Chicago Dentist for Life

Recent studies have produced results that show a link…

…between flossing and dementia.

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When your Dentist tells you that you need some form of dental treatment…

…check this blog first and educate yourself so you know what to expect.

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Periodontal disease, also known as gum disease…

This is the fifth service in our series “10 Advanced Chicago Dental Services to Keep Your Smile Beautiful” which is also available as a FREE eBook at www.DentalProfessionals.com/ebooks.

…is an infection of the tissues that support the teeth.

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A beautiful smile is not just for…

…movie stars and models anymore.

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Question 1
When is a gingival graft needed?

Answer 1
There are two basic reasons to perform gum grafting: to preserve a tooth’s bone support and ultimately its function, or to cover exposed roots.
Exposed root surface in the gums means there is already a loss of bone that supports the tooth.  We know from research that a tooth with one millimeter or less of gum tissue is much more likely to lose additional bone support in the future. Also, muscle pulls on thin gum and can further aggravate the problem, leading to additional loss of gum and bone. Placing a soft tissue graft helps to build up the amount of gum around a tooth and prevent further loss of gum and bone.
Gum grafts can cover most, if not all, of the exposed root surface.  A patient may want to cover exposed root surfaces to either improve the esthetics or to reduce sensitivity. Newer root coverage procedures also protect teeth with too-thin gums by increasing the amount of gingival tissue.
The most advanced procedures combine several technologies that enable rebuilding of both gum and lost bone.

Question 2
How long does the gum grafting procedure usually last?

Answer 2
Total time is approximately 60-90 minutes, which includes: pre-treatment preparation, time for you to choose music to listen to during the procedure, anesthetic, treatment and post-treatment instructions.

Question 3
What are the different types of ways to do grafts and the advantages of each?

Answer 3
There are two types of basic treatments for soft tissue grafting, each used successfully for many years.

The first procedure, developed in the early ‘60s, is called a soft tissue graft. This graft technique prepares a graft bed below the existing gum. This means that the increased gum tissue is directed away from the tooth and placed into the looser mucosal tissue. The grafted tissue is usually obtained by peeling a small and very thin sample of tissue from the hard palate or roof of the mouth. Some clinicians use tissue bank material that is processed to leave only a freeze-dried protein sheet. This material acts as a scaffolding and allows your own tissue to eventually grow over it. While this material does eliminate the need for a second surgical site in your mouth, as in the procedure detailed below, it does not appear to work quite as well as your own tissue.

The second, and newer procedure, is called a root coverage gum graft. The gum tissue surrounding the tooth in question is peeled away from the tooth, and deeper gum tissue is taken from the roof of the mouth. The site is stitched closed, leaving virtually no open wound. The graft material is then sandwiched between the peeled gum tissue and the tooth, closed with stitches, and hiked over the previously exposed root surface. This overlying flap of gum provides vital nourishment to the graft while the area heals.  Both sites heal within a few weeks and mature to a protective gum tissue.  Careful chewing is required to protect the graft while it heals. While this procedure does not cover the root surface of the tooth, it does protect the tooth against further gum recession.

Question 4
Which type of grafting is preferred?

Answer 4
The root coverage gum graft procedure is preferable in several ways. Since there is no open wound, the graft site is much more comfortable. Root coverage is more esthetically pleasing as the color match of the donor tissue is generally excellent.  Most important, the procedure protects the tooth against further breakdown. The only limitation is the need for neighboring teeth to have substantial levels of bone in order to ensure 100% root coverage.

Question 5
How long does it take to heal from the procedure?  Is there a lot of discomfort?

Answer 5
With either procedure, the vast majority of patients need mild pain medication for only ½ to 1 ½ days afterward.  While healing, patients need to take extra care while brushing and eating to protect the graft and allow it to bond with the underlying root surface.  Tooth brushing should be done gently.  A soft diet is required for the first few days while the graft begins to mature, and for one to two weeks after the procedure, patients should not allow more substantial foods to get into the graft site.

Question 6
Can gum grafting help a patient whose smile is affected by receding gums?

Answer 6
Yes, it absolutely can.  Receding gums can impact a smile as they cause an uneven frame to the teeth. When a patient has a high lip line, the gums will become a greater part of their smile.  If one or more teeth have changes in the height of their gums, this draws attention to the part that is different. Additionally, the tooth can appear longer than the rest of the teeth. That is why restoring the position of the gum back to its original position will also help restore a pleasing smile.

Question 7
Can any amount of exposed root be covered with grafting? What are some of the limits of grafting?

Answer 7
To answer this properly requires a bit of technical explanation. Placing a gum graft means you are relocating tissue that has been removed from its blood supply, which is its source of nutrition.  To keep this tissue alive until it can reconnect with the new area’s blood supply, it must be placed into an environment that can provide nourishment. A root surface has no vessels or blood supply to offer the graft, so we are dependent on the blood supply present in the bone neighboring the treated tooth. The better the bone support, the more blood supply is available to help the graft survive. That is why teeth with more severe bone loss around the sides have a poorer prognosis for root coverage. As the gum defect size increases, the chance for 100% root coverage decreases.
The same is true for dental implants, made of titanium.  The material presents the same challenges as a root surface and offers no nourishment, but tissue can be grafted over the top portions of an implant.

Question 8
Is grafting always necessary to treat receding gums?

Answer 8
No, it is not absolutely necessary except in cases where preserving the tooth’s bone support is necessary.  If the gums have receded to the point where there is no gum tissue surrounding a tooth, grafting is recommended.  You can choose not to graft if your concerns are cosmetic or you are experiencing hypersensitivity to temperature or pressure.

Question 9
What factors increase gum recession, and what can I do to prevent it?

Answer 9
I am so glad you asked! Factors that lead to receding gums include improper brushing techniques (aggressive tooth brushing, horizontal tooth brushing, or using medium and hard brushes), and clenching and grinding teeth.  A good first step toward prevention is to ask your dentist or hygienist for oral hygiene instruction.  They can show you how to brush in a way that reduces stress to the teeth and gums.  If you grind your teeth, ask about custom made acrylic appliances known as night guards, which will protect your teeth and gums from stress while you sleep.

Information courtesy of:
David Barack, DDS
University of Illinois Dental School
Diplomate of American Board of Periodontology

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