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Thread: Gum graft, Gingival graft

  1. #1

    Gum graft, Gingival graft

    Gum transplant: correct and stop the gingival recession

    Apart from gingivitis and severe periodontitis, the gums rarely speak of them. They can however diminish and leave the roots exposed with a risk of tooth decay and hypersensitivity. This gingival recession 1 can also compromise the aesthetic appearance of the smile.

    Gum transplant: how the procedure works?

    The gingival graft 2 restores thickness and height to the weakened gingiva, which stops its recession. Restorative, preventive and plastic, this surgery reinforces the support tissues to protect the teeth and often restore a nice smile. Dr. Antoine Popelut *, a dental surgeon specializing in periodontology, discusses in particular the evolution of grafting techniques and the progress made.

    The first techniques of gum transplants

    The gum covers the root of the teeth and the alveolar bone 3 which keeps them in the jaw. The gingival graft is used to correct and stop its loss of height or "recession" 1. The roots are naturally more vulnerable to dental caries and hypersensitivity that can impair quality of life. On the other hand, the teeth appear to be longer and interdental spaces appear, manifestations that are not very aesthetic and often badly experienced when they concern the anterior teeth.

    Less painful and more aesthetic grafts

    The gingival recession 1 is linked to the association of predisposing factors (alveolar bone shape, dental malposition, fine gingiva, age ...) and triggers (traumatic brushing, bruxism, misconduct orthodontics, poorly adapted crowns or amalgams) .

    What are the contraindications and precautions to take?

    Gingivitis and periodontitis are triggering factors. However, when the periodontium is too severely affected, with significant bone loss, gingival graft alone is not indicated. "The gum would not have enough bone to rely on," explains Dr. Antoine Popelut. Each situation is assessed on a case-by-case basis depending on the size of the recession, its repercussions and its evolutionary potential. "

    The gum graft consists of taking a "piece" of gum or palate, the "graft", to cover the roots denuded by the recession. It takes place under local anesthesia, in a private practice or in hospital, and generally does not require a work stoppage. The intervention takes place in three main stages: the preparation of the recipient site, the graft removal and its suture at the level of the recession.

    Since the beginning of this surgery, experimented since the 1950s, several techniques have been developed. To better understand them, one must take an interest in the constitution of the gum. "The gingiva consists of two tissue layers: the surface epithelium and the deep connective tissue, and the gingiva at the base of the tooth without adhering to it is called" free. "The gingiva is" attached "to the gingiva Root and alveolar bone, "says Dr. Popelut. The lower the attached gingiva height, the more rapidly you need to intervene to hope for recovery.

    And the dentist continued: "The first techniques were to move a gingival flap adjacent to the recession to cover it. However, these flap techniques moved to a fine gingiva are less successful in the long term than when they Are associated with a "real" transplant. "

    To obtain a sufficient thickness of gums, dentists have thought to resort to a more generous donor site: the palate. This technique, called "epithelio-conjunctive" 4, produces attached gingiva that stops the recession. The aesthetic result is more disappointing due to the differences, especially color, between the epithelia of the palate and the gum. These grafts may also be slightly painful in the palate. "There are now protective plaques that land on the donor site and limit pain," says Dr. Popelut.

    Although the first grafting techniques are still used for certain indications, there is a third approach that combines them: the "buried connective tissue" graft, which consists of incising the epithelium of the palate to remove only the connective tissue. "The graft is positioned at the recession and covered with an adjacent gingival flap," says Dr. Popelut. "The epithelium of the palate is sewn to protect the wound."

    This technique, less "invasive" than the previous one, is also less painful for donor and recipient sites. It leaves fewer scars and produces a gingiva of identical appearance to the adjacent gingiva. This is the preferred method for the anterior sectors, visible when smiling or speaking. To further reduce pain, the graft can be removed at the location of the wisdom teeth when extracted.

    Absolute contraindications are relatively rare. As with any surgery, general diseases such as diabetes, hypertension, AIDS ... must have balanced biological constants. It is also essential to have a perfect and non-traumatic oral hygiene. Dr. Popelut reviews the material and techniques of brushing the teeth with his patients: "It must be done vertically, from the root to the free edge, using a soft brush and without pressing too much."
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    Another contraindication: smoking. The ideal is of course to have stopped smoking several weeks before the intervention because smoking reduces its chances of success. "The success of the graft, objectified by the recovery rate, is inversely proportional to the number of cigarettes smoked," notes the dentist. Below five per day, however, surgery can be performed. Between five and ten, it is strongly advised to stop at least one week before the procedure. Beyond that, the transplant has little chance of success.

    During the first 24-48 hours after surgery, it is advisable to apply ice to limit pain and swelling in relation to the grafted area. Analgesics and anti-inflammatories may be prescribed. Bleeding is infrequent and should not worry. Simply compress the area with a sterile compress and avoid mouthwashes that reactivate them.

    Thereafter, and for two weeks, you should avoid eating and brushing your teeth on the side of the graft. The mouthwashes limit the inflammation and the formation of dental plaque. In order not to damage the still fragile graft, it is also advisable not to consume food that is too hot or hard, to pull on its lip to observe it, to chew objects ... The cigarette is prohibited. >

    In the best case, the new gum merges into the old, attaches to the tooth and the wires are removed after two weeks. The risk of necrosis sometimes worries patients. However, "if the indication is well laid and the intervention correctly performed, it is non-existent," says Dr. Popelut.

    A well integrated, aesthetically successful transplant can be seen in the first few weeks, says the dentist. However, the gingiva continues to evolve for six to twelve months, until producing an almost undetectable result with the latest grafting techniques.

    The success rate depends on the recession: the broader and deeper it is, the harder it is to cover it. It is now possible to recover 50-70% of all recessions. The average height of recoveries is 75%.

    To learn more about the gum transplant and its potential outcomes, you should ask your dentist who, if not a specialist, will contact a periodontist. In the hospital, a gingival transplant costs between 300 and 350 € per sector (one or more adjacent teeth), 500 to 800 € in private practice. The intervention is not covered by social security.

    - Interview with Dr. Antoine Popelut, dental surgeon specialized in periodontics, university attaché at the UFR of odontology of the University Paris Diderot - Paris VII. He practices in a liberal cabinet in Paris - Techniques of recovery root: what to choose? (2004) and Root recovery for patient satisfaction (2011), articles published on the website of the French dental association (ADF) - Root recovery: factors of predictability, dossier published in July 2012 in Le cour Of the dentist, dental portal francophone dental training and information.

    Notes

    1 - Gingival recession or "periodontal" because often it is the "periodontium", which includes all supporting tissues of the tooth (gingiva, ligament, alveolar bone), which is affected. 3 - The most superficial part of the bone of the jaw, the alveolar bone supports the teeth and "is born and dies" with the gingiva or more exactly "autograft", the donor tissue being taken from the person who will receive it. 4 - Epithelio-conjunctival graft or free gingival graft

    - The French Society of Periodontology and Oral Implantology (SFPIO) for its patient information, especially the page The periodontium is what ?, which details the different elements making up the periodontium, including the free and attached gums.

    - The Canadian Academy of Periodontology for its page on graft collection.

  2. #2

    Re: Gum graft, Gingival graft

    Gum Grafting also known as Gingival Graft is a surgical periodontal procedures that aim to cover an exposed tooth root surface with grafted oral tissue and it usually performed under local anesthetic. Exposed tooth roots are usually the result of gingival recession due to periodontal disease. It's procedure will depend on whether tissue is coming from the patient’s palate or a tissue bank. Most common types of gum grafting are Free gingival graft, Subepithelial connective tissue graft,
    Acellular dermal matrix allograft, Overly Aggressive brushing and trauma.


    Gum grafting might sound scary but the procedure is commonly performed with excellent results.The benefits of Gum Grafting is so nice because it can reduced sensitivity when you eat or drinks cold/hot foods. And also it can improve your personal appearance just because your teeth will look shorter.

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