Fifth Ave Perio

Improving Smiles

Indications for Gum Grafting

When New York City patients come in to Fifth Avenue Periodontics with gum recession, Dr. Cliff Melnick can help regenerate the lost tissue with a procedure called Connective Tissue Grafting, also called Gum grafting, or gingival grafting. It is a regenerative procedure to reverse gum recession. The goal is to recontour the gums to cover exposed root surfaces which protects the teeth and supporting bone from damage, and and improves your smile.

Recession is usually caused by normal activities like brushing, eating, teeth grinding and aging. If recession is not treated, the teeth, supporting tissue and bone can become so damaged that it may result in tooth loss.

What are the indications for connective tissue grafting?

New York City patients suffering from gum recession do not automatically require connective tissue grafting. There are five 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: The tough, pink tissue called gingiva, is found around the teeth and helps form a tight cuff or seal around the tooth. When the gums pull away from the teeth, the tight seal is broken, which creates the perfect environment for bacteria to grow resulting in deep pockets, infection, and recession. A connective tissue graft will regenerate a band of gingiva to reform the tight biologic seal around the tooth. This will help halt recession, reduce sensitivity, improve healthy tooth function, and improve the appearance of your teeth and smile.

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. The gums must be healthy to allow for tooth movement during orthodontic treatment. Moving teeth into proper alignment with inadequate gum tissue can lead to recession. 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 increased 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 is much softer than enamel. Covering the roots back up will reduce your risk to root decay, and help prevent other periodontal conditions.

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 or hot tea or coffee can cause discomfort. Covering up the roots can go a long way towards reducing tooth sensitivity.

How are connective tissue grafts done?

First, Dr. Melnick will make a pouch in your gums. Then Dr. Melnick will 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 your own gum tissue as a 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 appointment 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 mildly uncomfortable but for more patients, they report little to no pain.