Soft Tissue Grafting
Soft tissue grafting involves augmentation of the gums around teeth, typically where recession has occured. While not all recession requires grafting, there are some areas of recession that do require soft tissue grafting, and even some areas without recession that require soft tissue grafting. The four main reasons for soft tissue grafting are:
- Lack of Attached Gingiva:
There are two types of soft tissue in your mouth: Attached (or "Keratinized") Tissue and Unattached (or "Mucosa"). Attached tissue is pink and firm and found around the necks of the teeth. It is bound down to the tooth and bone and protects the tooth from trauma and plaque, the bacterial biofilm that causes cavities and periodontal disease. Mucosa is the unbound, freely movable tissue in your cheek. It's elasticity allows you to freely move your mouth to chew and talk, but provides no protection to your teeth. In some cases, teeth (or implants) have no (or minimal) attached tissue around them. This results in a tooth/implant that has a moveable gingival margin, collects plaque, is difficult to clean, is not resistant to trauma and increases the chance of recession and bone loss. This lack of attached tissue is called a "mucogingival defect" and, if present, a soft tissue graft is indicated to change the tissue around the tooth/implant to bound down tissue.
- Root Sensitivity
Root sensitivity occurs when the cementum surface of the root is exposed. This layer of tooth structure is not as thick nor resilient as enamel, and changes in temperature (air, cold) and osmotic pressure (sweets) can lead to sharp pains that can range from annoying to downright debilitating. Minimal recession can cause severe sensitivity. In fact, most of the sensitivity is due to exposure of dentin tubules (the structure under the cementum where nerves are located) where the crown of the tooth (enamel) meets the root of the tooth (cementum), an interface called the cementoenamel junction (or "CEJ", for short). Due to this, it is essential to cover the entire root when treating sensitivity with a soft tissue graft. If full root coverage is not achieved, sensitivity will likely be diminished but may never be eliminated. In some cases, full root coverage is not possible due to bone loss around the teeth, and other methods of root sensitivity control may be used.
While root coverage with soft tissue is the best way to treat root senstivity, there are a number of denitrifies that may affectively treat root sensitivity that your dentist or specialist can recommend.
It is important to have your dentist or specialist evaluate causes of sensitivity, as it may indicate a more severe problem such as a cavity, abscess, or need for a root canal.
One of the most common reasons for soft tissue grafting is to cover roots that are dark and make the tooth look longer. The cementum on the root surface is typically a light or dark yellow color, and when exposed can result in a very unaesthetic smile. In addition to color changes, root exposure can make teeth look long and ruin the symmetry with the remaining teeth in the arch. Fortunately, soft tissue grafting can often correct this by covering exposed roots and restoring the white and symmetrical smile that was once present. Soft tissue coverage predictability depends highly on the reason or recession - whether it is tooth brush abrasion or periodontitis. Typically, recession from toothbrush abrasion can be treated with grafting, while recession associated with bone loss cannot. Of course, it is important to address the cause of recession and correct any bad habits (forceful brushing) to avoid recurrence of recession following a soft tissue graft.
- Progressing Recession
Progressing recession is recession that is increasing over time. Without intervention, this recession will likely continue to progress and may cause bone loss, sensitivity and, ultimately, tooth loss.
How do you know if you have progressing recession? First and foremost, monitoring your recession to see if it has become worse over time. If you haven't monitored your recession, periodontal literature has shown that recession defects that are 3mm have a 67% chance of progressing and recession defects that are 4mm have a 100% chance of progressing. Ask your dentist how much recession you have. If he/she tells you 3mm or 4mm, then you need to have a consultation to determine if a soft tissue graft is indicated for you.
Root Caries: Although not a common reason for tissue grafting, root coverage may prevent root surface decay. Root surface ("Cementum") is not as resistant to acidic challenges than crown surface ("Enamel"), so covering the root surface with bound down tissue will help prevent future root surface decay in that site.
Thickening tissue: It is well documented that thicker tissue is more resistant to disease. Soft tissue grafting, by definition, involves thickening the tissue. This can help protect the area from future trauma or insult, prevent further recession, as well as provide better esthetics.
Soft Tissue Grafting Techniques
Connective Tissue Graft: Connective tissue grafts involving taking a small piece of tissue from the roof of your mouth ("donor site") and placing it at the area to be grafted ("recipient site"). The tissue on your palate is taken from underneath the epithelium (superficial layer), which is sutured back into place following removal. Patient's are given a palatal stent to wear for comfort and typically describe any palatal discomfort as a feeling similar to a "pizza burn". This "donor" tissue is typically tucked under the existing tissue and sutured into place.
Allograft: Allografts are similar to connective tissue grafts but no second surgical site (palate) is needed. The graft is from donated human tissue that has been processed to removal all cells and, thereby, any chance of disease transmission. Allografts have a long history of safety and efficacy, and play a large role in current periodontal treatment modalities. Since no cells are present, the allograft essentially acts as an infrastructure for your own cells to populate and grow. Allografts can be used in many cases and are great for treating multiple areas of recession at once, as "donor" tissue is not limited as it is in connective tissue grafts. In fact, a full mouth of recession can be treated in one appointment with allografts with no donor surgical site. While allografts can be used most of the time, there are certain instances when it is necessary to use connective tissue.
Soft Tissue Graft Procedure Allograft Root Coverage Procedure Soft Tissue Root Coverage
If you have been putting off having a tissue graft due to fear of palatal donor tissue, please schedule a consultation to see if an allograft can be used in your case. To schedule, click here.