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Geoffrey R. Bauman, DMD, MS | Treatment for Gum Recession in Newark

Geoffrey R. Bauman, DMD, MS / Board Certified,  American Board of Periodontology
Fellow, Midwest Implant Institute



Treatment for Gum Recession

Gingival (Gum) Grafting

The mouth is the only area of the body where a hard, bone-like tissue (teeth) penetrates the skin to the outside.  It is critical that the seal around the tooth where it passes through the gum (soft tissue) is maintained against bacteria and penetration by coarse/sharp foods.  

Most patients don't realize the difference between actual gum and the very fragile tissue (called alveolar mucosa) that is an extension of the inside of the lips and cheeks.  If the patient sees any soft tissue around the tooth, it is just presumed to be "gum."  However, except for the roof of the mouth, the teeth erupt with only a narrow strip of surrounding "gum" which is only about 2-8 mm wide after tooth eruption.  And if that gum is worn away (usually from aggressive brushing and/or flossing), all that remains is the very fragile soft tissue (alveolar mucosa) extending up to the teeth from the cheeks and lips.   This alveolar mucosa is recognizable by its much redder color and often one can even see the blood vessels through the thin surface.  This fragile tissue is not well attached to either the bone or tooth and so is more susceptible to bacterial attack, as well as to injury even from normal brushing and flossing.  Although areas where the gum is absent may remain unchanged for periods of time, it is an "accident waiting to happen."  All it takes is a coarse particle of food, a little slice of a tooth brush bristle, or an increase in bacterial load for a time and it is possible to experience more recession,  sometimes very rapidly.   And the underlying bone may then be lost also.  The further the recession progresses, the more difficult it is to treat.  Eventually it can become untreatable and the tooth lost. 

The primary purpose for gum grafting is to add gum back where it has been worn away and to bulk the tissue up against further loss.   Ideally, we’d like to see at least 3-5 millimeters of gum attached to the tooth in all areas.   A secondary reason for gum grafting is to cover damaged, sensitive, or unesthetic roots. 

It is much simpler and less expensive to just add gum at the level recession that exists.  So sometimes when the roots are not damaged, sensitive, of esthetic concern to the patient, or conditions are such that the roots just can't be covered, our only goal is then to add gum back where it is missing just to prevent it from getting worse.  This type graft is called a Free Gingival Graft.  It heals faster, with fewer complications, and probably has a tougher external surface, though both kinds of grafts are adequately tough.  The free gingival graft may be whiter in appearance and rougher on the surface.  In many areas of the mouth, the gums don't show when smiling so the appearance usually doesn’t matter.   And sometimes patients don't care about the appearance as long as the health is restored.   In such cases the graft can provide health less expensivly and with quicker healing and stability. 

The Connective Tissue Graft, which is used to cover the roots and provide a more cosmetic result, is a little more complex and requires that the patient be a little more careful about talking and activity in the first week or two after the surgery.  Since it covers the roots (about 90% success) and is more normal in color and surface texture, the result is usually much nicer in appearance.  With the roots covered, the appearance of the smile is usually more natural.  Both of the above grafts are taken from the roof of the mouth which is then dressed or sutured closed after the procedure.  With the modern dressings and protective appliances that we provide after the surgery, neither type of graft is usually very painful.  Prior to the modern dressings and appliances, the gum grafting used to be fairly painful, but these improvements have fairly well resolved that problem. 

Allograft (Dermis Membrane)  is a recently developed "off the shelf" graft material for gum grafting.  Allograft is human donor tissue from which all the cells have been removed and which has been disinfected to prevent disease transmission.  Allograft material is purchased from a medical tissue supplier so that we don't have to take the gum from the roof of the patient's mouth.  Allograft gum grafting is very good at providing the extra gum needed and usually covers the roots fairly well, though it is a little less predictable at covering roots than the patient's own gum and occasionally can have more complications if the patient is not very careful after the surgery.  In some instances patients just would rather not use their own gum from a second surgical site or they just don't have enough gum tissue to graft several areas of gum recession in a row.  Although the best results are generally achieved using the patient's own gum as the graft, very acceptable results can be achieved with allograft.   We have to purchase the material ahead of time so if this material is desired, it must be planned in advance.