This case demonstrates a tunneling procedure for gingival grafting. The exposed tooth root surfaces will be covered with the graft as well as simultaneously increasing the zone of attached tissue to prevent further periodontal breakdown / gum recession in the future.
The gum recession was caused by traumatic tooth brushing. The signs of this are abrasions on the tooth roots which are the visible notchings. This is typical when one brushes their teeth in a seesaw, side to side motion and or uses a medium to hard toothbrush. To prevent this, a soft toothbrush should always be used with the proper up and down motion. In this case, not only has tooth structure been lost, but also most of the gum tissue leaving cheek tissue around the tooth. This is not a stable situation and if not grafted, continued recession is expected. Both a connective tissue gum graft, and tooth brush technique modification will be part of this patient’s treatment plan. The graft is used to stabilize the area and regenerate lost gum tissue over the root surfaces. The toothbrush modification is also necessary to prevent the original trauma that created this situation originally.
Following anesthesia, a dissecting incision is made between the gum and tooth. The gingiva still remains attached at the tips of the papillae (the gum in-between the teeth). This creates a pocket or tunnel. The harvested graft, usually from the roof of the mouth, is placed inside this tunnel. The graft will receive nourishment from the gingival tunnel walls. If successful, the graft will integrate within the tunnel and attach to the tooth root surfaces. Initially following the graft the area will look thickened but will typically self correct with time. If complete root coverage is not achieved with this procedure additional supplemental procedures can be used to enhance that, such as a semilunar graft.
Post operatively there can be mild to moderate discomfort where the graft is placed. This is usually mitigated with Ibuprofen / Acetaminophen. However, there can be moderate to severe pain in the roof of the mouth where the tissue is harvested from. An acrylic palatal stint can be made to cover this donor site while the tissue is healing. This works like a band-aid on a skinned knee and allows the patient to eat and speak normally while it is place. The pain is also managed well with stronger pain medications such as Hydrocodone. Use of a palatal stint and Ibuprofen is usually sufficient to manage any discomfort resulting from this procedure. The connective tissue harvested from the palate regenerates completely without any scarring.