The treatments for gingival recession vary depending on the amount of recession, the type, the cause and also the expected outcome of the treatment. Certain Periodontal Plastic Surgery procedures can create thick tissue which will stop further recession but in some cases these procedures may not be able to cover existing recession. The plastic surgery procedures are:
- The Free Gingival Graft
- The Lateral Graft
- The Sub-Epithelial Connective Tissue Graft
The Free Gingival Graft
The Free Gingival Graft is a procedure where a thin piece of gum tissue is removed from the roof of the patient’s mouth and transplanted to another site in order to create thick tough tissue or “attached gingiva”.
In some cases, this type of gum graft can only prevent further recession, which is all that is necessary to keep the tooth or teeth healthy. In other cases, this type of gum graft can partially or almost completely cover previously existing recession.
The donor site (the roof of the mouth) will heal without damaging the underlying gums,bone or teeth. In some cases, a freeze-dried human tissue product can be used in order to avoid taking the tissue from the roof of the mouth.
This recession is not only unsightly but is also infected since she can’t clean these thin, fragile tissues properly.
After the gum graft has been done, you can see that the root has been partially covered. It is more difficult to cover roots if multiple teeth are involved.
The Lateral Graft
The lateral graft is also called a “pedicle” graft since the gum tissue is raised from the area immediately lateral, or adjacent, to the area of recession. In order to do this, there must be an abundant amount of thick, tough, “attached gingiva” lateral to this area of recession. This is frequently not the situation in many cases of recession.
This “pedicle” of gum tissue is then rotated over the area of recession in order to attempt to cover the recession, as well as create a thick band of “attached gingiva” which will prevent further recession. A limitation of this procedure is that there can be some recession occuring from where the “pedicle” was moved from.
The patient is unhappy with this recession which is readily visible to her and others.
The artist’s drawing shows from where the “pedicle” flap will originate.
The artist’s drawing shows how the “pedicle” flap will be rotated over in order to cover the recession.
The final healed result has created a good cosmetic result while also preventing further recession and disease
The Sub-Epithelial Connective Tissue Graft (“Sub-Epi Graft”)
The sub-epithelial connective tissue graft is a procedure that is designed to:
1. Cover Recession (when a lateral “pedicle” graft can’t be done)
2. Re-Construct Areas of Bone Loss or Bone Resporption
When there is not enough thick tissue next to an area of recession and a lateral graft can’t be done, the “Sub-Epi” graft can be done. This usually uses a piece of gum tissue taken from the roof of the mouth but from under the superficial, surface gum tissue. An option, in some cases, is to use a “man-made” membrane instead of taking any tissue from the roof of the mouth.
In the surgical procedure, the gum tissue or “man-made” membrane is placed over the root of the tooth. A flap of gum tissue is raised from the base of the recession in order to cover the gum tissue or membrane — in order to provide a blood supply to the graft. This creates the potential to create healthy, tough tissue and also create a better cosmetic result.
This tooth has severe recession that is very unsightly.
The “drawing” shows where a flap of tissue will be raised to cover the graft.
This drawing shows the gum tissue or the membrane (shaded blue for contrast) placed over the root.
This drawing shows how the flap from the base of the recession is now covering the graft.
The healed result has covered the root and created a pleasing appearance.
Reconstruct Areas of Bone Loss or Bone Resorption
When some of the upper front teeth are removed (usually if a tooth fractured or a root canal failed), there may be the excessive loss of bone from where the tooth came out. This can leave an unsightly, or even ugly “depression” in the gum tissue. Too often, when a “dummy” tooth is replaced into the mouth, this “depression” requires the “dummy” or replacement tooth to be too long and unsightly. Before the replacement tooth is to be made, the “Sub-epi” graft should be done in order to reconstruct this deformed area. The result will be a more natural looking tooth and a happier smile.
An Unsightly Result
This is a bridge with a very poor appearance. This long replacement tooth could have been avoided with a “Sub-epi” graft.
The “dummy” tooth on her partial denture has an ugly, discolored plastic extension protruding into the area of bone loss.
With the tooth taken out, you can see how the plastic extension has “dug” into the gum tissue. A “Sub-Epi” graft will be placed under this depression in order to “plump-out” the gums.
This shows the reconstructed area. The gum has been built-out as a result of the “Sub-epi” graft being placed under the gum to “bulk-out” this area.
This shows how her partial denture replacement tooth now looks with the ugly plastic extension removed.
Learn more when you visit Sunnyvale Dental Care. Call Sunnyvale Dentist Dr. Nasser Antonious at 408-720-0900/ TOLL-FREE 1-877-9DENTAL to schedule a consultation today!