What is Grafting?

Grafting is a procedure used to replace / restore missing bone or gum tissue.

Gum Grafting:

A gum (gingival) graft is used to replace missing and or receded gum tissue.

Types of gum tissue:

There are two types of gum tissue in the mouth, one of which surrounds the necks of the teeth and is thick and protective in nature (keratinized gingiva). The other of which lines our cheeks and floor of the mouth whose purpose is to be elastic and mobile in nature (mucosa).

Why is a gum graft needed?

Soft tissue grafts are used to replace missing thick tissue (keratinized gingiva), which has worn away from the necks of the teeth for a variety of reasons. The purpose of gum grafting is to minimize and or arrest the progression of recession.

Unfortunately associated with every type of recession, there is bone loss, because the bone resides just beneath the gums. Therefore, if the gums have receded, then the bone too has receded. The purpose of gum grafting is to arrest the progression of recession and thereby halt the bone loss as well, by restoring a thick zone of protective tissue around the neck of the tooth or teeth which exhibits an absence of this thick keratinized gum tissue.

In certain instances it is not only possible to restore the missing keratinized (thick / protective) gum tissue, but also to cover the exposed root surface of the tooth or teeth in question. Other issues must be addressed as well, such as the biting forces being placed on the teeth.

Unbalanced forces placed on the teeth in the presence of clenching or grinding can predispose an individual to recession. Being a candidate for this root coverage procedure, which is achieved by a connective tissue graft, is to be determined by the individual practitioner.

Cosmetic Gum Grafts:

Esthetic gum grafting can be used to "plump up" the gum tissue in an area that is deficient and would result an unaesthetic cosmetic make-over. Remember the teeth and gums should exhibit symmetry, yet sometimes one side is deficient, therefore, gum grafting may be essential to achieve symmetry prior to a cosmetic make-over.

What causes recession?

Aggressive brushing - potentially? Some people believe that aggressive brushing with a hard bristled brush may be a co-factor in recession or erosion of the neck of the tooth Excessive biting forces - clenching and/or grinding? This can result in bending or flexing of teeth, which will often result in fracture of a small portion of tooth structure at the gum line (abfractions) and consequently bone and gum recession Maloccluded and misaligned teeth? Teeth that positioned outside the normal arch form of the jaw are subject to having abnormal forces placed on them causing recession. When treating recession by gum grafting, the causative factor must also be addressed in order for the grafting procedure to be successful.

What are the different types of Gum Grafts?

1. Soft tissue graft: There are many types of soft tissue grafts. This type of graft involves taking a small piece of tissue from the surface skin on the roof of the mouth and transplanting it to areas in the mouth that are lacking. This type of graft restores and augments the missing thick keratinized gingiva, but does not result in covering of the exposed root.

2. Connective Tissue Graft: In this procedure tissue is taken from the undersurface of the palatal tissue (roof of the mouth) via tiny incisions, and is used to not only restore missing thick keratinized gum tissue, but also used to cover exposed roots of the teeth.

Bone Grafting:

Why is a bone graft needed?

Bone grafting is performed to reverse the bone loss / destruction caused by periodontal disease, trauma, or ill fitting removable dentures. It is also used to augment bone to permit implant placement, such as augmenting bone in the sinus area for implant placement, or augmenting bone to enhance the fit and comfort of removable prostheses, or to enhance esthetics of a missing tooth site in the smile zone. When one loses a tooth, as in an extraction, the surrounding bone collapses. To preserve this bone for future implant placement or for esthetics, a bone graft is used.

What does your dentist mean when he says a Bone Graft is necessary to place your dental implant?

The success of a dental implant, it's ability to support a dental restoration, is very much dependent upon how much bone is available in the site where the implant is placed. There are lots of things that affect the bone volume including things like periodontal disease, trauma and infections and it is not unusual to open up a site in the mouth for implant placement and find out that some of the critical supporting bone is missing. No problem.... We have great techniques available to us to replace missing bone. We can increase the height of bone and the width of bone. We can fill in anatomical voids in bone thereby creating new bone and we can fill in all sorts of defects that develop when teeth are lost. We can even use grafting techniques to prevent the loss of bone in circumstances where bone would normally be lost like the extraction of a tooth.

Replacing missing bone or adding to existing bone is very often essential to the success of a dental implant and the ensuing restoration. The techniques to do this are well documented and should be used when indicated by any dentist who places dental implants. Most of us will have a good idea when additional bone or bone repair will be necessary before actually starting the placement of a dental implant and the patients should be informed of this possibility. Sometimes, however, we do get fooled and run into areas where unexpected bone grafting is indicated. As long as the dentist is prepared to replace or add to the existing bone and the patient understands the bone grafting procedure, there should not be any problem with these techniques...