Why is a Soft Tissue Graft Recommended?

 

Rather frequently I see a patient in need of a soft tissue graft.  While there are certain conditions that lead to that recommendation, the primary reason is always the same – to save all the teeth!

 

When the gum recedes from the crown of the tooth, more root structure is exposed. The root does not contain any enamel on it and is frequently sensitive.   On a front tooth this can be a cosmetic problem as well.

 

The main reason that I refer a patient to the periodontist for grafting is when there is insufficient attached gingiva. What exactly does that mean? Well, there are 2 kinds of gum tissue. One is the attached gingiva, which is gum that is bound to the bone. The other is not attached to the bone and continues into the cheek. A tooth needs a certain thickness of the attached type of gum tissue or the recession will escalate. In extreme cases the survival of the tooth can be put in jeopardy.

 

There are a few causes of recession, but at the the top of the list I would put braces. When teeth are moved around they are sometimes moved forward from the top of the bone under the gum, just so that the teeth are occluding properly. So, if the tooth is forward, the bone level on the front of the tooth is lower and the gum recession is evident.

 

Other causes include grinding and clenching, which is very common in the population. Another problem is using hard or medium toothbrushes which will slowly abrade the tissue leading to recession.

 

Treatment is surgical, and there are various techniques available to the surgeon.

Prevention after surgery includes occlusal equilibration (adjusting the bite), orthodontic treatment (placing the teeth in a better position), bite guards, or a full restorative plan which could mean crowning all of the teeth. This last solution is why early treatment is better: avoiding major dental work.