Periodontal Treatment Options for Receding Gumlines

Erosion of the gums at the gumline is relatively common. It is seen as a result of chronic inflammation associated with chronic gum disease. I t is also fairly common in young adults with aggressive toothbrushing habits. Generally, teeth will develop gum recession when a root is prominent in the bone compared to other teeth. Patients who grind their teeth also stress the sockets in which the teeth reside. When this stress is delivered to sockets with thin bone, loss of bone and gum may occur. The resulting gum recession can lead to thermal sensitivity to the tooth and may be unsightly. Dentists are concerned about recession when the amount of gum tissue deteriorates. Research has shown that when the amount of attached gum tissue diminishes below one millimeter, these teeth are more vulnerable to developing further recession. When these teeth are treated with gum grafts, the recession will stabilize and help to prevent the further loss of tooth support.Soft Tissue Grafts are procedures that rebuild the protective gum tissue around the tooth or teeth.

The procedure usually follows the following protocol:
1) Local anesthetic is given.
2) The tissue below the receded gum is dissected away exposing underlying tissues.
3) Gum tissue is procured from the roof of the mouth. This is usually a 1-2mm paper-thin graft that can easily be positioned around the problem tooth. The roof of the mouth is essentially an eternal reservoir of gum tissue. The donor site will be slightly tender but usually heal quickly and return to normal after a few days.
4) The graft tissue is then sewed to place over the exposed underlying tissues. Sutures are enough to secure the graft and allow for proper healing. The graft will turn first white and then often red as the graft bonds to the surrounding tissue. Ultimately, grafts will range from normal colored to slightly.
New variations of grafting have emerged over the past several years. Tissue bank skin graft material is available for those patients who would prefer not to use the roof of the mouth as a donor site. These grafts tend to have more shrinkage but will provide more natural color matching to the surrounding gums. Root coverage is now a very predictable option for teeth with receding gum lines. Subepithelial Connective Tissue Grafts borrow internal tissue from the roof of the mouth. This tissue is positioned under a flap of gum in the area of recession. The combined nutrition from the gum under and over the graft keeps the graft alive over the previously exposed root surface. The result is both an increase in the amount of protective gum tissue as well as improved esthetics. These grafts also provide the best color match with the surrounding gums.

Case report: A lower anterior area generalized gingival recessions/fenestration with roots exposure during orthodontic treatment__The Subepithelial connective tissue graft to improve the thickness of overlying gingival tissue and roots coverage __Referred from other general practitioner for some malpractice during the orthodontic therapy