Gingival Grafting

Gingival grafting is an in-office surgical procedure done to correct a gingival (gum tissue) defect. This defect could be:

Lower Teeth - Gingival Defect

Thin gingival layer covering the tooth root

Gingival Defect - Exposed Tooth Root

Gingival Defect - Receding Gums

Gingival tissue pulling away from the tooth (receding)
Tooth/ root sensitivity caused by the exposed root surface as a result of the receding tissue Because the surface of the root is softer
than the tissue covering the crown, decay on the exposed root tissue can be more prevalent

In some instances, grafting is used to support tissue for crowns and implant placement

 

What can cause the gingival defect ?

The gingival thinning and recession originally is a result of how your teeth erupt in the jaw. A tooth is designed to erupt in the center of the tooth-holding bone (alveolus) so that there is as much bony support in front of the tooth as there is behind it. The presence of a bony support structure is necessary for the gingiva to stay healthy and supportive. If the bone thins or resorbs through the actions of periodontal disease, orthodontic tooth movement or physiological eruption patterns, the gum tissue may lose blood supply and recede from its normal position.
An individual can also affect the recession by habits. Aggressive brushing, a hard toothbrush or even a habit of using a fingernail or toothpick to “pick” at the gum margin, can cause recession.

How is the gingival defect treated?

There are three types of surgical repair procedures for gingival recession and loss of gingival attachment.

Free gingival grafting

Free gingiva refers to the type of tissue used for the graft. This procedure is done to augment the amount of tissue currently present, but which may have thinned or receded. This procedure does not return the gingival height to the original level, but augments the thickness which will add protection to the tooth root and blood supply to the tooth and surrounding gum. It is not meant to change the appearance. For some people, especially if the defect is in an area which is not normally visible to anyone looking at you, this is of no concern.

A small patch of donor tissue is taken from the roof (palate) of your mouth. In this procedure, the donor tissue is taken from the surface layer, leaving an area similar to a skinned knee or pizza burn. There are no sutures placed to close the wound, but a dental material can be used to cover the area similar to a bandage. If the donor site is taken to cover more than four teeth, Dr. Reidy may recommend that a stent, similar to a mouth guard or retainer, be made to cover the palate during the initial healing phase. The donor tissue is then placed in the area which needs the augmentation and then sutured in place. Healing time is subject to the individual’s own healing pattern, but usually is completely healed in 4-6 weeks.

Connective tissue grafting

Connective tissue grafting is done with the same goal in mind, to augment thinning or receding gingival tissue. However, in this procedure, the donor tissue may be placed to repair the defect to be closer to the normal level. This tissue is also taken from the palate, but not from the surface. A small incision is made in the palate and the surface tissue is folded down and the donor tissue is taken from a deeper layer. The surface tissue window is then folded back up, and sutured to cover the wound site.
A small incision is made in the area of the graft site and the donor tissue is placed in the pocket which results from the incision. The donor tissue is sutured in place. For this procedure, the graft site heals in approximately the same time frame, but because there is no open wound on the palate, the donor site generally heals more quickly and without as much discomfort.

A small incision is made in the area of the graft site and the donor tissue is placed in the pocket which results from the incision. The donor tissue is sutured in place. For this procedure, the graft site heals in approximately the same time frame, but because there is no open wound on the palate, the donor site generally heals more quickly and without as much discomfort.

Tooth - Before Grafting

Before

Tooth - After Grafting

After

Connective tissue graft with donor tissue

This graft procedure is the basically the same as the connective tissue described above, but the donor tissue does not come from the patient. It is provided by tissue which had been treated and sterilized for medical use. This type of graft will generally heal most quickly and least discomfort because there is not palatal wound. The tissue is sutured in place at the graft site