Soft Tissue Grafting
Gingival recession is an exceptionally common malady, and the most common reason patients are referred to periodontists for treatment. Gingival recession, or mucogingival defects may be caused by periodontal disease. As bone is lost due to disease, the soft tissue level follows as well. Other causes of gingival recession are trauma, such as toothbrush abrasion, and malocclusion (bad bite). Malocclusion will be discussed in greater detail later.
Soft tissue grafting can be accomplished either with the patient’s own tissue, or with donor material. Generally donor material is used to treat more extensive generalized lesions, and serves to thicken and strengthen soft tissue rather than to fully cover the roots of the teeth. There are many advantages to using the patient’s own tissue. It is unlikely to elicit an immune response, and therefore is less prone to rejection. It contains live cells, which assist in healing, and it is generally the same color, so as grafts heal, they blend in more thoroughly.
Soft tissue harvested from the palate has many advantages, its chief disadvantage is a lack of abundance. A very small area in the palate can be sourced for donor material. This area is bound by specialized tissue on the front and back, a large blood vessel toward the center, and the teeth on the fourth side. Generally enough tissue to treat one to three teeth is able to be harvested from the palate.
When soft tissue grafts are harvested from the palate, I generally harvest tissue only from one side, so the second side is able to function without impediment. Soft tissue grafts are harvested in a very gentle and conservative manner. A “trap door” of overlying tissue is dissected, left attached, and tissue is removed from beneath. The “trap door” is then closed, and the wound edges secured with sutures. A clear acrylic stent is fabricated and worn by the patient for five days following surgery. This stent significantly reduces post-operative discomfort, bleeding, and molds the tissue to its original shape, facilitating healing without a soft tissue defect.
Soft tissue grafts and the palatal donor site resolve rapidly, however like all healing tissue there are phases of healing, potential complications. Bleeding from the palate is rare, but is of primary concern. Wearing the clear palatal stent will markedly or completely eliminate the potential for bleeding from the tissue donor site and allow the tissue to regenerate to its original contour. As the tissue heals, it will initially be discolored, and may have a whitish sheen, or may be dark red or purple and slightly inflamed. This is natural, and it will become pink and firm in a short time. The grafted tissue is quite delicate, and pulling down one’s lip to look at the graft, or eating without caution can damage the graft, so both are best avoided.