Gum grafting is frequently recommended when gum tissue has pulled away from the teeth, a condition known as gingival recession. This common dental issue exposes the root surfaces, creating vulnerabilities that compromise long-term oral health. A gum graft is the primary method used by dental professionals to correct this tissue loss. The recommendation is based on preventing serious, progressive damage to the supporting structures of the teeth.
Understanding Gum Recession
Gingival recession is the downward or outward movement of the gum margin from the crown of the tooth, exposing the root surface beneath. This condition is measured during a dental examination using a periodontal probe to determine the distance between the cementoenamel junction (CEJ) and the current gum line. The CEJ is the boundary where the enamel of the crown meets the cementum of the root, serving as a fixed reference point.
Recession can be triggered by several factors, starting with aggressive toothbrushing, which physically wears away the delicate gum tissue. Periodontal disease is a major contributor, as the chronic bacterial infection breaks down the supporting gum tissue and underlying bone. Genetic predisposition also plays a role, as some individuals naturally have thin, fragile gum tissue. Anatomical factors, such as misaligned teeth or prominent tooth roots, can also increase the likelihood of recession.
The Purpose of a Gum Graft
The primary goal of a gum graft is therapeutic, addressing two critical needs for the affected tooth. The first goal is to halt the progression of gum recession and stabilize the tissue around the tooth. By transplanting healthy tissue, the procedure creates a thicker, more resilient band of gum, making it less vulnerable to further mechanical or bacterial damage.
The second purpose is to cover the exposed root surface, which is crucial for protecting the tooth’s integrity. Exposed roots are covered by cementum, a material significantly softer than the enamel that protects the tooth crown. Covering this cementum layer reduces tooth sensitivity and shields the root from decay and abrasion.
Two common techniques are used: the Connective Tissue Graft and the Free Gingival Graft.
Connective Tissue Graft
The Connective Tissue Graft involves harvesting sub-epithelial tissue from beneath a flap on the roof of the mouth, which is then placed over the exposed root. This method is often preferred for root coverage due to its aesthetic blending with existing tissue.
Free Gingival Graft
The Free Gingival Graft involves taking a small, full-thickness piece of tissue directly from the palate. It is typically used to create a wider, more robust band of attached gum tissue where the existing tissue is very thin.
Consequences of Avoiding Treatment
When a gum graft is recommended, it is generally because the recession has progressed to a point where the risks of inaction outweigh the intervention. Exposed tooth roots are highly susceptible to decay because the cementum covering them is much less resistant to plaque and acid than enamel. This root decay can advance rapidly, potentially requiring more invasive treatments like root canals or even extraction.
A common and immediate consequence of exposed roots is chronic, severe tooth sensitivity to hot, cold, or sweet stimuli. The dentinal tubules that lead to the tooth’s nerve are left open to the oral environment, causing significant discomfort. Ignoring the recession also means the underlying cause, often periodontal disease, remains active and continues to destroy the gum tissue and supporting alveolar bone.
Continued bone loss eventually compromises the tooth’s stability, leading to mobility and, in advanced cases, potential tooth loss. The recession tends to worsen over time, especially if the underlying factors are not fully corrected, which makes the problem harder to treat later. If the recession advances too far, the amount of remaining bone support may become insufficient, making a successful graft more difficult or even impossible to perform. Timely treatment protects the tooth from compounding, irreversible damage.
Alternatives to Traditional Grafting
While a traditional gum graft is the gold standard for moderate to severe recession, the management approach depends entirely on the degree of tissue loss. For very mild cases, the initial treatment may involve non-surgical management focused on eliminating the contributing factors. This includes modifying aggressive brushing habits and undergoing a thorough scaling and root planing procedure to remove tartar and smooth the root surface, thereby controlling inflammation and halting the recession’s progression.
For patients seeking less invasive surgical approaches, alternatives to traditional grafting have been developed, though they are not suitable for every situation. The Pinhole Surgical Technique (PST) is one such method, involving the creation of a small entry point in the gum tissue. Specialized instruments are then used to gently loosen the existing gum tissue and reposition it over the exposed root surface.
Other techniques involve the use of regenerative materials or soft tissue substitutes, which eliminate the need for a graft from the patient’s palate. These options often result in faster healing and reduced post-operative discomfort. However, the choice of procedure is always dependent on the specific diagnosis, including the amount of keratinized tissue present and the severity of the root exposure.