Grafting is a procedure
used to replace / restore missing bone or gum tissue.
A gum (gingival) graft is used to replace missing and / or receded
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).
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.
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 / 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 / teeth in question. Other issues must be addressed
as well, such as the biting forces being placed on the teeth.
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.
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.
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
biting forces - clenching and/or grinding? This can result in
bending / 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
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
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.
What is a bone graft?
Bone grafting is the replacement
or augmentation of the bone around the teeth.
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.
the types of bone graft?
1. autogenous - bone taken
from one area of the patient and transplanted to another area
requiring such grafting
2. allograft - either synthetic bone or bone from a bone bank
3. xenograft - bovine /cow bone
graft is used and when and why?
Autogenous bone is the
"gold standard" and oftentimes has the most predictable
results. This is described as the best type of graft because such
bone is live bone with live active cellular elements that enhance
bone growth, whereas other types of grafts are devoid of any active
Allografts and Xenografts
both do not require a second surgical site as does the autogenous
bone. Ample amounts can be easily obtained.
In conjunction with bone
grafting, membranes are often used to help stabilize the bone
graft as well as displace the gum tissue from invading the healing
bone graft. Gum tissue grows at a much faster rate than bone,
therefore, membranes are used to prevent gum tissue from growing
in and displacing the bone graft before it matures.
Crown lengthening is a
surgical procedure performed by a dentist to expose a greater
height of tooth structure in order to properly restore the tooth
prosthetically. This is done by incising the gingival tissue around
a tooth and predictably removing a given height of alveolar bone
from the circumference of the tooth or teeth being operated on.
While a general dentist may perform this procedure, he or she
may refer the procedure to be performed by a periodontist or an
This common procedure involves
the removal of gum tissue, bone or both to expose more of a tooth's
Crown lengthening is done
when a tooth needs to be restored, but there is not enough tooth
structure above the gum line to support a filling or a crown.
This can happen when a tooth breaks off at the gum line, or a
crown or filling falls out of a tooth that has extensive decay
underneath. If your dentist wants to repair the tooth using a
crown or a large filling, he or she may need to expose more of
the tooth by removing some soft tissue or bone.
In rare cases, a condition called gummy smile when an unusually
large amount of gum tissue shows around the upper teeth can
be treated using crown lengthening.
You will visit a periodontist
for a consultation before the procedure. During the consultation,
the specialist will review your medical history and your X-rays,
and set a date for the surgery.
periodontist will instruct you on how to keep the area clean after
the surgery. You may receive a tooth cleaning before the procedure.
If the tooth needs a crown, your periodontist may have a temporary
crown put on the tooth to protect it. This also makes the crown-lengthening
procedure easier because the tooth is already prepared for the
crown, and the periodontist can see precisely how much soft tissue
or bone will need to be removed.
Once the area has healed completely in about three months
your dentist will prepare the tooth again, and make a new temporary
crown before making the final crown.
This procedure is done
under local anesthesia. The amount of time it takes varies depending
on the number of teeth that requiretreatmente. Although your problem
may involve only one tooth, crown-lengthening surgery typically
includes neighboring teeth so that the tissues can be reshaped
gradually. If only soft tissue is removed, the procedure probably
will take less time than if both soft tissue and bone are removed.
The periodontist will
make incisions to "flap" the gums away from the teeth.
This provides access to the roots of the teeth and the surrounding
bone. In some cases, by simply removing a little gum tissue when
the incisions are made, enough tooth structure will be exposed
for your dentist to place a crown of filling. However, in most
situations it will also be necessary for the periodontist to remove
some bone from around the roots of the teeth. The bone is removed
using a combination of hand instruments (resembling chisels) and
rotary instruments (similar to the drill and burs used to treat
Once the periodontist is
satisfied that enough tooth structure is exposed, the surgical
area will be washed with sterile salt water and the flaps will
be stitched together. At this point, your teeth will look longer
because the gums are now sitting at a lower level then before
the surgery. Some dentists use a periodontal dressing called
an intraoral bandage to cover the surgical site.
Any temporary crowns will be removed before the procedure begins
and replaced afterward.
The periodontist will make
incisions to remove the soft tissue and to provide access to the
tooth roots and the underlying bone. Bone removal allows more
of the tooth structure to be exposed. If this is necessary, the
bone is removed using a combination of hand instruments (like
small chisels) and rotary instruments (similar to the drill used
to treat cavities).
After the soft tissue and
bone have been removed, the incisions are sutured. This will cause
more of the tooth or teeth to be exposed. Some dentists use a
periodontal dressing to cover the incisions.
You will be given prescriptions
for pain medication and a chlorhexidine mouth rinse. Your dentist
will review oral-hygiene instructions, and ask you to follow a
somewhat soft diet. You can brush the teeth in the area that was
worked on, but you should avoid the gums. You can remove food
particles around the affected teeth with a toothpick or a water
For the first two days,
use ice on your face to keep swelling down.
After the procedure, you will return to the periodontist in 7
to 10 days to have the sutures removed, and then return again
4 to 6 weeks later for a follow-up visit.
Your gums should heal for at least three months before the tooth
is prepared for the final crown. If you don't wait this long,
the gums may shrink as they heal and the margins of the crown
could show, or other problems could develop. You will visit your
regular dentist to have the crown or filling placed, and then
again for a follow-up visit.
As with all surgical procedures,
there is a risk of prolonged bleeding during crown lengthening,
as well as a risk of developing an infection after the procedure.
Additionally, many patients will experience sensitivity to hot
and cold because the roots of the teeth are now exposed. This
will go away when the roots are covered with new temporary crowns.
Because of the tissue and
bone removal, the affected tooth may look longer than adjacent
teeth. However, this is only a cosmetic consideration.
Removing bone from around a tooth can loosen it. In addition,
if the tooth is ever lost, the removal of bone could reduce the
chances of successfully placing a dental implant in that area.
Your periodontist will consider these details during your consultation.
Call a Professional
Contact our Dentist
You have bleeding that doesn't stop
You have pain that cannot be controlled by medication prescribed
by your dentist
You think the area might be infected
You have excessive swelling or discharge from the surgical area
The protective dressing becomes loose or is displaced
Lymph nodes beneath your lower jaw or in your neck become swollen
When you smile, do your
teeth look short because theyre concealed
by too much gum tissue?
Do you have a gummy smile?
An uneven gum line?
Or is there insufficient tooth structure available for a needed
Crown lengthening can more beautifully frame
your teeth and create the perfect setting for cosmetic restoration.
Dr. Phillip F. Ajaje has
extensive training and experience in periodontic
plastic surgery and crown lengthening. He pays meticulous attention
to detail with an artists touch. This is crucial since minute
dramatically affect the final outcome.
Prior to crown lengthening,
we will discuss your treatment goals and actually show you what
to expect with digitally enhanced photos.
During the treatment, excess
gum and supporting tissue is gently sculpted with a laser and
other microsurgical procedures, on one or more teeth to create
a more perfect frame and natural broad smile. Local anaesthetic
is used to ensure a painless treatment, and recovery
is rapid and comfortable.