Gum recession is a condition that happens to people of all ages, and can even occur in cases where the person is taking good care of their teeth. Typically in healthy teeth, the gum tissue fits around each too like a cuff. In a tooth that’s is experiencing gum recession, the tissue has pulled away from the tooth, which then begins to expose the root. Roots do not have hard enamel protecting them as the crown (or top) of the tooth does. This results in sensitivity and increases risk of decay and bone loss.

Types of Gum Tissue

There are two types of gum tissue found in the mouth:

• The first is attached (keratinized) gingiva – the normal gum tissue around the neck of the teeth. This is a firm, non-movable, pink colored tissue which is resistant to normal forces of chewing and brushing as well as bacterial invasion.
• The second is a darker colored, flexible tissue that lines the cheeks, floor of the mouth, and inside of the lips which is called alveolar mucosa. Muscles within the alveolar mucosa are constantly contracting and pulling down on the bottom edge of the attached gingiva.

In health, the attached gingiva is wide and strong enough to act as a barrier which prevents the gum from being pulled down (receding). Various procedures have been developed to deal with problems related to these soft tissues.

What Can Happen with Injury to the Gum Tissue?

Trauma to attached gingiva from overzealous brushing (use a soft toothbrush and change it every month), injury, malpositioned teeth, or habits can cause gingival recession. If genetically, there is minimal attached gingiva, this tissue can be totally lost. The result may be continued recession. If left untreated, this can cause tooth loss.

With recession and a lack of attached gingiva, the body loses its natural defense against both bacterial penetration and trauma. This can result in sensitivity to hot and cold foods, an unsightly appearance, and exposure of the root surface. The tooth root is softer than enamel, leading to root decay and gouging.

This type of recession is not an infection as with periodontal disease, but an anatomic condition. However, if bone recession is occurring at the same time the gum is receding, there is same potential for tooth loss.

Treatment of Recession and Inadequate Attached Gingiva

When gum recession or inadequate attached gingiva is a problem, reconstruction using gingival (gum) grafts is often indicated. Treatment with gingival grafts can be divided into two categories:

• Functional – Repair aimed at stabilizing the gum at its current level without root coverage. Used in areas where cosmetics are not a factor.
• Cosmetic – Repair aimed at covering exposed root surfaces for cosmetic purposes or to decrease sensitivity. Can also increase the amount of attached gingiva. Covering the root surface does not strengthen the tooth.

Gingival Graft

The gingival graft procedure is highly predictable and results in a stable, healthy band of attached tissue around the tooth.
The replacement of missing attached gum is called gingival grafting and is very similar to a skin graft. First, a small pouch is created in the tissue next to the tooth being treated. Next, a small piece of gum tissue is taken from the roof of the mouth adjacent to the back teeth or gently moved over from adjoining areas and transplanted around the tooth. The donor tissue reattaches and forms a new layer of attached gum which, with proper care, should last indefinitely. The roof of the mouth heals quickly just like a skinned elbow. At times, a temporary, clear plastic retainer is made to cover the donor area for further comfort. Usually, the exposed root is not covered and the tissue stays at the same level as before. However, the weak tissue has been replaced with stronger attached gingiva. A protective dressing often is placed around the necks of the teeth to cover the surgical area and to help secure the new gum-to-tooth relationship. You will need to be seen in 10-14 days to remove any remaining sutures and evaluate your healing.

Alloderm Gingival Grafts

When multiple grafts are necessary or the patient does not wish to have a donor site, healthy, highly-processed, sterile tissue from a tissue bank can be utilized. This product, Alloderm has been used to safely treat burn patients for a number of years. Over three million procedures have been performed using Alloderm without any transmission of HIV/AIDS or hepatitis. This tissue is equally successful with that obtained from the roof of the mouth. It is especially useful with children where adequate donor tissue is not available. Alloderm grafts eliminate a secondary surgical site along with its associated discomfort.
Gingival Grafting & Restorative Dentistry

Enhancing the zone of attached gingiva is particularly important when gingival recession is progressing or restorative dentistry is planned. Usually, the edge of a crown (cap) or white filling is placed just below the edge of the gum for optimum aesthetics. If the attached gingiva is too thin or inadequate, the gum may then recede after the restoration or crown is placed which will result in a poor cosmetic result.

Gingival Grafting & Orthodontics

Prior to orthodontics, it is important to evaluate the attached gingiva. Some types of orthodontic movement will result in the teeth being pushed outward. If the attached gingiva is too thin or inadequate, the gum may then recede during or shortly after active orthodontics.

It is not unusual for young children to require gingival grafting just before they get braces. This can help prevent unnecessary recession.

Root Coverage

When there is gum recession, the root of the tooth often shows and is unsightly. It is often desirable to recover the root surface. This is primarily done for cosmetics, but can also be done for root sensitivity. If there is also a lack of attached gum tissue (see gingival grafting), root coverage surgery can be designed to correct both problems at the same time. A connective tissue graft, which provides new attached gingiva while covering the root surface, is usually the procedure of choice. It is important to note that covering the root does not make the tooth stronger, since the bone, which actually holds the tooth in place, does not change regardless of the new gum level.

Connective Tissue Graft for Root Coverage

The procedure for a connective tissue graft is similar to a gingival graft. Incisions are made to release the gum leaving it connected at the base. Because the root has been exposed to bacteria in the oral cavity, all plaque and calculus must be thoroughly cleaned to provide a healthy root surface. This may be followed by root conditioning with citric acid or EDTA to promote better attachment of the graft. The donor tissue is obtained from the same area of the palate. However, only the inner tissue is taken, leaving the outer tissue to cover the wound. The graft is then placed over the exposed root and the original tissue is placed over it and secured with dissolving sutures (stitches). A surgical bandage or packing is then placed over the graft to protect it.