Soft Tissue Grafting

Gingival recession (receding gums) refers to the progressive loss of gum tissue, which can eventually result in tooth root exposure if left untreated.  Gum recession is most common in adults over the age of 40, but the process can begin in the teenage years.

Gum recession can be difficult to self-diagnose in its earlier stages because the changes often occur asymptomatically and gradually.  Regular dental checkups will help to prevent gum recession and assess risk factors.

The following symptoms may be indicative of gum recession:

  • Sensitive teeth – When the gums recede enough to expose the cementum protecting the tooth root, the dentin tubules beneath will become more susceptible to external stimuli.
  • Visible roots – This is one of the main characteristics of a more severe case of gum recession. Individuals will often notice a slightly discolored part of their tooth exposed that wasn't before, and that area is typically the root of the tooth that is becoming exposed.
  • Longer-looking teeth – Individuals experiencing gingival recession often have a “toothy” smile.  The length of the teeth is perfectly normal, but the gum tissue has been lost, making the teeth appear longer.

 

Causes of Gum Recession

Gum recession is an incredibly widespread problem that dentists diagnose and treat on a daily basis.  It is important to thoroughly examine the affected areas and make an accurate diagnosis of the actual underlying problem.  Once the cause of the gum recession has been determined, surgical and non-surgical procedures can be performed to halt the progress of the recession and prevent it from occurring in the future.

The most common causes of gingival recession are:

  • Overaggressive brushing – Over-brushing can almost be as dangerous to the gums as too little. Brushing too hard or brushing with a hard-bristled toothbrush can erode the tooth enamel at the gum line and irritate/inflame gum tissue.
  • Poor oral hygiene – When brushing and flossing are performed improperly or not at all, a plaque build-up can begin to affect the teeth.  The plaque contains various bacterial toxins which can promote infection and erode the underlying jawbone.
  • Chewing tobacco – Any kind of tobacco use has devastating effects on the entire oral cavity, chewing tobacco in particular.  It aggravates the gingival lining of the mouth and causes gum recession when used continuously.
  • Periodontal disease – Periodontal disease can be a result of improper oral hygiene or caused by systemic diseases such as diabetes.  The excess sugars in the mouth and narrowed blood vessels experienced by diabetics create a perfect environment for oral bacteria.  The bacterium causes an infection that progresses deeper and deeper into the gum and bone tissue, eventually resulting in tooth loss.

 

Grafting Methods and Materials

Soft tissue grafting is often necessary to combat gum recession.  Periodontal disease, trauma, aging, overbrushing, and poor tooth positioning are the leading causes of gum recession which can lead to tooth-root exposure in severe cases.

When the roots of the teeth become exposed, eating hot and cold foods can be uncomfortable, decay is more prevalent and the aesthetic appearance of the smile is altered.  The main goal of soft tissue grafting is to either cover the exposed root or to thicken the existing gum tissue in order to halt further tissue loss. The three different types of common soft tissue grafts include:

  • Free gingival graft – A strip of tissue is removed from the roof of the mouth and stitched to the grafting site in order to promote natural growth.  This type of graft is most commonly used for thickening existing tissue.

  • Connective tissue graft – For larger areas or root exposure, subepithelial tissue is needed to remedy the problem.  This subepithelial connective tissue is removed from a small flap in the mouth and sutured to the grafting site.  This is the most common treatment for root exposure.

  • Pedicle graft – This type of graft involves the “sharing” of soft tissue between the affected site and adjacent gum.  Tissue is moved sideways from a healthy area to cover the affected root.  The results of this type of graft are excellent because the tissue that is moved to the adjacent area includes blood vessels that are left in place.

  • Acellular dermal matrix allograft – This procedure uses medically processed, donated human tissue as a tissue source for the graft.  The advantage of this is procedure is that there is no need for a donor site from the patient’s palate (and thus, less pain). However, not everyone is eligible for this graft, depending on the location and the severity of the recession that needs to be addressed.

Reasons for soft tissue grafting

Soft tissue grafting is an extremely versatile procedure that has many uses.  Recent developments in dental technology have made soft tissue grafting more predictable and less intrusive.  Here are some of the main benefits associated with soft tissue grafting treatment:

  • Improved aesthetics – Gum recession due to periodontal disease can cause the smile to look “toothy” or the teeth to appear uneven in size.  Soft tissue grafting can be used as a cosmetic procedure to re-augment the gums, and make the smile appear more symmetrical.
  • Improved gum health – It has been shown in studies that, when left untreated, teeth with recession can eventually lead to significantly increased amounts of recession. Therefore, treating recession early and thickening the tissue before it disappears can prevent future recession and help keep your teeth and your gums healthy for many years to come. 

 

What does soft tissue grafting treatment involve?

Initially, cleaning will be performed both above and below the gum line to clear the teeth and roots of calculus (tartar).  The grafting procedure itself will be performed under local anesthetic. The technique we use will depend on the size of the areas receiving grafts, the material chosen, and the degree of recession present. There are many different techniques available to treat recession, but we have included videos of our most common techniques below. Please feel free to call our office if you have questions about the specifics of the grafting procedures that were recommended to you. 

Platelet-rich growth factors which stimulate natural tissue growth and promote good healing may be applied to the site before suturing.  In addition, tissue-stimulating proteins may be added to encourage quicker tissue growth.  Finally, the wound site will be sutured to prevent shifting, and surgical material will be placed to protect the sensitive area.  Gum uniformity and substantial healing will take place in the first six weeks after the procedure.

If you have any questions about soft tissue grafting, please contact us.

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