Connective Tissue Grafting

A quick lesson in anatomy. There are two types of oral mucosa around your teeth. Attached and unattached gingiva. Attached gingiva is firm, stippled texture, pink tissue which protects the gum line from shifting. It is directly adjacent ot the necks of the teeth. Unattached gingiva is directly below the attached and is redder and can be distinguished due to the small blood vesels which are readily visible and the fact that it moves when we eat and talk. When a patient has recession of the gum line, the underlying root surface becomes exposed and over time this can lead to tooth sensitivity. In the recession process you are losing attached gingiva and its underlying bone. If the recession continues and enough bone is lost you can also experience looseness of teeth as they become mobile. Dr. Kirshen will best advise you when it is time to reverse the process by recommending whether a connective tissue graft or free gingival graft is necessary. The concept is to borrow tissue from the roof of the mouth (palate) or use an allograft from a cadaver or porcine, and to graft it into place around the exposing root. There are two goals in achieving success with this technique.

First, Dr. Kirshen wishes to bolster the amount of attached gingiva so no further recession can occur and second, to attempt to cover the exposing root surface and lessen the amount of root exposure. The best success and most root coverage is achieved using a patient’s own donor tissue, but this is not always possible or warranted especially in treating a large number of teeth in the same session or to lessen the morbidity after surgery by not having to enter a second site. For these circumstances Dr. Kirshen has available in his armamentarium the use of cadaver tissue (Alloderm) or porcine tissue (specially treated connective tissue from pigs). As the trend of orthodontics is to try to treat the patient without extracting any teeth we are seeing more recession at an earlier age because the teeth have been moved into narrower parts of the arch unable to accomodate the width of the teeth and thus leading to recession.

By not extracting teeth we are seeing less problems later with joint soreness (TMJ Syndrome) but more recession. Please remember that the orthodontist has done the best with the genetic makeup of the patient and recession is a risk of treatment well worth taking.