The gingiva, commonly known as gum tissue, forms a protective seal around the teeth, covering the sensitive tooth roots and underlying bone. When this tissue margin pulls back, a condition called gum recession, it exposes the root surface, leading to sensitivity and an increased risk of decay. Lost gum tissue cannot regenerate naturally. However, modern periodontology provides effective surgical solutions to restore the lost tissue and stabilize the gum line.
Why Gums Do Not Regenerate Naturally
Gum tissue, unlike skin, does not possess the biological machinery for true regeneration, which involves the complete replication of the original structure. When gingival tissue is damaged or lost, the body initiates tissue repair, resulting in a scar or simple healing of the wound margin. This repair differs from regeneration, which requires the tissue to regrow fully and re-establish a functional attachment to the tooth root.
The complex structure of the supporting tissues, known as the periodontium, further complicates natural regrowth. The tooth is held in its socket by the periodontal ligament (PDL), which attaches the cementum (the specialized root surface layer) to the alveolar bone. When recession occurs, the PDL and cementum are often damaged or lost, making it nearly impossible for gingival cells to spontaneously re-establish a stable connection. Epithelial cells, which form the outer layer of the gum, proliferate faster than the cells required to rebuild the supporting bone and ligament. These fast-growing cells quickly occupy the defect space, preventing slower-growing tissues from reforming the original attachment structures.
Managing the Progression of Gum Recession
Before considering surgical restoration, the focus is on halting the progression of existing gum recession, especially when caused by periodontal disease. The primary non-surgical procedure is scaling and root planing (SRP), often called a deep cleaning. This method involves carefully removing plaque and hardened tartar (calculus) from below the gum line and smoothing the tooth roots to eliminate bacterial toxins.
Smoothing the root surfaces helps the gum tissue stabilize and may encourage existing tissue to reattach, reducing the depth of periodontal pockets. Localized antimicrobial agents or antibiotic therapies may be applied directly into the gum pockets to reduce the bacterial load and control infection. While these treatments stabilize the tissue and prevent further loss, they do not restore tissue that has already receded. Addressing contributing factors, such as aggressive brushing or teeth grinding, with personalized home care and protective devices is also part of this initial management phase.
Restoring Lost Tissue Through Surgical Procedures
For cases with significant tissue loss, surgical gum grafting procedures offer a predictable method to restore the gum line and cover exposed roots.
Connective Tissue Graft
The most common approach is the Connective Tissue Graft, used primarily to treat root exposure. A small flap is created on the roof of the mouth, and tissue is harvested from the underlying connective tissue layer. This tissue is then stitched over the exposed root surface at the recession site.
Free Gingival Graft
A Free Gingival Graft involves taking a small piece of tissue directly from the surface layer of the palate. This technique is selected when the goal is to thicken naturally thin gum tissue, making it more resilient against future recession, rather than primarily achieving root coverage. Both methods typically involve a donor site on the palate, though donor tissue from a tissue bank can be used as an alternative to avoid a second surgical site.
Pedicle Graft
The Pedicle Graft, or lateral sliding flap, uses tissue from the gum immediately adjacent to the receding area. The tissue flap is partially cut and then rotated or pulled over the exposed root, maintaining its original blood supply at one end. This often promotes faster healing. This technique is only feasible when sufficient healthy gum tissue surrounds the affected tooth.
Guided Tissue Regeneration (GTR)
Beyond replacing soft tissue, Guided Tissue Regeneration (GTR) is an advanced technique aimed at encouraging the growth of the entire periodontium, including bone, cementum, and the periodontal ligament. During a GTR procedure, a barrier membrane is placed between the gum tissue and the tooth root. This membrane blocks fast-growing epithelial cells from migrating into the defect, reserving the space for slower-growing cells from the bone and periodontal ligament to regenerate the lost attachment structures.
Maintaining Gum Health and Preventing Recurrence
Following any restorative treatment, maintaining long-term gum health is necessary to prevent the recurrence of recession. The most frequent cause of damage is aggressive tooth brushing, which can be mitigated by switching to a soft-bristled brush and employing a gentle, circular technique. Brushing should be performed twice daily, complemented by daily flossing to remove plaque from between the teeth and along the gum line.
Regular professional maintenance appointments are necessary, often scheduled every three to six months, to ensure gum pockets remain stable and free of plaque and calculus buildup. Identifying and managing other contributing factors is important, such as wearing a custom night guard if teeth grinding (bruxism) is a problem. Avoiding tobacco products is also advised, as smoking contributes to gum disease and impedes the healing process.