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Sunday, April 20, 2014
Gum roots exposed
My husband has a gum graft performed in January 2006 to fix the recession of his gum and to stop the exposure of the root of the tooth. He followed the doctor`s instrucions exactly and halfway thru the recovery week, the material covering the area along with part of the graft fell out while he was asleep. Now, they are saying he needs to have the procedure performed again. What guarantee do we have that it will actually work this time and it is common to need to have the procedure redone?
Based on what we practice with currently available data, there are three indications for this type of procedure:
1- Patient cannot brush exposed root surface. Dentist detects a lot of plaque and calculus. Or, there is beginning of root decay. Thus, we like to cover the root surface and create a maintainable place for the patient.
2- Patient complains about hypersensitivity due to exposed root surface. Thus, we try to cover the root surface.
3- Patient is not happy with the way that it looks. Thus, we try to cover the root surface for aesthetic reasons.
In addition, we recommend soft tissue grafting prior to fixed type of restorations to protect supporting teeth for certain cases.
How much coverage depends on the shape of the root and the type of soft tissue defect. Sometimes we know from the beginning that it would be impossible to cover all of the exposed surface. And sometimes we may do a couple of surgeries to move the newly created soft tissue toward crown.
Complications after surgery:
The survival of the graft tissue (generally obtained from the roof of the mouth) purely depends on blood supply which comes from surrounding bone (since there are no blood vessels on tooth surface). The stability of the grafted tissue is very important for the newly forming and migrating vessels. During healing, sometimes due to severe swelling and/or loosening of the sutures, graft may move and surgery will not be successful. In such cases, we wait until the maturation of the surrounding tissues is complete and try again. This does not happen very often. However, every case is different and some of the surgical sites are harder to deal with, depending on the severity of the exposure and what is left from soft and hard tissue support.
Binnaz Leblebicioglu, DDS, MS, PhD
Associate Professor of Periodontology
College of Dentistry
The Ohio State University