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In periodontology, gingival grafting, also called gum grafting or periodontal plastic surgery,[1] is a generic term for the performance of any of a number of surgical procedures in which the Gums (gum tissue) is grafted. The aim may be to cover exposed root surfaces or merely to augment the band of tissue.
Exposure of the tooth root due to loss of keratinized tissue around the neck of a tooth is referred to as gingival recession. This can result in sensitivity or pain from the exposed tooth root surface (dentin is more permeable and soft compared to enamel and dentin is what makes up the tooth root). Recession may also cause an unasthetic appearance especially if located in the anterior dentition (front teeth). While not all cases of gingival recession require surgical correction, there are various options if that is what the patient desires. It should be reinforced that recession left untreated will not result in tooth loss, contrary to popular belief. Also, recession that is left untreated can be maintained and the inflammation kept at bay with proper brushing and oral hygiene technique. On the other hand, if one desires to pursue corrective therapy, there are a wide variety of techniques ranging from autograft (one's own tissue, usually taken from the palate), allograft (another's tissue, cadaver tissue), xenograft (animal tissue, usually porcine or bovine) or simply repositioning of the tissue native to the site.
Following this procedure, patients have an improved quality of recovery and require less recovery time due to enhanced healing factors.
A free gingival graft is a dental procedure where a small layer of tissue is removed from the palate of the patient's mouth and then relocated to the site of gum recession. It is sutured (stitched) into place and will serve to protect the exposed root as living tissue. The donor site will heal over a period of time without damage. This procedure is often used to increase the thickness of very thin gum tissue.
A subepithelial connective tissue graft takes tissue from under healthy gum tissue in the palate, which may be placed at the area of gum recession. This procedure has the advantage of excellent predictability of root coverage, as well as decreased pain at the palatal donor site compared to the free gingival graft. The subepithelial connective tissue graft is a common procedure for covering exposed roots.
A lateral pedicle graft, or pedicle graft, takes tissue from the area immediately adjacent to the damaged gingiva. This is not always an option, as the constraint that there must be sufficient tissue immediately lateral to the area of interest is an onerous one. When this procedure is performed, the transplant tissue is cut away and rotated over the damaged area. This can place the donor area at risk of recession as well.
An acellular dermal matrix (such as Alloderm) graft uses donated medically processed human skin tissue as a source for the graft. The advantage of this procedure is no need for a palatal donor site, and though some consider it equally successful as a subepithelial connective tissue graft, others consider it less successful.
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Through the advent of micro-surgical procedures these procedures have become more predictable and comfortable for the patients. Gum grafts are usually performed by periodontists who are trained in these procedures, though general-purpose dentists may offer the procedures themselves. Outcome comparisons between both are highly variable, though with periodontists being specially-trained, periodontists generally recommend patients seeking their services over general-practice dentists. A literature review in 2018 showed that the amount of gum recession patients had was reduced after most types of root coverage periodontal surgery procedures. Reported unwanted outcomes were discomfort and pain, mostly related to the site where the tissue graft was taken. This usually occurred in the first week after surgery and had no influence on root coverage outcomes. Currently, more research is needed to determine whether one root coverage technique is more effective than others.
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