Gum (Gingival) Grafting
Gum recession occurs when the bone and gum tissue around a tooth deteriorates. Teeth are held in place by the jawbone with a layer of gum over the bone. If you can see the root, the bone is gone as well as the gums. While the gum loss is what is most visible, it is the bone loss around the tooth that is more important because this bone loss can endanger the tooth staying in your mouth if it becomes severe.
There are two kinds of soft tissue near teeth, a dense tissue that is tougher and makes a good seal against the root and bone, called attached keratinized tissue, and weaker, more elastic tissue called mucosal tissue. When the stronger, keratinized tissue is gone, the mucosal tissue is the only thing left against the tooth and bone. It can stretch away from the tooth and bone, letting bacteria infiltrate under it to irritate the bone and cause more bone loss. When recession of the dense gum tissue occurs, the body loses a natural defense against bacterial penetration.
In addition, the root of a tooth is made of a tissue called dentin, which is much softer than enamel. If dentin is exposed by recession, it will wear at a faster rate, which can cause significant damage to the root. It is also much more vulnerable to cavities, more sensitive to hot and cold temperatures, and the person may not like the appearance.
When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices, such as adjusting brushing techniques or wearing a night guard, is necessary. However, when gum recession is a more serious threat to the health of the tooth, gum reconstruction using grafting techniques is an option.
Examples of before and after gingival grafting performed in our office:
Conventional Connective Tissue Graft, Initial and 8 week follow-up
Connective Tissue Graft on multiple teeth using a tunnel technique,
Initial and 10 week follow-up
Free gingival graft, Initial and a 5 year follow-up
Connective Tissue Graft with a tunnel technique, Initial and 8 week follow-up
A gingival graft is designed to solve these problems. A thin piece of tissue is taken typically from the roof of the mouth to provide a stable band of attached keratinized gingiva around the tooth. This makes a better seal against the tooth, preventing bacteria from getting under the gums and strengthening the area against wear and tear. The gingival graft may be placed in such a way as to cover the exposed portion of the root. Covering the root is another goal of treatment but sometimes is not possible, depending on how bad the recession is.
The tissue on the roof of the mouth is very dense and an excellent choice to repair weak areas of the gums and bone. It’s considered the “duct tape” of the mouth! The tissue regrows on the roof of the mouth to the point where it’s possible to take another graft from the exact same spot after it’s done healing.
There are multiple techniques for gum grafts. These include the epithelial, or free, gingival graft, the connective tissue graft, acellular dermal matrix (donor) graft, tunneling techniques, and more. Not every technique fits every situation. We would be happy to talk about if grafting is actually needed in your case and what technique would be best.