Gingival Graft (gum graft)
Before
After
Multiple maxillary recessions - Connective tissue graft
Mandibular multiple recessions - Connective tissue graft
Mandibular unitary recession - Conjunctive graft
3. Why a gum graft?
Your dentist will therefore recommend a gingival graft in 3 main cases
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to correct and stop gum recession,
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to reconstitute part of the volume lost by the gum following the extraction of one or more teeth,
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to correct an aesthetic inconvenience.
Gingival grafting restores thickness and height to the weakened gums, which stops the recession. Gum grafting is both restorative, preventive and plastic. It strengthens the supporting tissues to protect the teeth and often restores a beautiful smile.
Your dentist will be attentive to:
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sensitive teeth: sensitivity is due to root exposure and nerve stimulation.
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aesthetic level:
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a sensation of long teeth: the teeth seem longer, which is not very aesthetic and is often not appreciated when it concerns the front teeth.
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a visible demarcation due to the difference in color between the exposed root (more yellow) and the crown of the tooth.
1. What is a gingival recession?
A gingival recession is a retraction of the gums that can go as far as exposing the dental root.
In reality, we should rather talk about periodontal recession because the recession corresponds to a global migration of the periodontium towards the root: the gum but also the alveolar bone, the dental ligament and the cementum.
Caution: not all gum recessions can be covered with a graft Consult your dentist
Different representations of gum recession.
2. What are the reasons of gingival recession?
The gingival recession is linked to the association of:
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Predisposing factors:
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shape of the alveolar bone,
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dental malposition,
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fine gum,
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age.
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Triggering factors:
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traumatic brushing,
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certain dental movements during orthodontic treatments,
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ill-fitting crowns or amalgams,
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The accumulation of tartar and poor oral hygiene leading to the appearance of gingivitis or even periodontitis. However, if the bone loss is too important, a gingival graft alone will not be sufficient and we may resort to a bone graft.
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3. What are the consequences and symptoms of gingival recession?
The gum covers the root of the teeth and the alveolar bone that holds them in the jaw. Exposed, the roots become porous and are more vulnerable to cavities and dental hypersensitivity that can alter the quality of life. Moreover, at the aesthetic level, as the root is uncovered, the tooth seems longer, a manifestation that is not very aesthetic and is often badly experienced when it concerns the front teeth.
Consult your dentist if:
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bleeding after brushing or flossing
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red and swollen gums
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bad breath
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pain in the gum line
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visibly shrunken gums
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sensitivity to cold and heat or sweet foods
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exposed tooth roots
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tooth appearing longer
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loose tooth(s)
5. What are the gingival grafting techniques?
There are many techniques and variants of grafting of which 2 are mainly used:
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the epithelial-conjunctive graft (also called free autogenous graft):
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The graft, of an adequate thickness, is taken from the palate
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It is then placed on the area of the recession previously "prepared".
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This technique is used in the case of very advanced recessions; however, the "patching" effect linked to the difference in color of the grafted gum forces us to reserve it for non-visible areas (lower incisors).
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the "buried connective tissue" graft:
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Only a thin layer of the inner part of the gum of the palate or of the wisdom tooth area is removed
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This technique consists of sliding the connective tissue graft under the existing gum, which is too thin and has been gently removed from its support. These two layers (gum and connective graft) are then placed back on the root that was bare to cover it.
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This technique gives a very good aesthetic result because the graft is hidden under the gum of the recipient site.
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Reminder: it is sometimes possible to treat or stabilize a gingival recession without a graft if the gum is thick and of good quality and if the bone support is also favorable. This technique, called coronal displaced flap, consists in taking off the retracted gum and replacing it in order to cover the recession.
Epithelial-conjunctive graft (free autogenous graft)
Coronally displaced flap (a) without (b) with embedded connective tissue
Graft Tunneling Techniques for Root Coverage
6. What are the contraindications and precautions for gum grafting?
Four main prerequisites for a gum graft:
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,the patient with a general disease, such as diabetes, hypertension, AIDS... must have balanced biological constants
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the patient must have acquired a perfect and non-traumatic oral hygiene
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the patient must not have a periodontal disease; if it is the case, it must be treated and stabilized before the intervention.
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the patient must not smoke tobacco for several weeks before and after the operation; indeed, the vascularization of the graft area is a key factor of success and tobacco is a powerful vasoconstrictor that decreases the blood flow, and therefore increases the postoperative complications.
7. Post operation
After a gum graft, it is more important than ever to have good oral hygiene.
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good brushing with fluoride toothpaste,
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daily dental floss,
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a healthy diet
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regular dental and periodontal checkups.
Maintaining healthy gums is essential to maintain your overall oral health and therefore to preserve your smile.
8. Does it hurt to have a gum graft?
Pain during the operation
The gum grafting procedure itself is painless. In fact, it is performed under local anesthesia. You may feel some movement or pressure while your periodontist performs the procedure. If you begin to feel pain during the procedure, be sure to let your periodontist know.
After the procedure
It is normal to feel some discomfort or pain as the anesthesia begins to wear off after the gum graft. The intensity of the pain depends on individual pain tolerance and the type of gum graft used. It can be relieved by taking analgesic or anti-inflammatory medication and will diminish over the course of a few days.
It is not the site of the graft itself that generates the pain. In fact, the graft area usually creates just discomfort due to potential swelling, gauze and stitches (see Question 9: postoperative advice).
It is the area of the palate where the graft is taken that will be a little more painful for the first 2 weeks. Some people compare this pain to a pizza burn on the palate. This is why your dentist will give you a tray/plate to protect the area.
Complete healing of your mouth usually takes a week or two; however, patients usually return to work or normal activities the day after the procedure.
You will find in our blog a compilation of some articles from reference sites about the aftermath of a gum graft.
9. Pre- and post-operative advice for gingival grafting
Other links that might also interest you
Dr. Barral-Cadière will give you detailed advice. You will find below the most important points
Pre-operative advice
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Stop smoking several weeks before the operation
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Maintain impeccable oral hygiene
Post-operative advice
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Do not smoke for several weeks after the operation because smoking has a negative impact on vascularization
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Do not try to look at the graft by pulling on the lips as this creates tension on the sutures and can have a negative effect on the result
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Apply ice regularly to the cheek of the area affected by the graft
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Do not brush the graft area (you can brush the other teeth normally)
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Use the prescribed mouthwash in a "passive" way, i.e. put some solution in your mouth and bathe the operated area by tilting your head
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Avoid drinking through a straw as the suction may compress the graft
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Feed yourself with soft, cold or lukewarm food (no alcohol or carbonated drinks)
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Do not exercise