Soft tissue grafting is often necessary to combat gum recession. Periodontal disease, trauma, aging, over brushing, and poor tooth positioning are the leading causes of gum recession which can lead to tooth-root exposure in severe cases.
When the roots of the teeth become exposed, eating hot and cold foods can be uncomfortable, decay is more prevalent and the aesthetic appearance of the smile is altered. The main goal of soft tissue grafting is to either cover the exposed root or to thicken the existing gum tissue in order to halt further tissue loss.
The three different types of common soft tissue grafts include:
Free gingival graft – A strip of tissue is removed from the roof of the mouth and stitched to the grafting site in order to promote natural growth. This type of graft is most commonly used for thickening existing tissue.
Connective tissue graft – For larger areas or root exposure, subepithelial tissue is needed to remedy the problem. This subepithelial connective tissue is removed from a small flap in the mouth and sutured to the grafting site. This is the most common treatment for root exposure.
Pedicle graft – This type of graft involves the “sharing” of soft tissue between the affected site and adjacent gum. A flap of tissue is partially cut away and moved sideways to cover the root. The results of this type of graft are excellent because the tissue that is moved to the adjacent area includes blood vessels that are left in place.
Reasons for soft tissue grafting
Soft tissue grafting is an extremely versatile procedure that has many uses. Recent developments in dental technology have made soft tissue grafting more predictable and less intrusive. Here are some of the main benefits associated with soft tissue grafting treatment:
Increased comfort – Root exposure can cause substantial pain and discomfort. Eating hot, cold or even warm foods can cause severe discomfort. Soft tissue grafts cover the exposed root, decreases sensitivity and restore good health to the gum area.
Improved aesthetics – Gum recession due to periodontal disease can cause the smile to look “toothy” or the teeth to appear uneven in size. Soft tissue grafting can be used as a cosmetic procedure to re-augment the gums, and make the smile appear more symmetrical.
Improved gum health – Periodontal disease is a progressive condition that can destroy soft tissue very rapidly. When used in combination with deep cleaning procedures, soft tissue grafting can halt tissue and bone loss, and protect exposed roots from further complications.
What does soft tissue grafting treatment involve?
Initially, deep cleaning will be performed both above and below the gum line to clear the teeth and roots of calculus (tartar). The grafting procedure itself will generally be performed under local anesthetic, but this will depend on the size of the areas receiving grafts. A small incision will be made at the recipient site in order to create a small pocket. A split thickness incision is made in this pocket and the donor tissue is placed between the two sections of this area. The donor tissue strip is generally larger than the incision, so some excess will be apparent.
Platelet rich growth factors which stimulate natural tissue growth and promote good healing may be applied to the site before suturing. In addition, tissue-stimulating proteins may be added to encourage quicker tissue growth. Finally, the wound site will be sutured to prevent shifting, and surgical material will be placed to protect the sensitive area. Gum uniformity and substantial healing will take place in the first six weeks after the procedure.
Example 1: Connective tissue grafting using a pedicle flap to cover the graft
This patient presented to Dr. Weber with severe gum recession. The patient was unaware of the condition, but the tooth was at significant risk of being lost.
A connective tissue graft (with pedicle) was performed and the tooth was saved. The photograph was taken 4 weeks after the procedure.
Example 2: Gingival grafting using freeze-dried tissue and Platelet Rich Plasma (PRP)
This patient presented with gum recession and symptoms of cold sensitivity. This made it difficult to brush properly and eat or drink. Also, the lost attachment jeopardized the prognosis of the tooth.
3 months later, the graft is stable, the patient can eat, drink, and brush with comfort. The prognosis for these teeth is good. The graft will blend-in further over the next 12 months.
Example 3: Failing white filing replaced with a connective tissue graft
This patient presented to Dr. Weber with a failing tooth colored filing. The filing was removed, and a gingival graft was placed.
Months later, the graft has integrated and the patient has no sensitivity. The benefit of soft tissue grafting over a filing is that a graft should never need replacing, is your own (or becomes your own) tissue, and looks better! Filings frequently need to be replaced after 5 years.
©Dr. Andrew Weber
If you have any questions about soft tissue grafting, please contact our office at 636-379-6905.