A Comprehensive Guide to Gum Grafting
I believe you will find my guide to gum grafting to be comprehensive and informative.
In this guide, I will share with you my knowledge, experience, and treatment examples that relate to gum grafting.
My name is Dr. Rana Shahi, DDS, MS, MSD, and owner of LA Periodontics & Implant Specialists --- which is one of the leading periodontal centers in Los Angeles and Brentwood, California.
So if you're searching to learn as much as you can about a gum graft, I hope that you will my guide to be of value.
DR. RANA G. SHAHI, DDS, MS, MSD
Diplomate, American Board of Periodontology
What Is A Gum Graft?
A gum graft is a surgical procedure, usually performed by a periodontist, to correct gum recession. In the most common type of gum graft, a piece of tissue is taken from the roof of the patient’s mouth or a tissue bank and adhered to the receded area of the tooth and attached to the existing gum. The goal is to cover the receded area of the tooth, so it is no longer exposed and further recession doesn’t occur.
There a few different types of gum grafts, depending on the patient’s needs. If the patient has thin gums, a periodontist might perform a free gingival graft. In this procedure, a periodontist will cut out a piece of tissue from the roof of the mouth and transfer it to the exposed root of the tooth, stitching it to the existing gums. This is a better option for those with thin gums and was actually the earliest type of gum graft surgery performed by periodontists.
In 1985, Dr. Burton Langer developed the connective-tissue graft. This procedure uses tissue from the roof of the patient’s mouth to perform the graft. A flap of tissue is cut into the palate and tissue from beneath the flap called subepithelial connective tissue is removed and then stitched into the gums surrounding the affected area where the gum has receded. Today, this is the most commonly practiced gum graft procedure.
A pedicle graft might be performed if the patient has plenty of gum near the receded area. The periodontist will use the existing gum tissue above the receded area. By cutting a flap, known as a pedicle, into the gums, a periodontist can simply pull down the existing gum to cover the exposed area of the tooth’s root.
A patient can receive a gum graft on just one tooth or their entire mouth, depending on the location of the gum recession. The goal for any gum graft is for the graft to be successful, meaning the transferred tissue adheres to the new surface. A patient will need to visit his periodontist for follow up visits to make sure the graft is adhering correctly.
Gum recession is the No. 1 cause of tooth loss, which is why it needs to be treated as early as possible. Even though many people do not even notice when their gums are receding, a dentist will be able to detect gum recession with regular visits. If you are concerned you may have receding gums, make an appointment with your dentist. He or she can refer you to a periodontist for a gum graft if needed.
While gum recession is the most common reason for having a gum graft procedure done, some patients choose to receive a gum graft to correct an uneven smile line. For this reason, periodontists are sometimes known as the plastic surgeons of dentistry.
Periodontal disease, or periodontitis, is an advanced stage of gum disease. Whereas gingivitis can be treated with a consistent at-home oral hygiene routine of regular brushing and flossing, periodontitis occurs when gingivitis has not been corrected with proper care and the gums have begun to recede due to excessive plaque build-up. Periodontitis can be treated with professional cleaning, a root planing procedure, or antibiotics. But some cases of periodontitis will require a gum graft if the gum recession is affecting the placement and security of the teeth.
Some people are genetically predisposed to having thin gums. In this case, there’s nothing you can do to increase your gum tissue, so you may need a gum graft as a useful preventative procedure, ensuring you have enough gum in place when the inevitable recession begins.
If you have ever had braces, you are at risk for gum recession. Each year, 400,000 Americans develop gum disease or gum recession caused by orthodontics. This is because orthodontia can make oral hygiene difficult. Brushing and flossing are inhibited by braces, retainers, expanders, etc., so you could develop gingivitis that turns into the more severe periodontitis. Braces also put pressure on the teeth to move them into alignment. This pressure can cause gum inflammation and bone loss around the tooth, both of which can lead to gum recession.
If you have not had braces but you are planning to in the future, your dentist may recommend having a gum graft procedure first to prevent future gum loss.
Excessive Tooth Brushing
While brushing your teeth regularly is necessary to prevent gum recession, brushing your teeth too much, too vigorously, or with a toothbrush with harsh bristles can also cause gum recession. Gum recession caused by tooth brushing is most often seen on the left side of the mouth. This is because most people are right-handed, and when using a toothbrush with their right hand, too much pressure is applied to the left side of the mouth.
Ideally, we would all have perfectly aligned teeth, where our upper and lower teeth fit together seamlessly. But for most, this is not the reality. When our top and bottom teeth are misaligned, the teeth can come together and rub on the sides of some teeth rather than fitting right on top of them. This off-center pressure can cause damage to the gums and bone, which can in turn lead to gum recession.
Lip and Tongue Piercings
A study conducted by Dr. Dimitris Tatakis of Ohio State's College of Dentistry found that 41% of people with a lip piercing had receding gums. Tongue piercings have also been linked to gum recession. Constant contact between gums and jewelry can damage the gums in the area of contact, leading to periodontitis and gum recession.
Many people choose to have a gum graft simply for cosmetic reasons. They may have an uneven gumline, which makes their smile appear crooked and causes them to be self-conscious. Although an uneven gumline is often due to gum recession, it can sometimes just be uneven due to genetics. The patient may not need a gum graft for the health of their teeth, but rather may choose to have one for aesthetic reasons.
What to Know Before, During, and After Your Gum Graft
A gum graft procedure is a routine surgery performed by periodontists on a daily basis. Most procedures are relatively short and so is the recovery time. Even though gum grafts are not major surgery, it is good to be as prepared as possible for your procedure by knowing what to expect. Here is what you should know before, during, and after your gum graft.
What To Know Before A Gum Graft
Before you have your procedure performed, check with your insurance to know how much it will cost you out-of-pocket. You do not want to receive an unexpected bill after your procedure is already completed. If you do not have insurance or your insurance does not cover this type of procedure, talk to your periodontist’s office about payment plan and financing options.
Even though a gum graft is not major surgery and is non-invasive, you will want to bring someone with you to your appointment. You will likely be on pain medication directly after the procedure, which means you will need someone to drive you home. You will also need someone present after your appointment to take notes on any post-surgical instructions from your periodontist. Since you will be on pain meds, you may not remember these instructions.
What To Know During A Gum Graft
A gum graft procedure typically takes anywhere from 45 to 90 minutes, so it is a relatively short surgery. A periodontist will administer local anesthesia to numb the surgical area, but sedatives and general anesthesia are available upon request. If you have a fear of dental work or are feeling anxious about your procedure, ask your periodontist about your sedation options.
You can receive an IV drip for anesthesia and be put under completely, or you can take an oral sedative for conscious sedation, meaning you will be somewhat aware of what is happening, but you will feel sleepy and relaxed. This is another good reason to make sure someone accompanies you to your appointment.
What To Know After A Gum Graft
Recovery time for a gum graft is typically one to two weeks, and most patients report only moderate pain. Many compare it to a pizza burn on the roof of your mouth. You will be limited on what you can eat or drink during this time, so be sure to stock up on post-operative appropriate foods before you go into surgery. Soft foods and liquids, such as smoothies and soup, are ideal while you recover.
Complications are rare with a gum graft because the procedure is so straightforward, and most grafts are successful. Occasionally, some complications can occur, which can include:
- graft tissue that fails to graft to the new site
- loose teeth
- sensitive teeth
- space between the teeth
- swollen or bleeding gums
If you experience any of these complications following surgery, contact your dentist or periodontist immediately.
What Is A Gum Procedure Like?
Being told you need surgery is nerve-wracking. No matter how minor the procedure, you probably immediately wonder, What will the procedure be like? How will I feel? What will happen?
Allowing a surgeon to operate on your body makes you feel vulnerable, so it is helpful to know exactly what the surgeon will be doing. You cannot have control over the procedure, but knowing what to expect will give you some peace of mind.
What exactly happens during your gum graft procedure will depend on which type of gum graft you are getting. We already discussed the different types of gum grafts in Chapter 1, but let’s review them briefly.
Free gingival graft
In this procedure, a periodontist will cut out a piece of tissue from the roof of the mouth and transfer it to the exposed root of the tooth, stitching it to the existing gums. This procedure is best when the root of the tooth is not exposed, and the gum graft is more for aesthetic purposes.
This procedure also uses tissue from the roof of the patient’s mouth but is ideal for a patient who does have an exposed root due to gum recession. This is because a connective-tissue graft uses deeper, sturdier tissue from the roof of the mouth known as subepithelial connective tissue, hence “connective-tissue” graft. A flap of tissue is cut into the palate and the subepithelial tissue is removed from beneath the flap and stitched into the gums surrounding the affected area where the gum has receded.
This procedure might be performed if the patient has plenty of gum near the receded area. The periodontist will use the existing gum tissue and by cutting a flap known as a pedicle into the gums, a periodontist can simply pull down the existing gum to cover the exposed area of the tooth’s root.
Because the connective tissue graft is the most common, let’s walk through what that procedure would be like.
Gum Graft Surgery
On the day of your gum graft surgery, you will arrive at your periodontist’s office and be led to your surgery room. (Hopefully, you will have heeded our advice from Chapter 3 about what to know before your gum graft surgery.)
After being seated in a chair, much like the chair at your dentist’s office, your periodontist will begin administering local anesthesia to ensure you do not feel any pain during the surgery. You can also ask for general anesthesia if procedures like this tend to cause you severe anxiety.
After you are fully numb in the appropriate areas, your periodontist will prepare the recipient site—the tooth or teeth that will be receiving the graft—by separating the gum from the bone. Then, the donor site—the place on the roof of your mouth where the connective tissue will be taken from—is prepared by cutting a flap that will allow the top layer of tissue to be lifted and expose the graft tissue beneath. After harvesting the graft tissue, your periodontist will transfer it to the recipient site and stitch it into place. The final step is stitching the donor site.
Pretty simple, right? Some periodontists might cover your stitches with a clay-like substance, so you don’t accidentally irritate them with your tongue. You can also ask for a stent that can be placed over the donor site stitches. This stent can be moved in and out of your mouth, so you can eat without worrying about disturbing the sutures.
After Gum Graft Procedure
Immediately after your procedure, you can expect your mouth to feel numb until the anesthesia wears off. You can also expect to see some swelling for a few days after your procedure. After that, the swelling should go down as your graft site heals. You may also see some bleeding the first day, which is normal, but if you have excessive bleeding, contact your periodontist immediately.
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