Dr. Nattkemper has had extensive training in various types of soft tissue grafting. He utilizes a dental operating microscope for these procedures and was one of the first periodontists in the U.S. to regularly utilize the operating microscope for soft tissue graft procedures. For detailed information about these procedures in Dr. Nattkemper's own words, please see our section on Periodontal Plastic Surgery.
Soft tissue grafting is often utilized to treat, or in some cases prevent, gum recession.
Soft tissue grafting is a conservative and permanent treatment for recession--to be contrasted with placement of tooth-colored filling material over exposed root structure, a procedure most dentists use to "treat" recession. It is important to understand that any dental restoration placed along the gumline may over time lead to worsening of the recession problem.
Periodontal disease, trauma, orthodontic treatment performed to correct severe crowding, aging, over brushing, gumline fillings or crowns, and poor tooth positioning (root prominence) are the leading causes--often working together--of gum recession which can lead to sometimes painful and unsightly root exposure in severe cases.
When the roots of the teeth become exposed, eating hot and cold foods can be uncomfortable, decay is more prevalent and the aesthetic appearance of the smile is altered. The main goals of soft tissue grafting are to attempt coverage of the exposed root and to augment the quality and thickness of the existing gum tissue in order to halt further tissue loss.
The three different types of common soft tissue grafts include:
Free gingival graft – A strip of tissue is removed from the roof of the mouth and stitched to the grafting site in order to promote natural growth. This type of graft is most commonly used for thickening existing tissue. Dr. Nattkemper generally uses this procedure in children or in certain cases in combination with frenectomy or frenotomy procedures (repositioning of muscle attachments near the teeth)
Connective tissue graft – For most adults and in almost all situations where aesthetics and patient comfort are primary concerns, subepithelial connective tissue--or allogenic dermal matrix graft tissue-- is utilized to remedy the problem. Dr. Nattkemper removes a precise, thin strip of connective tissue from a small "pouch" in the mouth and inserts and secures this within a pouch over the exposed roots. Dermal matrix material is used the same way. Results are consistent and comfortable, and in virtually all cases the area(s) treated appear totally natural and indistinguishable from adjacent regions.
Pedicle graft – This type of graft involves the “sharing” of soft tissue between the affected site and adjacent gum. A flap of tissue is precisely dissected and released, retaining its connection to its nutrient (blood) supply, and slid sideways to cover the root. Dr. Nattkemper often combines pedicle grafts with connective tissue to provide increased predictability of root coverage, especially in situations with severe root exposure. The results of this type of graft are excellent because the tissue that is moved to the adjacent area includes blood vessels that are left in place--thus healing begins virtually the moment tissues are fixed in place.
Reasons for soft tissue grafting
Soft tissue grafting is an extremely versatile procedure that has many uses. Recent developments in dental technology have made soft tissue grafting more predictable and less intrusive. Here are some of the main benefits associated with soft tissue grafting treatment:
Increased comfort – Root exposure can cause substantial pain and discomfort. Eating hot, cold or even warm foods can cause severe discomfort. Soft tissue grafts cover the exposed root, decreases sensitivity and restore good health to the gum area.
Improved aesthetics – Gum recession due to periodontal disease can cause the smile to look “toothy” or the teeth to appear uneven in size. Soft tissue grafting can be used as a cosmetic procedure to re-augment the gums, and make the smile appear more symmetrical.
Improved gum health – Periodontal disease is a progressive condition that can destroy soft tissue very rapidly. When used in combination with deep cleaning procedures, soft tissue grafting can halt tissue and bone loss, and protect exposed roots from further complications.
What does soft tissue grafting treatment involve?
In cases where deposits (plaque and tarter) have resulted in inflammation, pocketting as well as gum recession, Dr. Nattkemper may recommend deep cleaning (root planing) as an "initial phase". In many others, particularly in patients whose hygiene is rigorous and/or aggressive, initial instruction in correction of brushing technique is critical if soft tissue grafts are to be performed successfully and last for the patient's lifetime. Dr. Nattkemper will usually perform the graft procedure itself under a combination of oral sedation and local anesthetic; this will depend on the patient's desires and on the size and number of areas receiving grafts. Microsurgical instruments are used to develop a tiny incision along the gumline around the teeth excibiting recession (the "recipient site") in order to create a small pocket. Donor tissue (removed from another site, or dermal matrix tissue) is gently inserted into the recipient site, and secured in place with tiny sutures. The donor tissue strip, along with the overlying tissue pouch, attach to the previously exposed root surface as the area heals.
In certain cases, tissue-stimulating proteins may be added to encourage quicker tissue growth. Gum uniformity and an immediate improvement in comfort and appearance of the area typically occur within the first several days of healing. The majority of healing will be complete within the first six weeks after the procedure.
If you have any questions about soft tissue grafting, please ask your dentist. Please also refer to ncofi.org or perio.org