Tissue Regeneration

Graft Surgery | Gingival Graft | Connective Tissue Graft |Connective Tissue Graft with Alloderm | Post-Surgical Instructions

Graft Surgery

Tissue regeneration diagramGraft surgery is recommended when you have one tooth, or more, on which the gum level has receded from the natural level on the tooth. There are two types of tissue in your mouth. Gingiva surrounds the tooth and is coral pink in color. Gingiva has an appearance that resembles the surface of an orange peeling. Part of it is firmly attached to the underlying bone. Its function is to make a seal around the tooth, which acts as a barrier to help keep bacteria from getting to the underlying bone. It also helps withstand the trauma from eating and brushing.

The second type of tissue is gingival mucosa. Mucosa is red, shiny and loosely attached to the underlying bone. It is more delicate and not as able to withstand trauma. If you look in your mouth and gently pull the lower lip out, you can see the pink gingiva, the red mucosa and the line that appears where the two types meet.

Sometimes, the gingiva will pull away from the tooth causing recession or the gingival layer covering the tooth root may be very thin. It can happen for several reasons. The tooth may have come into the mouth a little out of line causing the bone covering the root on the tongue side or the lip side to be thin, it may be the result of orthodontic treatments, as the result of tension on the tissue caused by a tight muscle attachment from the lip or, on occasion, from loss of underlying bone from periodontal disease, or for mechanical reasons such as a hard toothbrush or “picking” habit.

Gingival recession results in exposure of the root structure and indicates loss of supporting bone. degenerated tissue above a toothThis may cause the tooth to be sensitive to hot or cold stimuli. The surface of the root is also softer than the tissue covering the crown of the tooth. This makes the tooth root more susceptible to decay. For many people, the recession is also a matter of aesthetics, or how it looks when you smile or talk.

The incidence of recession increases with age. The percentage of people with recession increased 3.5% with each decade of life. By the age of 65, 88% of people have at least one tooth with recession. Recession is slightly more common in men than women.

To correct the recession or thin tissue layer, a graft will be recommended. A graft is a procedure designed to replace or augment the amount of gum tissue supporting the tooth by adding tissue. There are three types of graft procedures.

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Gingival Grafttissue graft diagram

A gingival graft procedure is done to enhance the amount of gum tissue already in place and protect the underlying bone. It will not cover the root exposed through recession.  The donor tissue, or the tissue used to augment, is taken from the roof of the mouth, the palate. It is the same type of tissue found around the tooth.

In a gingival graft, the donor tissue comes from the smooth top layer of tissue on the palate found toward the back and closer to the teeth. Take your tongue and feel the roof of your mouth. In the front part, you will feel that the tissue is “bumpy”. Feel a little further back and you will feel the smooth tissue on either side of the bony line down the middle. That is the tissue used.

Because there is a limit of acceptable donor tissue available, the number of teeth that can be grafted at one time with a gingival graft is limited.

The procedure is done in the office with a local anesthetic. The donor tissue is taken from surface tissue of the palate. The wound feels like a “pizza burn” or a skinned knee.

An incision is made in the tissue between the lip and the gum tissue. Into this pocket, the donor tissue from your palate is inserted and stitched into place. Sometimes one or both of the surgical sites will be covered with a periodontal pack during the healing phase.

This material does not help in healing, but does make the healing time a little more comfortable for you. If you have several graft sites done at one time requiring that tissue be taken from both sides of the palate, Dr. Reidy may recommend that you have a stent made to cover the palate during the healing. A stent is a mouth guard-like appliance that we can make that is worn on the palate during the first part of healing.

You will be asked to return to the office in 7-10 days to have the stitches removed and then in about four weeks to have the surgery checked to make sure healing is progressing well.

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Connective Tissue Graft

A connective tissue graft is similar to the gingival graft, but uses a different tissue layer, and is designed to cover the root surface exposed in recession.

An incision is made in the palate in the same area as when doing a gingival graft, and the surface layer is folded back. The donor tissue is taken from the next layer down. The tissue layer taken is thicker and contains some blood vessels and stronger connective tissue. After the donor tissue is removed the surface tissue is folded back over the wound site.
A similar incision is made in the area in which the graft is to be made. This type of graft is meant to cover the root that is exposed for protection of the root and the underlying bone. This type of graft is often used in areas that are easily visible.

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Connective Tissue Graft with AlloDermalloderm tissue

The third type of graft is also a connective tissue graft, but instead of using your own tissue, a type of donor tissue is used. The donor tissue is AlloDerm, a tissue from organ donors that has been treated and sterilized, killing all the live cells in the tissue. All that remains is a matrix of connective tissue that helps new tissue develop.

The same surgical procedure is followed except there is no wound on the palate. Because the donor tissue is not limited to the appropriate tissue from the palate, more graft sites can be done in one appointment. No stent or periodontal pack is required.

This type of graft is also done to cover recession and protect the bone.

The length of each surgery will depend upon how many teeth are involved.

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Post-Surgical Instructions

After surgery, it is best to rest for 24 hours. Try not to do anything strenuous, such as running or bending. It is recommended that you do not drink anything through a straw for the first day. The vacuum action required to work a straw might cause bleeding to start.  Do not vigorously rinse your mouth for the first 24 hours. Do not brush or floss the surgical area until you have the sutures removed. You will be given home care instructions at the time of surgery.

Beginning the day after surgery, you may rinse gently as often as desired with a diluted flavored mouthwash. The solution should be 1/3 mouthwash to 2/3 warm water. A warm salt-water rinse, prepared with one teaspoon of salt to 8oz. of warm water may also be used, if you are not on a salt restricted diet.

You will be given pain medication for after surgery, and you should take it as long as you have pain. You will still be under the influence of the local anesthetic for 3-4 hours after the surgery so be careful about hot drinks. To help prevent swelling, sip ice chips for the first five hours after surgery. If any swelling develops, it should shrink in 3-4 days. The use of an ice pack will help reduce swelling. Apply ice to your face in the surgical area as soon as possible. Continue up to six hours, removing for five-minute intervals every half-hour. If swelling persists after the first 24 hours, use warm, mist heat, such as a face cloth placed under warm running water. If swelling persists beyond four days, call the office.  It is also recommended that you try not to smoke during the healing of your surgery.

It is normal to have a tinge of red in your saliva. If there seems to be heavier bleeding, try to find the source of the bleeding and apply pressure. The pressure should stop the bleeding in less than 30 minutes. You can try to apply pressure with a damp teabag. In addition to the pressure, the tannic acid in the tea helps stop bleeding. If you cannot stop the bleeding within 30 minutes, call the office.

Your diet will be restricted only to the level that you feel like eating. Just a hint – orange juice, bananas and tea with peppermint/spearmint may sting. For the first day or so, you will not want to eat anything crunchy. Soft foods like chicken, hamburger or protein drinks are always good.

You will have an appointment to return for suture removal and surgical check. If you have any questions, please feel free to contact our office.

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Website addresses for more information:
www.perio.org
www.ada.org

If you would like to search for additional information on line – keyword search:
“gingival+graft”
“connective+tissue+graft”