Gingival Recession

Are your teeth constantly aching when eating hot or cold foods, if yes, then you may be developing gingival (gum) recession. In addition to the sensitivity felt in your roots when enjoying such foods, your gum and tooth may appear unsightly. Also, when recession of the gum tissue occurs, the body loses its natural defense against bacterial penetration and trauma and reconstruction using grafting techniques is an option. If there is minimal recession, then there is still some healthy gingiva to protect the tooth and no treatment other than modifying home care practices is necessary. When recession reaches the mucosa, the first line of defense against bacterial penetration is lost. When the recession is severe, the root surfaces are exposed and can lead to root caries. A gingival graft is designed to resolve this issue.

If this is the case, gum or skin grafting is a plausible option that you should consider. Gum grafting will strengthen the tissue surrounding the tooth, anchoring the tooth in and preventing further gum recession.

- - Connective Tissue Grafting
  - Free Gingival Grafting

The procedure involves taking a thin piece of tissue from the roof of the mouth to provide a stable band of attached gingiva around the afflicted tooth or teeth. Generally, Dr. Shelby can borrow this tissue with minimal disruption to the surface gum and enables the roof of the mouth to heal quickly without the discomfort traditionally associated with gum grafts. The gingival graft is placed in such a way as to cover the exposed portion of the root. The gingival graft procedure is highly predictable and results in a stable, healthy band of attached tissue around the tooth.

As in all elements of health care, there exists an art and a science that must be melded to successfully perform these very delicate and precise micro-plastic surgical procedures. Dr. Shelby has a particular passion for restoring a natural pleasing look, function and support to teeth and in so doing, return you back to health. Gum graft surgery can be divided into various procedures and techniques, each customized to address a patient’s unique care issues.

An autogenous connective tissue graft is the most common method used to treat root exposure. During the procedure, a flap of skin is cut at the roof of your mouth (palate) and tissue from under the flap, called subepithelial connective tissue, is removed and the stitched to the gum tissue surrounding the exposed root. Following removal of the connective tissue, the palatal flap is stitched back down. In the event that the palatal tissue is not thick enough, or an excess amount of tissue is necessary, a substitute (allograft) may be necessary to accomplish root coverage.

An allograft is any human tissue that is transplanted from one person to another. Allograft tissues have been used in millions of surgical procedures for many years. Allografts are donated skin that undergo a vigorous processing to remove cells, leaving only the dermis, or bottom layer of the skin. This process is highly regulated by the FDA to ensure the safety of the patient. Following transplantation, the graft gradually becomes a natural part of the patient’s own tissue and performs like normal, healthy tissue thereafter. An additional benefit of allografts is the lack of a second surgical site (roof of the mouth) that can make the procedure more comfortable for the patient.

The free gingival graft (FGG) is a surgical procedure frequently used in periodontics to increase the amount of keratinized tissue surrounding a tooth or a dental implant. Keratinized tissue plays a major role (around teeth and dental implants), helping to maintain and facilitate oral hygiene.

Indications for free gingival graft

- Increase of keratinized tissue adjacent to teeth, dental implants, or edentulous ridges
- Coverage of certain type of gingival recessions

Contraindications for free gingival graft

- High esthetic demand
- Need for an intraoral donor site

The esthetic result of the FGG technique can range from poor to excellent, depending on tissue characteristics proper of each patient. As this is not always predictable, I tend not to use this technique in patients demanding an excellent esthetic outcome. The second major limitation is the need for a donor site. Most commonly the tissue is harvested from the palate. The need for a second surgical site may increase the length of the procedure, as well as postoperative discomfort. Protecting the area with a stent or a periodontal dressing can reduce this discomfort. Also, alternative grafting materials have been introduced into the market to avoid harvesting tissue from the palate. (copied)

Gum grafting is a minor surgical procedure that is suitable for most people who have receding gums. If you are healthy, have controlled the cause of your receding gums, an aren’t taking medications that can interfere with healing, then you are a good candidate for gum grafting. You also need to commit to caring for your gums after a gum graft.

The only way to learn for sure whether you are a candidate for gum grafting is to talk to a periodontist. To schedule an evaluation with Dr. Andrew Shelby, please call (785) 841-1188 or email us at info@lawrenceperio.com.

The most important consideration for a gum grafting candidate is whether you will benefit from the procedure. You will benefit from gum grafting if:

You are bother by the appearance of receding gums
Receding gums expose the root material (cementum) and can lead to an increased risk for decay, possible tooth loss
You have significant sensitivity where the gums have receded
Your gums are still receding

Gum grafting can correct all of these concerns. A gum graft is intended to restore the healthy, attractive appearance of your gums. It will cover the unsightly and vulnerable cementum. It will protect the sensitive tooth root. And it will arrest the progression of receding gums.

In order to have gum graft surgery, you have to be in good health. In particular, your gums must be healthy. Uncontrolled gum disease is an absolute contraindication for gum grafting procedures. If your gums are unhealthy, any gum graft is likely to fail or be subject to a future recession.

The tooth or teeth to be covered by a gum graft have to be healthy. An infected tooth or teeth might not benefit from gum grafting and can cause further infection if not treated. Teeth that are too loose may not serve as an adequate anchor for a gum graft.

Other conditions that may prevent gum graft success are those which put your gums at increased risk, including diabetes and compromised immune systems.

Certain medications can interfere with your healing. Blood-thinning medications and nutrient supplements, for example, can be problematic, as can those drugs that can lead to gum overgrowths, such as some anti-seizure medications, calcium channel blockers (used for high blood pressure control), and immunosuppressants.

You shouldn’t feel much (if any) pain right after because you will still be numb. As the local anesthesia wears off, the discomfort may start to creep in. So, if you can, get your prescriptions immediately following the procedure. That way, you can take your first dose of pain medication before the anesthesia completely goes.

Swelling tends to peak around day three before going down. You may notice some bleeding the first day through the morning after. But if anything beyond the level of pink saliva in the sink, that is not normal, and you should contact Dr. Shelby.

You will want to avoid brushing and flossing in the surgical areas for the first two weeks following the procedure. During this time you will be instructed to gently rinse with an antiseptic mouthwash (Chlorhexidine) to keep the area clear of bacteria.

The biggest issue, of course, is eating. In general, you’ll have to avoid eating anything on the affected side of your mouth for ~2-3 weeks. You’ll also be advised to avoid eating anything hard, foods that can break up into small pieces (nuts, chips, crackers, seeds, popcorn, etc), acidic, spicy, or anything potentially irritating to the surgical sites. The temperature of the of your food/drink will need to be cool for the first several days following the procedure, also accompanied by instructions to avoid hot substances such as hot soup or coffee.

Complications with a gum graft can occur and are usually accompanied by excessive bleeding from the palate, extreme pain, or fever. If you notice any of these issues, please contact Dr. Shelby immediately.

You will be seen for a 2-week post-operative visit to usually remove the sutures from both the grafting site and the roof of the mouth where the tissue was taken from. At this point, you will be allowed to start brushing in an upward motion away from the gum tissue with a post-operative ultrasoft toothbrush that will be provided to you. Pt will still refrain from flossing for an additional two weeks but return to normal hygiene habits at 4-weeks. Your gum tissue will continue to mature for the next 2-months before a procedure is considered a success.

Gingival Recession

Gingival Recession

Connective Tissue Grafts

Free Gingival Grafts

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