Gum Grafting

Having problems with gum recession?

There are many reasons that you maybe losing gum. For a variety of reasons this can cause a lot of stress, discomfort. and if left alone long enough, eventually tooth loss!

Common causes are:

• trauma (tooth brushing, lip piercings),
• systemic (smoking, gum disease)
• side effects (orthodontic tooth movement, medications)

What ever the cause, knowing that you are losing gum can be both very distressing and often, when it is occurring on the top teeth - aesthetically challenging. The loss of confidence and unwillingness to smile broadly is not a position that anyone wishes to be in!

What are my treatment options?

Traditionally, we would take a piece of gum from the palate, the donor site. that piece of gum would be taken, and then sutured to the area with gum recession. Whilst there is some pain on the area where the gum was grafted to, it is the donor site (the palate) which really hurts afterwards!

With new innovations in materials science, Geistlich has for years now an alternative, and that is the Mucograft^TM and Fibrogide.  Although the product it self is fairly expensive, the amount of time we would save from the procedure of harvesting gum from the palate (and the management of the bleeding afterwards), means that the costs of the bio material is offset by the amount of time we would save, meaning that overall - there is no extra expenses! Furthermore - you avoid having a hole cut into the palate! #Palate Free

We simply make a small incision near/around the recession area, and suture the material in (a slight simplification, but not too far from what actually happens).

Depending on how severe the recession is - there is different fees. To  understand how we determine the recession severity, read down below for a more details.

Two different types of gum

We have two different types of gum in our oral mucosa. keratinised epithelium (or keratinized epithelium for you Americans) and non-keratinised epithelium. Keratinised epithelium is essentially toughened gum. It is skin which has many rough long strands of keratin (the stuff which makes up your hair and nails) interwoven within in the skin. Non-keratinised epithelium is simply normal gum which is normal and does not have the extra reinforcement.

Take a quick look at this picture to see the two separate layers (the pink gums near the teeth is the keratinised epithelium).

Keep in mind - that our bodies are if anything SUPER efficient. There is very little waste, and skin - having a turn over rate of around 7 or so days means that every 7 days or so, the old skin (or gum) is shed, and new reinforced gums are produced. This toughened gum (keratinised epithelium) is expensive upkeep!

So why does our body "waste" extra precious resources to toughen up these parts of the mouth (a thin layer around our teeth, and our palate).

Well, when we chew - especially hard foods back when we didn't used to cook our food, our teeth would cut what we're eating, and the hard food scraps would tear into our gums! This toughened gums are there for necessity!

When our toughened gums thin out, or disappear we're in trouble! Even ordinary actions such as tooth brushing or eating would eventually exacerbate and cause gum recession

Knowing the classifications

Now the two different layers of gum in our mouth, and being able to recognize them, enables us to now classify how severe the gum recession is.

The generally used gingival recession is called "Miller's classification for gingival recession"

This fantastic diagram makes it very easy to see.

In short:

• Grade 1 - the gum recession has just started and is completely within the attached gingiva (or keratinised epithelium)
• Grade 2 - the gum recession is getting very close to the junction where the keratinised epithelium ends, but there is still some keratinised epithelium left
• Grade 3 - the recession has progressed beyond the keratinised epithelium and has entered the non-keratnised epithelium
• Grade 4 - the recession involves multiple teeth, and is now horizontal in nature in addition to vertical loss.

Why does this classification matter to me?

When we graft into the area, obviously the more damage to repair the harder it is to heal. The process is a bit complicated, but can also be simplified.

Grade 1 and 2 is relatively simple to repair, and chances of success is very high,

Whilst Grade 3 often requires a second attempt to produce desired results, or often, simply will never be back to the way it was.

Grade 4 gum recession cannot be grafted individually, and often requires much more advanced surgery (coronally advanced flap) to correct, and is outside the scope of this article today.