Periodontal Plastic Surgery
Soft Tissue Grafting for Coverage of Exposed Tooth Roots with Progressive Gum Recession
Both teeth and implants are best maintained when they are in healthy gum tissues. In the past, poor gums were considered untreatable and were blamed as the cause for the failure of complicated dental restorations.
Today, Dr. Kroum Dimitrov utilizes the most advanced techniques to reconstruct the periodontal and gingival tissues. These techniques are both functional (improve cleanability and reduce sensitivity of exposed roots) and cosmetic (allow for natural appearing restorations with good shape and color).
Periodontal plastic and reconstructive surgery may involve procedures as simple as the minor recontouring of your gums or as complex as multi-staged grafting operations. Dr. Kroum Dimitrov will be glad to discuss your individual needs with you.
A frequent periodontal condition is known as gum recession. This means the existing gum tissue has receded exposing various amounts of the root. Root exposure can create root sensitivity to brushing and especially to hot and cold. This hinders a patient’s ability to perform oral hygiene procedures providing an increased incidence for root decay, and esthetic concerns. For years, gum grafting procedures have been the treatment of choice to prevent or correct gum recession from continuing further. There are many different types of recession and hence many different types of gum grafting procedures. Some are aimed at covering the root of the tooth and other procedures are focused on providing an excellent new zone of gum tissue to halt the recession.
Traditionally the gum tissue is harvest from the internal portion of the palate. This type of gum graft is called a Palatal Subepithelial Connective Tissue Graft. The donor site is dressed with a collagen plug that serves to prevent pain during healing. A few resorbable sutures are placed to close the site. More recently, gum tissue grafts can be harvested for the thick pad behind the most posterior upper molar tooth (Tuberosity Subepithelial Connective Tissue Graft). The tissue harvested from this area is of very good quality and thickness and the donor site typically heals with little if any pain. In many cases we can get enough good quality connective tissue from this site to treat 2-4 root recession defects.
These procedures can be performed under local anesthesia or IV sedation in our office hospital grade surgical suites. Initial healing occurs between 10 days to 3 weeks. The grafts are fully mature at 3 months. A soft diet is required for the first 1-2 weeks. The teeth are gently cleaned with a super-soft tooth brush. Any remaining sutures are removed at your postoperative visit.
In certain more complex cases a traditional gingival graft may be needed to restore an adequate band of good quality gum tissue that will halt gum recession around a single or multiple teeth. This graft is harvested from the surface of the palate (Gingival Graft). The donor site is dressed with a collagen membrane saturated in a solution of your platelets called Platelet rich plasma (PRP). This procedure has a reputation of being very painful. Nevertheless, if the donor site is dressed as described above and if a customized protective retainer that covers surgical area is used, most patients tell us that they did not experience any real pain only minor discomfort when placing and removing the retainer after the 10 day postoperative visit.
Tissue Engineering Approach to Biotype Conversion Surgery for Coverage of Exposed Tooth Roots with Progressive Gum Recession
Gingival biotype is the term used to describe a genetic predisposition for thin or thick gums. Generally, patients with this gum tissues and large teeth are most susceptible to progressive gum recession that can lead to tooth loss. Traditionally, these recession defects are treated with the gum graft procedures described above. Nevertheless, with the advent of blood component therapies, growth factors that promote periodontal regeneration and collagen based soft tissue graft substitutes (Mucograft™) we are able to fully correct or halt further gum recession without harvesting tissue from our patients. Dr. Sclar has over 5 years of experience with this innovative approach. To begin with the Biotype Conversion Surgery Represents a Paradigm Shift in Cosmetic and Functional Periodontal Plastic Surgery that includes both bone and Gum tissue regeneration that changes the genetic of the gum tissues to become thick and resistant to further recession. As the Biotype conversion surgery does not typically require surgical donor sites the recovery is much quicker and patients rarely experience any post procedure pain.