Tissue Grafting for gum recession

Gum recession occurs when the gums around the tooth move away from the tooth, exposing the root surface underneath. It can be caused by vigorous toothbrushing, thin underlying bone, plaque/tartar buildup, and very thin/inadequate type of gums overlying the tooth. Teeth that are moved from braces may also develop recession if the underlying bone in front of the tooth root is too thin to withstand movement. For someone with gum recession, there may or may not be sensitivity, but not having treatment in the area can increase the risk of further tissue and bone loss, as well as increased plaque retention and risk for caries.

Tissue grafting is a wonderful way to treat the area by increasing the thickness and strength of the tissues overlying the root, and obtaining partial if not complete root coverage. The success of grafting primarily depends on how severe the gum recession is, how much bone loss is under the gums, what the "leftover tissue" is like, and also how good the individuals's home care and health are. There are many types of gum grafting procedures out there, with different materials and different techniques involved, but for simplicity of this article we will just discuss two types here: connective tissue grafting and free gingival grafting. These both involve obtaining a small piece of tissue from the roof of the mouth as the "donor tissue". The roof of the mouth does heal quickly however and regenerates the tissue back in around 8 weeks.

Connective Tissue Grafting

Connective tissue grafting involves taking underlying tissue from the roof of the mouth and placing it in front of the exposed root. Then, the existing gums are drawn over the gum graft with the goal of covering the graft and obtaining as much root coverage as possible. The results can be quite aesthetic and natural looking.

Here are some examples of connective tissue grafting I've done over the years.

Free Gingival Grafting

While most tissue grafting is of the connective tissue type, sometimes free gingival grafting is used when significant root coverage is unlikely, or if the goal is mainly to develop thick pink tissue over the tooth, which will help protect the tooth from further tissue and bone loss. This is a very predictable procedure, and helps strengthen and protect the tooth significantly, but the aesthetic look may be slightly less desirable than connective tissue grafting, due to the differences in color between the graft and the surrounding tissues. Some but not full root coverage is usually expected with this procedure.

Here are a few examples of free gingival grafts I've done over the years.

What type of grafting should I have done?

Your periodontist will be able to go over the pros and cons of the these two types of procedures, and also discuss whether you are a candidate for other types of materials (Emdogain, donor tissue, root coverage procedures without any grafting material). Whichever method is employed, the goal is utlimately to create stronger, healthier tissue which will help resist further tissue and bone loss around your tooth.