This is a category of procedures which are used to treat gum recessions and the anatomic deformities (exposed root surfaces) which may compromise structured integrity of teeth or negatively impact cosmetics.

Exposed root surfaces not only are unsightly, but this condition may lead to sensitivity (tooth or gum), increased susceptibility to dental caries (decay) and periodontal bone loss. These conditions are usually caused by anatomic predisposing factors such as congenitally thin gum attachment, strong muscle (frenum) pull or aggressive tooth brushing. Correction of these problems is intended to regain esthetics, improve comfort and ultimately save teeth.

The primary goal of surgical intervention is to strengthen the gum by increasing its thickness and relieving muscle attachment pull. Correction of the recession by regaining root coverage is also an objective, but this may have limitations based on anatomic findings and the degree of severity of a particular situation.

 

Free Gingival Graft This procedure was first described in literature in 1968. Gum tissue is harvested from the palate (donor site) and is transferred to areas where active recession is occurring (recipient site).

This procedure is commonly used to treat lower anterior (front) recessions and is particularly applicable in children and younger patients where recessions are diagnosed at a comparatively early stage. This procedure is predictable, safe and time proven.

It will arrest further recession and stabilize the gum position by increasing gingival thickness an relieving muscle pull (mucogingival stress). It is not the best procedure for achieving root coverage.

 

 

Subepithelial Connective Tissue Graft

Interpositional Connective Tissue Graft (Subepithelial Connective Tissue Graft) These are newer procedures which have been developed to treat recessions and maximize root coverage.

Surgical techniques may vary to some degree but the basic premise is to improve survival of grafted tissue over exposed root surfaces by covering the grafted tissue in order to increase blood supply to the donor tissue.

The covering gum tissue (flap) is elevated (coronally repositioned) to cover the graft and exposed root surface.

This has greatly increased predictability in achieving root coverage, but it can have limitations.

Each case must be carefully evaluated, and your Periodontist can assess all factors and determine the prognosis for correction based on all diagnostic criteria.

Crown Lengthening

This procedure is used for two different applications. The most common problem requiring crown lengthening is tooth decay or broken cusps which extend below the gumline. If restorations (fillings, crowns) extend too far under the gum this results in inflammation and gum discomfort. The second application is for esthetics. Gum can be removed or repositioned higher up on the tooth exposing more clinical crown to reduce gummy smile.

Ridge Augmentation

There is a type of graft procedure which is used to correct deformities in the jaw bone which have resulted from loss of teeth. When teeth are lost the remaining bone (residual ridge) may be injured or become atrophic and lose height or volume. This may result in cosmetic and or functional deformities. The bone volume may be too small to hold dental implants or loss of gum height under bridges may negatively effect the smile. These ridge deficiencies can be corrected using bone or soft tissue graft techniques. Ridge augmentation is a safe, predictable surgical enhancement.

Sinus Lift

In the upper jaw when molars (back teeth) are lost it is common that bone above the sinus will be shallow and have too little depth to hold dental implants. Sinus lift refers to a surgical bone graft technique whereby the floor of the maxillary sinus can actually be elevated to change the anatomy, increasing bone depth and volume. The scientific term is called subantral augmentation which means below the sinus addition of bone. The bone graft is placed under the sinus, not actually inside it so sinus physiology and function are not disturbed. This is a safe and predictable procedure which is often required when patients need dental implants in the posterior maxilla (upper position jaw).