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.
How long should one wait to eat solid foods after this type of surgery. How long is the healing process?
A soft food diet is recommended for one week is recommended following this procedure. The length of healing depends on whether the donor tissue is harvested from the roof of the mouth or acquired from a tissue bank. When the tissue is harvested from the roof of the mouth healing takes place over 7-10 days, pain can be moderate to severe but can be mitigated with a special retainer for the roof of the mouth and pain medications. When the donor tissue comes from a tissue bank, healing takes place over 2-4 days and discomfort is mild to moderate.
What is the standard cost for a connective tissue gum graft using donor tissue?
Hi Dolores,
Unfortunately, I cant say. I think there are standard fees for certain geographic areas. For example the fees in Beverly Hills are much higher than you would pay for the same service in a neighboring city. Insurance contracting could also be a factor. What I would recommend is that you get a second or even third opinion about condition and the fees involved for treatment. Most healthcare professionals will not quote fees over the phone as its important to have a proper diagnosis first. Sorry I couldn’t be more helpful about this.
I had this surgery 6 weeks ago and my mouth still doesn’t feel right. I have a tingling sensation in my lower lip and cheek closest to the area where the gum was grafted.
The graft is lumpy and my gums are numb where graft was attached.
Will the numbness and tingling go away? I asked the periodontist that did the surgery and he said to come back in two months!
At what tooth sites was the graft performed? Have you followed up with your doctor about this condition? Tingling following any surgery may be a sign of nerve trauma, however it usually resolves with time. Is the tingling getting better or staying the same? If it is getting better then I would expect it to completely resolve. It may be difficult to gauge this on a day to day basis, but compared to the date of surgery to where you are now how is the progress?
I had this done about a week and a half ago. I was supposed to have the stitches removed after two weeks, but they fell out last night and it looks like the skin that was stitched over is now falling lower and lower. Is it possible to go in and have the skin stitched up higher again to prevent from redoing the entire procedure?
Hi Karla,
I would go see your Periodontist and ask them about that. Its hard to answer your question without seeing it. I would typically give it a chance to heal. Sometimes minor touch ups are necessary with these types of procedures.
I want to get gum recession surgery of my five teeth.pleaselet me know about the expenses.please e-mail me
Dear Azhar,
Thank you for your post. The standard procedure is for you to have an exam and diagnosis first. There are many treatment options, and ultimately which option you choose will dictate the expenses involved.
i have to have this done, probably the end of this month. However, I have braces on, which i’ve now had for about two and a half years. When i get another tightening on my wire, will that cause any pain to the area they’re grafting? I was super curious and haven’t seen my orthodontist about it yet. Thanks!
No you should be fine.
How often do allografts from donor patients get rejected? Is one better than the other?