|Soft Tissue Grafts - Gum Graft Surgery|
Gum graft also called soft tissue graft is a surgical periodontal procedure in which tissue is taken from the palate or another source area in the mouth and added to an area where the tooth roots have become exposed due to gums recession caused by periodontal disease or other reasons. Gum grafting is also known as root coverage.
Soft tissue or gum graft surgery is a dental procedure usually performed by a periodontist, a dental specialist who has advanced training in diagnosing and treating conditions that affect the gums and supporting bone. Gum graft surgery may be recommended for one tooth or several teeth in order to:
Gum grafting may become necessary due to receded gums caused by:
Although gum grafts are in most cases part of a periodontal disease treatment, they can also be used to improve the gumline symmetry as part of a cosmetic make-over.
Before the periodontist proceeds to the gum graft surgery, it is necessary that the causative factors of gum recession are already addressed and treated. This may involve a number of treatments or behavioral changes depending on the specific cause of receding gums from periodontal disease treatment to orthodontics or more. Otherwise gum recession will soon re-occur.
The gum graft procedure is performed by a periodontist under local anesthesia and it involves moving soft-tissue from another area of the mouth in order to cover the exposed tooth roots. There are three different types of soft-tissue grafts: free gingival grafts, connective-tissue grafts and pedicle grafts.
In a free gingival graft procedure, the periodontist cuts a small strip of soft tissue from the roof of the patient’s mouth (palate). The soft tissue graft, is then sutured to the existing gum tissue in the area of gum recession.
This type of gum graft procedure is often used for people who naturally have very thin gum tissue around their teeth and need to have them enforced. Freeze-dried human tissue from another donor may also be used for free gingival grafts to avoid the need of a second surgical site in the mouth or when large amount of gum graft is needed.
In a connective-tissue graft, the gum graft is also taken from the roof of the mouth but in this case it is the sub-epithelial connective tissue that is used for the soft-tissue graft, and not the outer epithelial layer as in free gingival grafts. An incision is made in the roof of the mouth in a way that a flap is formed (also called a ‘trap door’). The underlying connective tissue is removed from the palate and sutured under the existing gum tissue next to the exposed root. The flap on the palate is put back and stitched into place. Connective tissue grafts is the most common type of gum graft surgery used for the treatment of exposed roots.
In a ‘pedicle’ graft, also known as lateral graft, the gum graft is not taken from the palate but from the area immediately adjacent to the recessed gums. A flap of gum tissue from the adjacent area is partially cut away with the edge close to the recession site still attached. The flap (pedicle) is then rotated covering the exposed root and stitched into place.
Lateral gum graft is considered as more successful than other types of gum graft surgery because the blood supply is not interrupted. Some of the original blood vessels continue to feed the grafted section after surgery and help in healing. However there are two drawbacks:
Whatever the type of graft, after the gum graft surgery the periodontist will usually place a periodontal dressing over the treated area to protect the graft for the first healing period.
Some discomfort, swelling or bruising is normal after a gum graft surgery. Free gingival and connective tissue grafts usually cause more discomfort than lateral grafts due to the second surgical site in the palate. The periodontist may prescribe some pain medication to help control after surgery discomfort.For the first days the graft may look whitish or yellowish as the exposed surface cells die and peel off. After a few days the graft will take a more natural reddish color as the blood supply is fully restored.
A follow-up appointment is scheduled 7-10 days after gum surgery for the periodontist to examine the progress of healing and remove any periodontal dressing, but the stitches are not usually removed until 2-3 weeks later. The gum graft will have significantly healed until then but full integration of the graft may take up to 6 months.
If the gum graftiing surgery is performed by an experienced periodontist and the patient follows the post-operative instructions, the procedure is successful in almost all cases. Complications such as the graft failing to integrate with the existing gum tissue are rare, especially if the lateral graft technique is followed. Infections of the graft area are also rare.
Problems related to the aesthetic appearance of the graft are a possible complication but it can be easily corrected. Any abnormalities usually disappear within some months. If the gum graft continues to look lumpy and bumpy, the periodontist can reshape the gum tissue and correct its appearance with a simple procedure called gingivoplasty.
Gum grafting is a periodontal procedure which is performed to treat the consequences of receded gums but also to prevent further gum recession and bone loss. Gum grafts can effectively treat root exposure and tooth sensitivity and improve the aesthetic appearance of teeth affected by gum recession.