A gingival graft (also called gum graft or periodontal plastic surgery) is a generic name for any of a number of surgical periodontal procedures whose combined aim is to cover an area of exposed tooth root surface with grafted oral tissue. The covering of exposed root surfaces accomplishes a number of objectives: the prevention of further root exposure, decreased or eliminated sensitivity, decreased susceptibility to root caries and cosmetic improvement. These procedures are usually performed by a dental specialist in the field of gingival tissue, known as a periodontist, but may be performed by a general dentist having training in these procedures.
Coronally and apically positioned flaps, although technically not grafting procedures, are other forms of a pedicle grafts in that gingival tissue is freed up and moved either coronally or apically. This requires adequate thickness and width of gingival tissue at the base of the recession defect.
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 very 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 periodontists consider it equally successful as a subepithelial connective tissue graft, others consider it less successful.
Guided bone reconstruction is a technique in which bone growth is enhanced by preventing soft tissue ingrowth into the desired area and utilizes either resorbable or nonresorbable membranes. Metallic membranes (von Arx et al. 1996) or membranes supported by a titanium frame (Simion et al. 1994, 1998, 2001) have been tested and have been successful. The acellular dermal matrix has been used as a barrier membrane with demineralized freeze-dried bone allograft.
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.
- See article by Wennstrom et al. in the journal Annals of Periodontology, 1996
- See article by Hirsch et al. in the Journal of Periodontology, 2005
- See article by Harris et al. Journal of Periodontology, 2004.