Connective Tissue Grafts

Your general dentist may have told you that you have gum recession, or you you may have noticed you are having hot/cold sensitivity when you eat and drink. When patients come in with gum recession, we can help regenerate the lost tissue with a procedure called Connective Tissue Grafting.

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What are the indications for connective tissue grafting?
Simply having gum recession does not mean you have to have a connective tissue graft. There are 5 MAIN INDICATIONS for connective tissue grafting:

1. Esthetics: Recession of the gingival (gums) can result in unsightly yellow root exposure, as well as abnormally long appearing teeth. Connective tissue grafts can cover up most, and sometimes all of the recession that has taken place. Once the regenerated tissue has healed and matured the tooth will look more natural, with a beautiful, healthy appearance.

2. Inadequate Gingiva: There are two types of tissue in your mouth. There is the tough, pink tissue called gingiva which is meant to be chewed and functioned on. The gingiva is found around the teeth as well as on the palate, and helps form a tight biologic seal around the tooth. The other tissue is the loose, flabby tissue found in your cheeks and lips. This loose, flabby tissue is not meant to be chewed and functioned on. If you do not have adequate gingiva you cannot form the tight biologic seal around the tooth. This will allow bacteria to enter into the pockets and cause infection and further recession. A connective tissue graft will regenerate a band of gingiva to reform the tight biologic seal around the tooth.

3. Pre-Orthodontic: You may have consulted with your orthodontist and were told you need to have connective tissue grafting done before you start your orthodontic (braces) treatment. This is especially important if you are going to have expansion or if your teeth are going to be flared out. Sometimes recessions occur during active orthodontic treatment. If this is the case we can regenerate the tissue that has been lost to keep your orthodontics moving ahead.

4. Root Decay: Patients with gingival recession are at greater risk for decay on their root surfaces. The white, hard tooth structure we see is enamel, and it is meant to be exposed to the oral environment. The root surface, which tends to be more yellow, is made of dentin which tends to be much softer than enamel. In patients with less than ideal home care, this can pre-dispose them to decay on the root surface. Covering the roots back up will reduce your risk to root decay.

5. Tooth Sensitivity: When roots are exposed this can cause the roots to be very sensitive to hot, cold or touch. Just drinking a cold glass of water can be very unpleasant. Covering up the roots can go a long way towards reducing tooth sensitivity.

How are connective tissue grafts done?
First, we make a pouch in your gums, similar to a pita pocket. Then we borrow some tissue from the roof of your mouth, place the tissue into the pouch and close the flap back up. In essence, we are using you as your own Band-Aid. The roof of your mouth will also be sutured and the tissue will regenerate. This tissue will integrate with your gums. Usually we can cover up most and sometimes all of the recession that has taken place.

What type of healing can I expect?
In the early days you can expect your graft to look worse before it looks better. There will be a whitish/yellowish appearance on the surface. This is simply the surface cells of the graft dying off. A few days later you will see a raw, reddish appearance. This is a good sign that the graft is receiving an adequate blood supply. When you return for your post-op 10 days later we will remove the sutures for you. The graft may appear to be lumpy and bumpy. If there is excess tissue regenerated, then this is a wonderful problem to have. Your body will remodel and reshape the graft with time and as it matures, it will blend in beautifully. If, after 3-4 months, there are still some residual lumps and bumps we can usually reshape the tissue in just a few minutes. There is no additional charge for any reshaping. Will it hurt? The site where the graft goes usually does not cause any significant discomfort. The site where the tissue came from (the palate) can be uncomfortable for a few days or even a week.

How should I care for my graft?

  • Do not rinse your mouth the day of the surgery unless otherwise instructed to do so.
  • Do not eat or drink anything hot for the first 6-8 hours following surgery. Heat can contribute to bleeding and can soften the protective dressing that may have been placed over your gums.
  • Keep taking nourishment. Try not to skip a meal. Begin by eating soft foods or liquids, but return to your normal diet as soon as possible. You will feel better, have more strength, less pain and heal faster if you continue to eat. Avoid contact with the grafted area.
  • You may notice that sutures and/or dressing have been placed in your mouth. If gut sutures were used, they will dissolve in 6-8 days, along with the clear adhesive dressing.
  • If a pain pill has been prescribed for you, take the first one BEFORE your anesthesia wears out. Or you may take an aspirin-free pain reliever, such as Tylenol.
  • It is very important not to disturb the graft during healing. DO NOT BRUSH THE GRAFT SITE FOR 5 DAYS. Then you may very gently brush the teeth only using the extra soft toothbrush that you may have been given (stay away from the graft). After 2 full weeks, you can brush the teeth and gums still using the extra soft toothbrush. After 3 weeks, no special care is needed. Brush the graft area as you would any other areas. It is very important to keep it clean.
  • Keep all physical activities to a minimum the first 24 hours to help prevent bleeding.
  • Slight oozing is to be expected for several hours (oozing is a little blood mixed with your saliva).
  • In the event of more significant bleeding, determine whether it is the graft site or the palate (donor site) that is bleeding. Apply pressure with a dampened gauze pad or a moistened tea bag on the palate. This should stop any bleeding from the palate. If it is bleeding from the graft site, DO NOT apply pressure to the graft or the graft could fail. Gauze can be placed on either side of the graft, but not over the graft.
  • If the above treatment is unsuccessful, feel free to call us at the office, or after hours using the emergency numbers.

Gallery of Connective Tissue Grafting

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Lyle B. (Periodontal patient)
Jun 29, 2014

 

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Jun 29, 2014

 

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