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Gum Diseases

Gum graft and bone loss

09/05/2008

Question:

In the past 3 months I have had 2 gum grafts done in different areas of the mouth. On both occasions, the grafts were only partly successful. My periodontist said that this was due to too much bone loss and I may need bone grafts in the future. The first area where I had the graft had severe gum recession prior to surgery and the doctor said that he saw significant bone loss during the surgery, but the second sugery was for mild gum recession and the periodontist thought that I would not have any problems with this graft.

1) Does this explanation sound plausible? 2) How do you know if you need a bone graft?

Thanks.

Answer:

1- Yes...When the supporting tissue loss is extreme, we prefer to increase soft tissue support before we do the hard tissue grafting since it would be difficult to find enough soft tissue to cover the biomaterial that we want to place. However, your periodontist should inform you about this approach before the initial surgery.

2- Bone graft cannot be placed everywhere. The ideal bony defect to fill with bone graft material should have a vertical component (intrabony defect) so that the biomaterial can be placed and stabilized for the healing period. We generally cannot perform bone graft procedures if bone loss is horizontal. (I use the term generally since there is a new product now in gel form, and it gives good results with horizontal bone loss, too).

Summarizing the answer to your question, we try to determine the need for bone graft prior to surgery by evaluating clinically and with X-rays. We may change our mind during surgery when we see the defect in 3-D (since X-rays do not tell the complete story all the time because they are 2-D).

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Response by:

Binnaz   Leblebicioglu, DDS, MS, PhD Binnaz Leblebicioglu, DDS, MS, PhD
Associate Professor of Periodontology
College of Dentistry
The Ohio State University