What are the gum grafts?
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16 Jul 2018

What are the gum grafts?

A modern minimally invasive treatment that improves the prognosis of teeth.

The gum grafts are a surgical procedure that is performed taking a piece of soft tissue from a donor to use it in another place, called recipient site. The donor tissue can be obtained from the palate, the maxillary tuberosidad (zone of the wisdom teeth when they are not present), from the adjacent gum to the affected teeth, even from a tissue bank from humans or animals, or from artificial substitutes.

The recessions are essentially a condition in which the gum begins to recede leaving the root exposed to the mouth. With time, this process can continue forming small pockets between the tooth and the gum. This promotes the accumulation of bacteria in this zone and if they are not eliminated adequately complications can carry with time. Before getting to these situations, the gum recessions can be prevented without needing a surgical procedure. Some of the signs that can appear in an early way are an increase of the dental sensibility (hypersensitivity), perception of longer teeth, and gum clefts which is a gum wear in the free gingival margin or where the tooth joins to the gum.

The recessions can be caused by different reasons. The principal reason is the bacteria of the disease periodontal. The treatment of the gingivitis prevents the formation of initial recessions since in more advanced phases of periodontitis these are almost an inevitable condition. Another causing factor can be the trauma provoked by different agents as brushed aggressively (horizontal or circular) or the presence of a piercing. The bruxism might be another reason due to the fact that the nearest part of the tooth to the gum fractures as a wedge or abfracción, exposing the root of the teeth that are weakening with time. Another factor that predisposes to the recessions of the gums is to have a gum and bone thin in the outer (buccal) part of the teeth, and it is given specially in the patients of Caucasian race. In addition, another factor that facilitates and can cause recessions in patients with thin bone and gum is the teeth movement with orthodontics; evidently an expansive movement of orthodontics or towards the outside since it might be in the cases of severe crowding or compressions of the maxilla.

The surgical treatment of gum grafts are a valid treatment for the recessions in more advanced phases. We can divide the types of grafts in three groups: grafts of connective tissue, free gingival grafts and pedicle grafts.

The grafts of connective tissue are the type of graft mostly used and that according to the studies obtain the best results. To obtain it a small incision is performed in the palate in such a way that the periodontist could obtain the connective tissue from the interior of the palate (as if we were taking the cheese of a sandwich and closing back the bread). Hereby it generates a minimal inconvenience in the palate and heals internally. Later it is placed covering the exposed root and it remains covered by the gum of the patient. The free graft is taken directly from the palate including the skin and the internal tissue up to 2mm, and it is placed on the root exposed without covering it. The pediculated graft would be the displacement of the gum of neighboring zones to the affected one.

After the surgery it is important to follow the instructions explained by the dentist or periodontist (dentist specialist in gums). It is important that the graft receives neither any type of trauma nor movement until it is healed (from 4 to 15 days) so brushing will be avoided in this zone and the use of the dental floss, too. To support a correct hygiene and to avoid possible infections the dentist will recommend the use of mouthwashes or antibacterial gels. Also the diet will be affected being soft and cold diet. The pain that the patient could experience is very slight, being greater the inflammation that depends on different factors as the complexity of the surgery and the quantity of implied teeth. The anti-inflammatory medicines post surgery will help to control the pain and the inflammation.

The gum grafts allow to reduce the progression of the recessions and this way to improve the prognosis of teeth; to reduce also the sensitivity of the root to cold or warm stimuli protecting the roots of the teeth; to improve the aesthetics leveling the gum of the different teeth. In addition it allows to treat some consequences of the periodontal disease.

Dr. José Nart Molina

Dr. Jose Nart Molina is a specialist in periodontics and dental implants. He has a degree in Dentistry from the UIC (2006) He also has a doctorate in Dentistry from the UIC, certified in periodontics and implants by the University of Tufts University (2007), accredited by the European Federation of Periodontology, Vice President of the Spanish Society of Periodontics and Osseointegration and Vice Dean of Research.

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