A tooth is surrounded by two types of tissue. The first is gingiva (gum), which is pink, thick and dense. It is also called keratinized tissue. Gingiva forms a tight seal around the tooth which serves as a barrier against the penetration of bacteria to the underlying bone. The gingiva also helps to withstand trauma from brushing, eating, etc. The other type of tissue, mucosa, found directly below the gingiva, is red, thin and loose or elastic. It does not seal tightly around the tooth, nor does it withstand trauma well (as shown by how easily you can "scratch" the floor of the mouth).
When gum recession occurs, the body loses a natural defense against both bacterial penetration and trauma. When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than gentle oral hygiene is necessary. Recession can be caused by genetically thin bone and gum, overscrubbing or toothbrush bristles that are too stiff, or by clenching and grinding habits.
When recession reaches the mucosa, the first line of defense against bacterial penetration is lost. No matter how meticulously the patient tries to control the bacteria, there is a greater chance of it penetrating and affecting the underlying supporting bone. In addition, gum recession may result in root sensitivity as well as an unsightly appearance to the gum and tooth.
Some people genetically have extremely thin gingiva and require grafting to prevent recession before it starts. This is quite common when orthodontic tooth movement is planned.
A gum graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth, or moved over from adjacent areas, to provide a stable band of dense gingiva around the tooth.
What are the benefits of gum graft surgery?
A gum graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. This may reduce tooth sensitivity and improve esthetics of your smile. Whether you have a gum graft to improve function or esthetics, patients often receive the benefits of both: a beautiful new smile and improved periodontal health – your keys to smiling, eating and speaking with comfort and confidence.
Also called regenerative surgery, a bone graft is used to recreate bone and soft supporting tissues lost due to trauma or periodontal disease. If you have periodontal disease, you may be losing bony support around your teeth, and in order to avoid extractions, your periodontist may recommend regenerating the lost bone with a grafting procedure.
The goal of bone grafting is to encourage the body to rebuild the bone and other structures that attach a tooth to the jaw. First, your dentist or periodontist will separate the gums from your teeth in order to gain access to the roots and bone. The roots will be thoroughly cleaned, and the defect in the bone will be filled with a graft material that usually consists of your own bone or donor bone. After this process is completed, your dentist or periodontist will put the gums back in place and stitch them together. Over the next few months, the grafted material will be encouraged to grow in order to regenerate the lost bone and soft tissue.
Where does the grafting material come from?
It can come from a variety of sources, including your own body. These days, however, laboratory-processed bone from a human or animal donor (usually a cow), as well as synthetic materials, are frequently used.
Crown lengthening is a surgical procedure to expose a greater amount of tooth structure by cutting down the bone around.
Crown lengthening serves two purposes: to improve the appearance of the teeth or to prepare teeth for further dental or periodontal work.
On the cosmetic side, crown lengthening can help correct a "gummy smile." This occurs when the teeth are the correct length, but they are covered by too much gum tissue, making them appear too short.
Crown lengthening can be necessary if there isn’t enough of the tooth in place to hold the crown on its own. Teeth that are broken or affected by tooth decay may prohibit a crown from firmly attaching.
Crown lengthening can provide enough tooth surfaces for the gum to attach to when there isn't enough because of deep decay below gum line. Gum needs about 2 mm of attachment to the tooth surfaces to make a tight seal around. Intentional removal of the gum and the bone can proved adequate tooth surfaces for that attachment.