Soft Tissue Grafts
Having a healthy gum tissue around the tooth contributes not only to the health
of the tooth but also how natural and beautiful they look.
Gum recession is very common and can happen due to many reasons out of which most
frequent are periodontal (gum) disease, excessive brushing, brushing with a hard
toothbrush, unfavorable position of the tooth, and sometimes trauma due to wrong
bite, defective dental restorations, or due to foreign objects like tongue and lip
piercings. Aging is another factor for gum recession.
As a result of gum recession root surface of the tooth becomes exposed. Since it
is not protected with enamel of the tooth it can become sensitive to cold, hot,
and touch. It also wears off faster during brushing creating abrasions. Exposed
root surface becomes susceptible to root decay. Gum recession can also create impaired
oral hygiene and esthetic issues.
Gum plastic surgeries are performed to prevent or treat gum recessions. One of the
most predictable gum plastic surgeries to cover the root surface is soft tissue
graft also called sub-epithelial connective tissue graft.
The Root Coverage Procedure
It involves creating a pouch by separating the gum tissue from the tooth,
inserting connective tissue graft underneath and anchoring it with sutures. The
tissue can be harvested from the patient (from the roof of the mouth) or obtained
from tissue banks, which is equally effective and there is no need for second donor
site surgery.
If the graft tissue is harvested from the roof of the mouth, the healing is associated
with some discomfort in the palate. It feels like a significant pizza burn.
If the graft tissue is obtained from tissue banks, the healing process is pretty
uneventful.
Keeping good oral hygiene is important for fast healing. The teeth should be brushed
and flossed regularly. Surgical site can be cleaned with q-tip dipped into a mouthwash
with gentle rubbing motion over the surface of the gum, teeth, and the sutures.
In some cases after the healing gum tissue needs reshaping and recontouring. The
procedure of reshaping and recontouring the gum is called gingivoplasty.
Case Presentation
Following patient has congenitally missing second incisor on his right side. The
canine has moved forward to fill in its space. The gum over that canine is recessed
and the conture is very high compared to the rest of the teeth. In order to restore
her smile to her liking it is imperative to make sure gum architecture follows the
guidelines.
The crown on her canine was made to look like second incisor to achieve symmetry
in her smile. This photo is flipped horizontally to make unbiased judgment on the
result. Connective tissue graft surgery is used to correct the gum architecture
and the rest of her upper teeth were crowned with porcelain crowns.
Here is the close up picture of the area that was corrected with connective tissue
graft. In this picture the gum tissue looks healthy and naturally pleasing.
