Gum grafting (soft tissue augmentation) is a surgical procedure that helps protect the tooth roots and improve the smile for patients who are self-conscious about receded gums. Gum grafting also helps protect the mouth from bacteria and trauma.
Gum recession is a common problem, usually resulting from gingivitis, that can lead to exposure of an excessive amount of tooth, or even of the tooth root. This can not only result in pain and damage, but can adversely affect the appearance. Gum recession is a gradual process, often not noticed until an exposed root appears, looking unpleasant and causing extreme tooth sensitivity, particularly to hot or cold. In order to repair gum recession, a graft procedure may be necessary both to restore oral health and for aesthetic purposes.
Autogenous Gum Grafting
There are several autogenous procedures of gum grafting, in which tissue from the patient's own body is used as grafting material. These include the following:
In performing a connective-tissue graft, a flap of skin is created in the patient's palate (roof of the mouth), and subepithelial connective tissue from under that flap is harvested. Once the tissue has been harvested, the flap is stitched back in place.
Free Gingival Grafts
This type of graft makes use of the palatal tissue itself. Instead of creating a flap in the roof of the mouth, the dental surgeon uses the removed tissue from the palate, attaching it directly to the gum. This method is normally used on patients with thin gums.
In performing a pedicle graft, tissue is harvested from the gum around or near the affected tooth. In this case, the flap (pedicle) is cut away in such a way that one of its edges remains attached. The loosened flap is then pulled down and over the exposed root and sutured into place. This type of gum graft can only be performed on patients with a large amount of gum tissue near the targeted tooth.
Gum Grafting Using Allograft
More recently, the use of allograft, a less invasive method of gum grafting, has been developed. This type of gum graft involves using soft human tissue previously harvested and available from donor banks, rather than tissue from patients themselves.
While not preferable in all cases, allograft procedures have several advantages over autogenous grafts. These include:
- Reduced patient discomfort
- Predictable aesthetic results
- Likelihood of rapid tissue growth
- Likelihood of rapid revascularization
Allograft is always available and does not require a harvesting procedure from the patient undergoing the grafting procedure.
The Gum Grafting Procedure
The tissue graft, whether obtained from the patient's own mouth or from a donor bank, is placed in the receded area of the gum to cover the exposed root and carefully sutured into place. The graft helps correct the appearance of teeth that may seem "too long," affecting the patient's smile, and also reduces further gum recession.
Recovery from Gum Grafting
Gum grafting is performed outpatient, although frequently the patient is sedated and must therefore make arrangements for transportation home. There are certain postoperative restrictions during healing, a process which may take as much as a week or two. These may include:
- Limiting the diet to soft, cool foods
- Limiting physical activities
- Altering other medication regimens
- Not brushing or flossing the affected area
- Rinsing with a special mouth wash to control plaque
- Taking a prescribed antibiotic to reduce infection risk
Patients are normally able to return to normal activities the day after the procedure.
Complications of Gum Grafting
Although gum grafting is considered a very safe procedure, as with all medical procedures, there is a possibility of complications. In this case, complications may include:
- Excessive bleeding, bruising or swelling
- Loosening sutures
- Tooth movement
While rare, it is also possible that the repair will heal unevenly and that a gingivoplasty will be necessary to remove extra gum tissue.