which can lead to tooth-root exposure in severe cases.

When the roots of the teeth become exposed, eating hot and cold foods can be uncomfortable, decay is more prevalent and the aesthetic appearance of the smile is altered.  The main goal of soft tissue grafting is to thicken the existing gum tissue in order to halt further tissue loss.

The three different types of common soft tissue grafts include:

  • Connective tissue graft – For larger areas of root exposure, subepithelial tissue is needed to remedy the problem by building up the weakened thin gum tissue to prevent further recession. This subepithelial connective tissue is removed from a small flap on the palate and sutured to the grafting site. This objective of damage control by increasing tissue thickness to prevent further recession is very predictable, especially at the earlier stages.  Root coverage where possible is always beneficial but variable due to the compromised blood supply that is lost once the gums have receded.  As such, early intervention is always critical to maintain the existing blood supply of the tissues and protect the underlying bone supporting the tooth.    This is the most common treatment for root recession as it is much more comfortable for the patient at the donor site compared with the Free Gingival Graft approach.
  • Free gingival graft – A strip of tissue is removed from the roof of the mouth and stitched to the grafting site in order to promote natural growth.  This type of graft is less commonly used compared the the connective tissue graft since it is generally associated with more discomfort at the palatal donor site.
  • Pedicle graft – This type of graft involves the “sharing” of soft tissue between the affected site and adjacent gum.  A flap of tissue is partially cut away and moved sideways to cover the root.  The results of this type of graft are excellent because the tissue that is moved to the adjacent area includes blood vessels that are left in place.
  • Acellular dermal matrix allograft – This procedure uses medically processed, donated human tissue as a tissue source for the graft. 

Reasons for soft tissue grafting

Soft tissue grafting is an extremely versatile procedure that has many uses.  Recent developments in dental technology have made soft tissue grafting more predictable and less intrusive.  Here are some of the main benefits associated with soft tissue grafting treatment:

  • Increased comfort – Root exposure can cause substantial pain and discomfort.  Eating hot, cold or even warm foods can cause severe discomfort. Soft tissue grafts cover the exposed root, decreases sensitivity and restore good health to the gum area.
  • Improved aesthetics – Gum recession due to periodontal disease can cause the smile to look “toothy” or the teeth to appear uneven in size.  Soft tissue grafting can be used as a cosmetic procedure to re-augment the gums thereby preventing further recession which would make the smile appear less symmetrical.
  • Improved gum health – Periodontal disease is a progressive condition that can destroy soft tissue very rapidly.  When used in combination with deep cleaning procedures, soft tissue grafting can halt tissue and bone loss, and protect exposed roots from further exposure and associated complications.
    What does soft tissue grafting treatment involve?

Once the need for gum grafting surgery has been determined, there are several treatments that may be performed before gum grafting takes place.  First, the teeth must be thoroughly cleaned supra and subgingivally to remove calculus (tartar) and bacteria.  The dentist can also provide literature, advice and educational tools to increase the effectiveness of home care and help reduce the susceptibility of periodontal disease in the future.

The gum grafting procedure is usually performed under local anesthetic and oral sedation to alleviate patient anxiety  The exact procedure will depend on whether tissue is coming from the patient’s palate or a tissue bank.

Initially, small incisions will be made at the recipient site to create a small pocket to accommodate the graft.  Then a split thickness incision is made and the connective tissue graft is inserted into the space between the two sections of tissue.  The graft is usually slightly larger than the recession area, so some excess will be apparent.

Sutures are often placed to further stabilize the graft and to prevent any shifting from the designated site.   A post-surgical appointment is arranged 10-14 days later.  Uniformity and healing of the gums will be achieved in approximately six weeks.

If you have any questions about soft tissue grafting, please contact us.

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