What is Grafting?
Grafting is a procedure used to replace / restore missing bone or gum tissue.
|Click to watch Alloderm Tunnel Graft for Gums
A gum (gingival) graft is used to replace missing and / or receded gum tissue.
Types of gum tissue:
There are two types of gum tissue in the mouth, one of which surrounds the necks of the teeth and is thick and protective in nature (keratinized gingiva). The other of which lines our cheeks and floor of the mouth whose purpose is to be elastic and mobile in nature (mucosa).
Why is a gum graft needed?
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Soft tissue grafts are used to replace missing thick tissue (keratinized gingiva), which has worn away from the necks of the teeth for a variety of reasons. The purpose of gum grafting is to minimize and/or arrest the progression of recession.
Unfortunately associated with every type of recession, there is bone loss, because the bone resides just beneath the gums. Therefore, if the gums have receded, then the bone too has receded. The purpose of gum grafting is to arrest the progression of recession and thereby halt the bone loss as well, by restoring a thick zone of protective tissue around the neck of the tooth / teeth which exhibits an absence of this thick keratinized gum tissue.
In certain instances it is not only possible to restore the missing keratinized (thick / protective) gum tissue, but also to cover the exposed root surface of the tooth / teeth in question. Other issues must be addressed as well, such as the biting forces being placed on the teeth.
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Unbalanced forces placed on the teeth in the presence of clenching or grinding can predispose an individual to recession. Being a candidate for this root coverage procedure, which is achieved by a connective tissue graft, is to be determined by the individual practitioner.
Cosmetic Gum Grafts:
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Esthetic gum grafting can be used to "plump up" the gum tissue in an area that is deficient and would result an unaesthetic cosmetic make-over. Remember the teeth and gums should exhibit symmetry, yet sometimes one side is deficient, therefore, gum grafting may be essential to achieve symmetry prior to a cosmetic make-over.
What causes recession?
When treating recession by gum grafting, the causative factor must also be addressed in order for the grafting procedure to be successful.
- Aggressive brushing - potentially? Some people believe that aggressive brushing with a hard bristled brush may be a co-factor in recession or erosion of the neck of the tooth
- Excessive biting forces - clenching and/or grinding? This can result in bending / flexing of teeth, which will often result in fracture of a small portion of tooth structure at the gum line (abfractions) and consequently bone and gum recession
- Maloccluded and misaligned teeth? Teeth that positioned outside the normal arch form of the jaw are subject to having abnormal forces placed on them causing recession
- Genetic Predispostion - Many patients are predisposed to having marginal or less than optimal oral tissue "bulk". While no disease or health issue may exist, some patients can experience gum recession or thinning out of tissue for no apparent reason.
What are the different types of Gum Grafts?
1. Soft tissue graft: There are many types of soft tissue grafts. This type of graft involves taking a small piece of tissue from the surface skin on the roof of the mouth and transplanting it to areas in the mouth that are lacking. This type of graft restores and augments the missing thick keratinized gingiva, but does not result in covering of the exposed root.
2. Connective Tissue Graft: In this procedure tissue is taken from the undersurface of the palatal tissue (roof of the mouth) via tiny incisions, and is used to not only restore missing thick keratinized gum tissue, but also used to cover exposed roots of the teeth.
3. Tunnel Grafting: A specialized procedure practiced by some periodontists who are able to use a tunneling method that places graft membranes "into and under" gum tissue, thereby creating an optimally healthy environment for the growth and regeneration of new or more gum tissue. Commonly used in cases where tooth root covering needs to be increased either in height or thickness. (bulk) Click here to view a live tunnel grafting surgery.
|Click picture to watch Bone Grafting Procedure
What is a bone graft?
Bone grafting is the replacement or augmentation of the bone around the teeth.
Why is a bone graft needed?
Bone grafting is performed to reverse the bone loss / destruction caused by periodontal disease, trauma, or ill fitting removable dentures. It is also used to augment bone to permit implant placement, such as augmenting bone in the sinus area for implant placement, or augmenting bone to enhance the fit and comfort of removable prostheses, or to enhance esthetics of a missing tooth site in the smile zone. When one loses a tooth, as in an extraction, the surrounding bone collapses. To preserve this bone for future implant placement or for esthetics, a bone graft is used.
What are the types of bone graft?
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1. autogenous - bone taken from one area of the patient and transplanted to another area requiring such grafting
2. allograft - either synthetic bone or bone from a bone bank (cadaver bone)
3. xenograft - bovine /cow bone
Which graft is used and when and why?
Autogenous bone is the "gold standard" and oftentimes has the most predictable results. This is described as the best type of graft because such bone is live bone with live active cellular elements that enhance bone growth, whereas other types of grafts are devoid of any active cellular material.
Allografts and Xenografts both do not require a second surgical site as does the autogenous bone. Ample amounts can be easily obtained.
Barrier membranes - Guided Tissue Regeneration
In conjunction with bone grafting, membranes are often used to help stabilize the bone graft as well as displace the gum tissue from invading the healing bone graft. Gum tissue grows at a much faster rate than bone, therefore, membranes are used to prevent gum tissue from growing in and displacing the bone graft before it matures.
Learn more details about tissue regeneration and the different types of products being developed that continue to accelerate tissue surgery possibilities.
Dr. Ernest Orphanos