What are the indications for gum grafting?
The fact that you have gum recession does not necessarily mean you need or are even a candidate to have a gum graft. Adequate surrounding bone is necessary for successful grafting because the bone acts like a “curtain rod” to hold the gum tissue up.
There are two main types of gum grafts, connective tissue grafts, which are most common, are primarily used to cover the root surfaces where recession has occurred, and free gingival grafts, which are mainly used to create a thick band of strong keratinized tissue around the tooth. There are certain INDICATIONS for each type of procedure.
Connective Tissue Grafts
This procedure is usually used in the following circumstances:
1. Aesthetics – Gum recession can result in unsightly yellow root exposure, as well as abnormally long appearing teeth. Connective tissue grafts can cover up most, and sometimes all of the recession that has taken place. Once the regenerated tissue has healed and matured the tooth will look more natural, with a beautiful, healthy appearance.
2. Tooth Sensitivity – When roots are exposed this can cause the roots of your teeth to be very sensitive to hot, cold, and even touch, even drinking a cold glass of water can be very unpleasant. Covering up the roots can go a long way towards reducing tooth sensitivity.
3. Progressing Recession – When you or your general dentist notice that your gum recession keeps getting worse. Sometimes recession occurs or progresses due to a cavity or a filling on the root surface. In some cases, such as these, the filling or cavity can be cleaned out and a graft done to cover the area, depending on the extent of the cavity or restoration.
4. Compromised Oral Hygiene – Sometimes an area of recession can act as a plaque trap and your gums in that area become red and inflamed making it difficult and uncomfortable to brush and keep the area clean. A graft can be done in these circumstances which will cover the root and eliminate the plaque trap and make it much more comfortable to perform normal brushing and flossing in the area.
Free Gingival Grafts
This procedure is usually used in the following circumstances:
1. Inadequate keratinized (thick) tissue or gingiva – There are two types of tissue in your mouth. There is the tough, pink tissue around the necks of your teeth which is keratinized and meant to be chewed and functioned on. This keratinized tissue is known as gingiva and is found around your teeth as well as on the palate. The other tissue is called mucosa and is the loose, red, flabby tissue found below your gingiva and in your cheeks and lips. This loose, flabby tissue is not meant to be chewed and functioned on. Inadequate gingiva may result in gum recession occurring from such things as frenum pulls, orthodontics, dental cleanings and even tooth brushing.
2. High frenum attachment with inadequate Keratinized tissue – This is usually a dual procedure when a frenectomy needs to be performed in an area where it is pulling on an area that is deficient in keratinized tissue.
How are gum grafts done?
First, we make incisions in your gums at the recipient area, similar to a pita pocket. Then gum tissue is harvested from the roof of your mouth and placed into the pouch, or onto the area needing the graft and the flap or pouch is closed back up. Normally a plastic palatal stent similar to an orthodontic retainer is placed over the roof of your mouth to act like a Band-Aid to protect the area when you eat. The graft will integrate with your gums over the next several weeks as long as it is not moved and the blood supply from the surrounding tissues are not compromised. Usually we can cover up most, and sometimes all of the recession that has taken place.
What type of healing can I expect?
In the early days you can expect your graft to look worse before it looks better. There will be a whitish/yellowish appearance on the surface. This is simply the surface cells of the graft dieing off. A few days later you will see a raw, reddish appearance. This is a good sign that the graft is receiving an adequate blood supply. When you return for your post-op 7-10 days later, we will remove any loose sutures, but probably not all the sutures will be removed for 2-3 weeks following the surgery.
Sometimes the graft may appear to be lumpy and bumpy. This also is normal, and over the next few months your body will remodel and reshape the graft, and as it matures it will blend in beautifully. If, after 3-4 months, there are still some residual lumps and bumps we can usually reshape the tissue in just a few minutes doing some simple gingivoplasty. There is no additional charge for any reshaping.
Will it hurt? The site where the graft goes usually does not cause any significant discomfort. The site where the tissue came from (the palate) can be uncomfortable and feel like a pizza burn for a few days or even a week.
Post-operative care for my graft?
- Do not rinse your mouth the day of the surgery unless otherwise instructed to do so and then only with the prescribed mouth rinse
- Do not eat or drink anything hot for the first 6-8 hours following surgery. Heat can contribute to bleeding and can soften the protective dressing that may have been placed over your gums
- Stay nourished and hydrated. You will feel better, have more strength, less pain, and heal faster if you do this. Only eat soft foods or liquids that do not need to be chewed for the first week. After that slowly return to your normal diet trying to avoid contacting or getting food in the grafted area
- If a pain pill has been prescribed for you, take the first one BEFORE your anesthesia wears off. The best thing for you will be an anti-inflammatory such as Motrin (i.e., Advil® or ibuprophen)
- It is very important not to disturb the graft during healing. YOU WILL NOT BRUSH IN THE GRAFTED AREA FOR ABOUT 30 DAYS. This will allow for adequate healing of the graft and attachment of the new tissue and blood vessels. You may brush everywhere else but not in the grafted area. After 1 month you will begin brushing the teeth in the surgical area using only an extra soft toothbrush that will be given. Remember, it will be very important to keep it clean.
- Keep all physical activities to a minimum the first 24 hours to help prevent bleeding
- Slight oozing is to be expected for several hours (oozing is a little blood mixed with your saliva).
- In the event of more significant bleeding, determine whether it is the graft site or the palate (donor site) that is bleeding. Apply pressure with a dampened gauze pad or a moistened tea bag on the palate. This should stop any bleeding from the palate. If it is bleeding from the graft site, DO NOT apply pressure to the graft or the graft could fail. Gauze can be placed on either side of the graft, but not over the graft.
If the above treatment is unsuccessful, feel free to call us at the office, or the after-hours numbers given to you after surgery.