GINGIVAL (Gum) Grafting
Gingival grafting is used to correct or to prevent gum recession, and to repair anatomical gum defects around teeth or dental implants. These procedures may be performed for health reasons, for esthetic reasons, or both. There are various grafting techniques and, depending on your specific needs Dr. Ronderos will make recommendations regarding the type(s) of gum tissue graft that would work best for you. The most common techniques used for gingival grafting are briefly described in this section.
Not all cases of gum recession need grafting. When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession is more severe and it reaches the mucosa, gingival grafting is sometimes needed. Grafting is generally reserved for cases with moderate or severe recession and/or cases with high risk for further recession.
When you come to our office for your grafting procedure, a local anesthetic will be given to numb the areas involved. You may also receive medicine to help you relax. We want your experience in our office to be as comfortable as possible, so let us know if there is anything you need during your procedure.
Connective tissue graft:
Connective tissue grafting is the most frequently used and most researched method to cover exposed roots. It involves harvesting a thin piece of connective tissue from the inner side of the roof of your mouth (palate), and transplanting this tissue to the area of gum deficiency surrounding the exposed root. The grafted gum and the palate are then sutured. The effectiveness of this technique in obtaining root coverage is largely dependent on the anatomy and the extent of the gum recession. This type of grafting leads to a perfect color match and a completely natural appearance.
Free gingival graft:
Similar to a connective tissue graft, a free gingival graft involves the use of tissue from the roof of the mouth. But, instead of removing tissue from the inner side of the palate, a thin layer of tissue is removed from the surface of the roof of the mouth and then attached to the gum area being treated. This technique does not predictably lead to root coverage and after healing the gum tissue in the area may have a lighter tone than the surrounding gum. The free gingival graft is a very effective technique to prevent further gum recession.
Allogenic (acellular) dermal graft:
Acellular dermal matrix (ADM) grafts are an alternative to the use of tissue from the roof of the mouth. ADM is a soft tissue graft generated by removing all cells from dermis (form human donors), while preserving intact the extracellular skin matrix. Upon implantation, these grafts serve as a scaffold for the patient’s cells to grown and the graft becomes vascularized and integrated. These grafts have been used for more than 15-years in plastic surgery, reconstructive surgery, and periodontal surgery; they are safe and do not lead to rejection. The use of ADM for treatment of gum recession is widely supported by peer-reviewed clinical evidence. Multiple studies have shown comparable results for ADM grafts and Connective Tissue grafts. Aside from not needing to harvest tissue from the roof of the mouth, ADM grafts allow us to treat multiple recession defects given the unlimited amount of grafting material. Not all patients or sites are good candidates for the use of ADM grafts. Dr. Ronderos has more than 10 years experience in the use of ADM grafts. After a careful evaluation he will discuss with you the risk and benefit of this and other techniques that may be appropriate for your particular case.
Enamel Matrix Derivative
Enamel matrix derivative (EMD) is a widely used biologic agent in periodontics. The application of EMD promotes periodontal regeneration mimicking the events that take place during the development of the supporting structures of the tooth. EMD comes as a gel that has been shown to enhance the results from soft tissue grafting procedures.
There are various surgical techniques not mentioned in this information page. Advances in surgical materials and techniques has led to less invasive grafting procedures and improved results. The use of microsurgery instrumentation and technique with more precise incisions, better wound closure, and reduced trauma. Dr. Ronderos, after careful evaluation, will present the treatment options that will work best for you, your health, and your smile.