When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. When gum recession is a problem, gum reconstruction using soft tissue grafting techniques is an option.
When recession is only minor, some healthy attached gingiva often remains and protects the tooth. By using proper toothbrushing technique, patients may experience “creeping attachment” which may allow the soft tissue to rebound and cover the root surface. However, when recession reaches the mucosa (the tissue which lines the cheeks), the first line of defense against bacterial penetration is lost and soft tissue grafting may be indicated.
In addition, gum recession may result in root sensitivity to hot and cold foods as well as create an unsightly appearance of the gum and tooth. When significant, gum recession can predispose to worsening recession and expose the root surface, which is softer than enamel, to root decay and root abrasion.
- Palatal Connective Tissue Autograft – This method involves harvesting a piece of soft tissue from the palate and transplanting it underneath the gum tissue where the seal is compromised.
- Donor Human Dermal Allograft – This method involves reconstituting human acellular cadaver-sourced dermis, or skin, and transplanting it underneath the gum tissue where the seal is compromised.
- Donor Human Amnion-Chorion Allograft – This method involves placing human acellular placenta tissue underneath the gum tissue where the seal is compromised.
- Sliding Pedicle Graft – This method utilizes special incisions to slide attached gum tissue from a neighboring tooth with or without one of the above graft options to re-establish the seal over the root.
Since 2000, Dr. Noraian has used periodontal plastic surgery to restore the attached gum tissue around teeth with recession and/or sensitive roots. Regardless of the tissue option selected, the technique first involves microsurgery to make a small pouch were the seal needs to be restored. Next the root surface is cleaned and medicated with an antimicrobial rinse which gets rinsed off. The graft is then placed in the pouch and the soft tissue is brought up around it with sutures and then sealed with some other dressing material. During the first two weeks post-operatively, you are instructed to avoid chewing and brushing on the grafted area, avoid straws, and return for a two week post-operative visit to check sutures and review home care instructions. At the six week visit, periodontal charting will be done and a clearance letter will be generated. Occasionally additional follow-up may be indicated.
Using your own palatal tissue was the first method developed for treating recession and runs the risk of causing temporary or permanent numbness in addition to being quite uncomfortable during the healing process in the roof of the mouth. If you know someone who has had tissue harvested from their palate, they may have told you how uncomfortable it was for them. For procedures using your own tissue, a special appliance may be made ahead of time called a palatal stent to help cover the palatal wound and reduce discomfort.
Using donor tissues has become a method with which Dr. Noraian has become very comfortable and very predictable. The Human Acellular Dermal Allograft was the first method Dr. Noraian used with great success with the plastic surgery technique, but the inflammation was significant and patients were concerned about the odor. Dr. Noraian still discusses this option with patients but since 2008, it has given way to the use of Human Acellular Amnion-Chorion Allograft. Both options are freeze-dried and acellular so the body does not recognize these tissues as foreign so there is no risk of rejection. The amnion-chorion allograft is derived from tissue donated by mothers who deliver healthy babies via Caesarean section (sterile surgical delivery) and has been used in eye surgery for over 15 years.
American Association of Tissue Banks Protocol
All of the donor tissues used by Dr. Noraian follow the American Association of Tissue Banks (AATB) protocol for safety. By the amnion-chorion allograft has surpassed the other options in patient selection, and with Dr. Noraian, it is always your choice as to which tissue option to use.
Regardless of which tissue option is chosen, the gingival graft procedure is highly predictable and results in a stable, healthy band of attached tissue around the tooth.