Gingival grafting for the treatment of MucoGingival Problems (MGPs)

In addition to maintaining your teeth, the other significant component is the periodontium.  The periodontium consists of all the structures which attach your teeth to your jawbone.  One component of the periodontium that we will constantly be measuring and evaluating is the gum and its level of attachment.  In fact, we are evaluating two factors here; the first being the amount of recession of the gum at each tooth as well as the amount of remaining gum (attached gingiva) that is actually bound down firmly to the bone.  In the event that the attached gingiva is significantly reduced or non existent, then recession usually progresses since the remaining tissue surrounding your teeth is only mucosal tissue.  We refer to this as a Muco-Gingival Problem (MGP).  Consider the analogy of a cedar tree along a river bank where the high water has washed the soil away from the roots.  In this analogy, the tree is still healthy, however its support is dwindling and threatening the health of the tree.  If you haven't seen this along a river bank lately, you might have seen it in the tropics where the same happens to palm trees along the seashore.

Once recession occurs, more  root exposure is the natural outcome.  The root surface, which is not protected by the hard enamel, becomes susceptible to abrasion, decay as well as plaque/calculus accumulations.  The more recession occurs, the more it seems to advance.  Causes for recession are multiple and may include:

  • genetics

  • orthodontic therapy where the arch is over expanded

  • crowding where certain teeth are situated further out in the arch

  • parafunction (grinding and clenching habits)

  • trauma due to improper brushing

  • natural ageing process

What can be done about this?  Once we feel that your gum levels are no longer sustainable and stable, we will likely recommend gingival augmentation procedures by a periodontist (a certified specialist in gum treatments).  This is a relatively simple procedure where a thin strip of gum tissue from your palate (most common donor site) is transplanted over the area of mucogingival deficiency.  Success of this procedure is usually 100%, however, success can be reduced by factors such as smoking or uncontrolled diabetes.  When it is obvious that the problem will only get worse over the course of time, we will be fairly aggressive in making this suggestion since the outcome is so predictable and can save you, the patient, a lot of problems in the future.  In the event that you arrive with advanced recession or have failed to deal with it in a timely manner, the procedure can still be performed, however, the first procedure will simply build a base of tissue in order to prevent further recession.  At this stage, it cannot be expected to cover your root surface, however, once the base/foundation is established, subsequent grafting can be done and further cover the root surfaces.

A slight variation to gum augmentation is a frenectomy.  This is where recession is starting and is, in part, due to a strip of tissue (frenum) which is actively putting tension on the edge of the gum.  Where no augmentation is required but the gum is starting to recede, a laser frenectomy can be done in our office using a soft tissue diode laser.  This takes minimal anaesthetic and requires only about 20 minute total chair time.  Post-operative discomfort is minimal and the site heals uneventfully.  This is somewhat analogous to laser eye surgery where laser surgery can be done in a matter of minutes as opposed to scalpel intervention requiring a longer procedure as well as several hospital days to recover.  In the event that gum augmentation is required in addition to the frenectomy, we will probably refer you to our friendly periodontist for this procedure.

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