Tissue Grafting Procedure
Tissue grafting is a procedure periodontists perform to treat receded or thin gums. Gum recession causes exposed roots, which can age a smile and make teeth sensitive. Also, exposed root surfaces are more prone to getting cavities. Whether you wish to enhance your smile by covering exposed root surfaces that make your teeth appear too long, or you no longer want to cringe because the exposed roots are sensitive to hot or cold foods and liquids, soft tissue grafting can help you strengthen your smile.
Why Do Gums Recede?
Gums may recede for a variety of reasons including: aggressive tooth brushing, excessive biting forces and periodontal disease. Prior to treatment your periodontist can help you identify the factors contributing to the problem. Once the root of the problem is controlled, a soft tissue graft (gum graft) is done to cover the exposed roots. The gum graft will also “thicken” the gum in order to provide better protection against future gum recession. The procedure requires the periodontist to take a small piece of gum tissue from your existing tissue (autogenous) or from a donor bank (allograft). This tissue is then transferred to the receded gum area to cover the exposed root(s) and stabilize the teeth.
We perform this procedure using minimally invasive instruments. With these dental tools, your gums do not have to be cut open. Rather the gum tissue is slightly loosened and the gum graft material is slid underneath your existing gum tissue. A few thin sutures are placed for safety and to prevent movement of the graft. These sutures are removed in 3-4 weeks depending on the healing of the tissue graft.
The goals of gum tissue grafting are:
1) To increase the amount of attached gum tissue
2) To increase the thickness of the gum tissue
3) To cover the root surface
Depending on your situation, your periodontist at PerioLife will discuss the best treatment option for you regarding gum grafting and receding gums.
Frequently Asked Questions
A gum tissue graft is a procedure completed by a periodontist to correct receding gums. Tissue can be harvested from your mouth or come from a tissue bank. Both options work but your periodontist will assess your specific condition and recommend the best procedure for you. At PerioLife, we offer a minimally invasive technique where no cuts need to be made in your mouth and microsurgical instruments are used. This procedure is called tunnelling. Ask your PerioLife periodontist if you are a candidate for this modern procedure.
There are a couple of different types of gum grafts depending on your dental needs.
A connective tissue graft is used to increase root coverage when there is existing attached tissue albeit minimal. In this case, tissue can be harvested from your palate. However, the tissue is harvested from underneath the skin on your palate. A single incision is made on your palate and the inside tissue called connective tissue is harvested. The single incision is then sutured closed. Conversely, the tissue can also be obtained from a donor bank. The gum tissue is called acellular dermal matrix. It is used extensively in dentistry and medicine. The gum tissue has no cells and has been through several layers of cleansing and is thus safe to be used.
Another type of tissue graft is the free gingival graft. The free gingival graft includes the top layer of epithelium in your palate. This type of graft is used with there is no attached tissue over the tooth. This graft is then sutured over your tooth and allowed to heal. With this type of tissue harvest, the gum has to regenerate much like a scrape anywhere else on your body. The blood must clot and then “scab” to heal.
Gum recession most often occurs from abrasive or excessive toothbrushing. A soft tissue brush is always recommended as soft is the only bristle that is small enough to clean inside your gum pockets and not cause damage to your gums. Medium and Hard bristle toothbrushes have bristles that are too large to actually clean within your gums. Furthermore, several studies have shown that electric toothbrushes are better long term for preventing gum recession and managing periodontal disease. Oftentime, electric toothbrushes will stop working if you put too much pressure onto your gums. It is best to hold your toothbrush like a violin bow with 2-3 fingers instead of a drum stick which would involve a whole hand hold.
Furthermore, gum recession can occur when there is a lack of attached gum tissue or gingiva. There are 2 types of gum tissue- attached and mucosa. The attached gum tissue is most closely connected to your tooth and is bound down to the underlying bone. It is a protective barrier for your teeth to prevent the downgrowth of plaque and bacteria. Mucosa is the layer of gum tissue directly below attached tissue. It has elastic fibers and thus is very moveable. Due to its elastic nature, your mouth is able to eat, speak, and chew. Thus, both types of tissues are important. However, gum recession often occurs when there is a lack of attached tissue. Without the protective barrier of attached tissue, mucosa is not able to adequately protect the root surface of the teeth and can be brushed away over time. Thus it is important to restore the attached tissue for the long term health of the tooth.
Gum tissue can either be harvested from your palate or come from a tissue bank.
There are two different ways to harvest tissue from your palate : the subepithelial connective graft or a free gingival graft. Palatal tissue of course comes from you. Tissue from the tissue bank comes from a tissue bank from human cadaver tissue. It has been through several cleansing processes and thus is safe to use. It is called acelluar dermal matrix and there are several dental and medical uses for it.
Pain is a very personal measure and thus everyone has different experiences. Free gingival grafts tend to be the most uncomfortable of the gum grafts but your periodontist will discuss pain control options with you. Connective tissue grafts that are completed with donor tissue tend to be the least painful as there is no second surgical harvesting site.
Swelling is usually the cause for pain. Swelling from gum grafting typically starts at day 3 and increases until day 5. Swelling will then taper off from there.
Gum grafting ranges from $300-1200 per tooth depending on the type of gum grafting and what your insurance policy may cover. Dental insurance may pay $1500-2000 of the cost of the gum grafting. Our PerioLife offices in Dallas, Irving, Keller, and Fort Worth are in network with all major insurance companies and thus we can help you minimize out of pocket costs. Contact us for more information regarding pricing.
Gum grafts typically do not fail in a healthy individual. Gum tissue can recede again if aggressive brushing habits are not changed. Thus it is important to listen to your Periodontist regarding aftercare. Also, it is very important to not lift your lip to look at the surgical site after the gum graft has been completed to avoid movement of the gum graft as it is healing. Pulling your lip up to see the surgical site can rip the stitches or move the gum flap to an undesirable position.
Our general rule of thumb is to eat foods that you could cut with a fork. The following foods would be acceptable:
- Scrambled eggs
- Tuna or any soft fish
- Soup (as long as it’s not too hot)
- Ice cream!
Make sure to avoid chips, popcorn, berries with small seeds (blueberries, strawberries, raspberries), or any other crunchy foods.
We recommend light tooth brushing after the surgery to sweep away any food that may be caught in your teeth after eating. You will also be prescribed a mouthwash to keep your mouth clean after the surgery. Avoid flossing the first week.