Periodontal Plastic Surgery

Periodontal Plastic Surgery:  Subepithelial Connective Tissue Grafts, Alloderm Grafts, Other Soft Tissue Grafts, Esthetic Crown Lengthening and Implant Plastic Surgery

Subepithelial Connective Tissue Grafts:

When recession of the gum has occurred or is expected to occur following orthodontic treatment or placement of restorations at the gumline of the teeth, gingival grafting can help reverse, correct or prevent recession.  Recession will frequently be accompanied by sensitivity to cold or sweets in the exposed root surfaces, tenderness in the gum tissues when brushing, wear or abrasion of the exposed root surfaces over time, and in some cases, development of decay in the exposed root surface.  Dr. Nattkemper will usually recommend a subepithelial connective tissue graft for this problem.  He performs this procedure using the dental operating microscope, using microsurgical techniques he has learned from the finest periodontal microsurgeons in the world in addition to techniques he himself has developed. 

The subepithelial connective tissue graft involves several steps:  first, careful preparation of the root surface so as to improve its ability to “stick” to new tissue.  Then, a small “pouch” is created in the tissues overlying the tooth or teeth with recession.  The connective tissue graft is obtained from a similar tiny “pouch” in the palate, which is then precisely sutured closed.  The graft is then inserted in the pouch over the affected tooth or teeth, fixed in place, and the overlying tissues advanced to cover the grafted tissue and root, providing a source of protection and nutrients for the graft.   

Patients typically experience only minimal postoperative discomfort, and mild swelling for one to two days following connective tissue graft procedures.  The treatment provides a resilient, highly esthetic, firmer and comfortable covering of gum tissue over the root surface, in most cases eliminating recession, sensitivity and the risk of further recession over time. 

Dermal Matrix Grafts:

In cases where several teeth require soft tissue coverage, in cases where the palatal tissues are too thin to be useful for removing tissue for grafts—and most frequently, when patients just don’t want tissue taken from the palate, Alloderm Tissue Matrix works beautifully.  Alloderm is used in plastic reconstructive surgery and in periodontics.  It is human dermis that has been sterilized and aseptically processed to eliminate any cells.  When placed within gingival (gum) tissues (just as a connective tissue graft is placed within a small “pouch” overlying the teeth being treated) Alloderm serves to provide a consistent improvement in resilience, firmness and comfort—virtually indistinguishable from what connective tissue grafts provide. 

Alloderm dermal matrix allows treatment of many teeth in a single visit, whereas only two to three teeth usually can be treated (in most cases) at a time using connective tissue.    Use of the operating microscope assures precise tissue management, such that Dr. Nattkemper’s results with this material are very consistent.

Other Soft Tissue Grafts:

In some situations a single tooth, or a pair of teeth, will develop recession right next to an area where there is firm, relatively thick gum tissue on adjacent teeth or in a space between teeth.  Often, a lateral sliding pedicle graft, coronally advanced pedicle or a double pedicle graft can be performed in such cases.  These grafts simply involve sliding tissues over from an adjacent area or up to cover an exposed root, and don’t require a separate donor at all. 

Sometimes if children develop recession over their lower incisor teeth, a free gingival graft will be Dr. Nattkemper’s recommendation.  This type of graft has been performed by periodontists for over 40 years on children and adults (and is still performed by most as their “graft of choice”).  Free gingival grafts provide very consistent results.  They are similar to connective tissue grafts in technique but do not involve an attempt at covering of the graft with any sort of “pouch” (adjacent tissue) once positioned over the root or roots being treated.  Free gingival grafts usually result in a firm, relative thick region of new gum tissue and help prevent recession.  In many cases they can also help cover roots that have become exposed, but this is not as predictable as with connective tissue or Alloderm grafts.

Esthetic Crown Lengthening:

Many people suffer from what is usually called a “gummy smile”—relatively short looking teeth and lots of gum tissue above their upper teeth showing when they smile.  In some situations, one or more teeth on the right or left will appear shorter or asymmetric in comparison to the corresponding teeth on the opposite side of the mouth.  Orthodontic treatment (and in some cases orthognathic surgery) may in some cases be helpful in addressing these problems.  For many people though, a simple treatment called esthetic crown lengthening can improve the length and symmetry of the teeth by altering the position and thickness of the gum tissues.

Dr. Nattkemper uses the operating microscope to perform esthetic crown lengthening.  This may be accomplished using the dental laser or as a microsurgical flap procedure (see osseous surgery).  In most cases, your restorative dentist and Dr. Nattkemper will work closely together, in order to provide you the most ideal result possible, with minimal discomfort or “downtime”.  People of all ages can benefit from esthetic crown lengthening, and, like dental implant-supported teeth, this procedure can substantially improve self confidence and appearance. 

Implant Plastic Surgical Procedures:

Dental implants sometimes develop soft tissue esthetic problems, such as metal exposure or loss of the gum “papilla” between the implant-supported tooth and an adjacent tooth.  This can occur if implants are placed in regions lacking adequate thickness or height of bone or gum tissue, are improperly positioned, or in some cases following trauma or infection.  In many cases, the operating microscope again can be useful for augmenting or repairing lost tissues.  Dr. Nattkemper often uses combined approaches—bone grafting and guided tissue regeneration, connective tissue or Alloderm grafts—to restore the lost tissues and help create a more “normal” framing of the implant-supported teeth.  As with esthetic crown lengthening, Dr. Nattkemper will often work with your restorative dentist to provide the best result possible.   

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