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Periodontal Care and Dental Implants
Dr. Dante Tomaselli DMD

Gum grafts

Gum grafting is a relatively common option for addressing a number of dental conditions such as excessive tooth sensitivity and tooth abrasion.  We offer all of the current surgical options such as Connective Tissue Grafts, Tissue Bank Allografts and Free (Autogenous) Gingival Grafts.

The zone of attached gum tissue is like a defense mechanism for your mouth.  It is this tissue that maintains the seal of the gum to the tooth, preventing plaque from getting under the gum and destroying the underlying bone support.  When this tissue is thin or completely absent, this defense mechanism is no longer effective.

Studies have shown that inadequate zones of gum tissue do not break down in a regular pattern. Usually, it stays stable for a non-specified period of time.  Then, once it has been irritated by some factor, it breaks down and begins to recede, sometimes significantly down the root.  Gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance of the gum and tooth.  The irritant that causes this recession may be a toothbrush, hard food, gum infection, thin anatomy or other factors.  Once this tissue has receded and the tooth looks longer, it is very difficult to place new gum tissue back to the original height. 

A gum graft is performed in order to correct this problem, protect the underlying bone and prevent the gum tissue from receding even further. The goal is to create a new zone of defense, or gum tissue.  The gingival graft procedure is highly predictable and results in a stable, healthy band of attached tissue.  The longer tooth (exposed root), caused by recession, is extremely difficult to cover up again once it is exposed.  There are, however, special circumstances and procedures where exposed roots can be covered.

Autogenous Gingival Graft Procedure

Once the areas are numb, a small piece of gum tissue is gently taken from around the necks of the teeth on the roof of the mouth (palate).  This area heals like a scrape and grows back leaving sufficient gum tissue there.  The piece of gum tissue taken from the palate is used to replace the weakened tissue of the tooth being grafted.  The gum graft is placed at the level of the old receded gum tissue and held on by either resorbable stitches or a special biological glue.  This area will heal with a thicker, denser gum tissue which will protect the underlying jaw bone.  A periodontal dressing (a soft material with a texture like modeling clay) is placed on the palate and the grafted area and will remain for a period of one to two weeks.

Connective Tissue Graft (Root coverage) Procedure

When there is recession but an adequate zone of attached gum tissue still exists, a graft can be placed to cover the exposed root.  Connective tissue grafting is a surgical procedure in which connective tissue is harvested from your palate and inserted surgically in the gingival area that needs to be regrown.  In a connective tissue graft, a flap is created in the roof of the mouth.  The flap forms a "trap door" shape.  Some tissue from under the flap is removed.  The flap is then stitched back down.  The tissue that was removed is known as subepithelial connective tissue.  The gingiva around the root exposure is slid toward your tooth and the connective tissue is slipped under the gum tissue that surrounds the exposed root and it is stitched into place.  There also is a variation which doesn't harvest tissue from the palate, but instead uses a commercially prepared gel (Emdogain).

Pedicle Graft Procedure

A pedicle graft uses a flap of tissue from the gum of a tooth next to the one with recession. The flap is partially cut away, with one edge still attached. This flap is called a pedicle.  It is slid sideways to cover the exposed root and stitched into place.  A pedicle graft may be more successful than a free gingival graft.  That's because at least some of the blood vessels that feed the grafted section remain in place. However, a pedicle graft can be done only in specific cases.  There must be a tooth next to the one being treated that has enough gum tissue to share.

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