GUM TRANSPLANT

Gum recession

Gum recession or receding gum could be defined as the clinical loss of gum margin toward and along the root surface. Gingival or gum recession could be caused by the damage to the tooth-supporting periodontal tissues i.e. fibres, cementum, and alveolar bone, such as iatrogenic factors, orthodontic movement, infectious oral disease, chemical trauma e.g. chewing betel nuts.

Periodontal disease, aggressive oral hygiene activities, frenal pull, bone dehiscence, a defective restoration, tooth misalignment, viral & bacterial infections have all individually or in combination been associated with the gum recession. The clinical signs & symptoms attributed to gum recession are tooth hypersensitivity, root caries, and disturbing aesthetic.
The most efficient clinical approach to the restoration of the gum recession defects both in a short- & long-term is the application of the periodontal plastic /gingival transplant surgery to augment and replace the function and architecture of the lost tooth-supporting/periodontal tissues.

The periodontist in London Specialist Dentist with more than 2 decades of experience in periodontal specialism offers the most well-documented treatment strategies i.e. free gingival, connective tissue transplant, and tunnel techniques combined with guided-tissue-regeneration (GTR) strategies to restore both the soft and hard tooth-supporting tissues in order to enhance the long-term prognosis of your tooth.
 

Gum recessionGum transplant


Photo 1: Gum recession on the tooth 31 (LL1) cervical margin
Photo 2: Root coverage following the surgical gum transplant

Mucogingival deformities

Gingival recession is a part of mucogingival deformities with a prevalence of ca. 50% in people aged between 18 to 64 years, and ca.88% in people aged > 65 years.
 
The adverse impacts of gingival recession for the patient are as follows:
  • Aesthetically compromise
  • Dentin Hypersensitivity
  • Root surface alterations: Denuded root may be associated with cervical carious lesions (CCL), or non-carious cervical lesions (NCCL) e.g. abrasion and erosions, with increased age-related prevalence.
Cairo et al. described gingival recessions based on interdental Clinical Attachment Levels (CAL) and treatment-oriented classification:
  1.  Recession Type 1 (RT1): Gingival recession with no loss of interproximal attachment. Mainly associated with traumatic tooth-brushing.
  2. Recession Type 2 (RT2): Gingival recession associated with interproximal CAL loss. Mainly associated with horizontal interdental bone loss.
  3. Recession Type 3 (RT3): Gingival recession associated with interproximal CAL loss. Could be associated with infrabony defects (IBD).
A thin gingival biotype is more prone to develop increasing gingival recession lesions. There is evidence reporting a correlation between the gingival and buccal bone plate thickness (bone morphotype).
The severity of the gingival recession has also been correlated with 1) the interdental clinical attachment level, 2) the gingival phenotype, 3) root surface condition, 5) tooth position, 6) aberrant frenulum, and 7) the severity of adjacent recessions.
 
Presence of marginal tissue recession is associated with:
1. Traumatic tooth-brushing (Khocht et al. 1993)
2. Alveolar bone dehiscences (Bernimoulin & Curilivic 1977; Løst 1984),
3. High muscle attachment and frenal pull (Trott & Love 1966),
4. Plaque and calculus (van Palenstein, Helderman et al. 1998; Susin et al. 2004), and
5. Iatrogenic factors related to restorative and periodontal treatment procedures (Lindhe & Nyman 1980; Valderhaug 1980).
6. Periodontal CAL loss may cause compensatory remodelling and MBL, hence apical migration of gingival margin (Serino et al. 1994).
 
Other contributing factors:
  1. Para-functional activities
  2. Localised tooth-related factor: proclined tooth position
  3. Excessive buccal alveolar bone resorption/dehiscence caused by:
  • Aggressive non-regenerative surgical periodontal treatment
  • Uncontrolled aggressive orthodontic teeth movement beyond the buccal bone plate/alveolar bony housing, whilst surpassing the natural bone turnover.
  • Inter-dental attachment/bone loss
  • Localised dental prosthesis-related factors
  • Necrotizing Ulcerative Periodontitis
  • Localised prosthesis-related factors

Confounding factors:
  • High aberrant muscle & frenal attachment
  • Reduced vestibular depth
  • Inadequate attached gingival
 
Aetiology of progressing gingival recession
Based on the clinical observation that recession may occur during orthodontic therapy involving sites that have an “insufficient” zone of the gingiva, it was suggested that a grafting procedure to increase the gingival dimensions should precede the initiation of orthodontic therapy in such areas (Boyd 1978; Hall 1981; Maynard 1987).
 
As discussed previously, the with respect to orthodontic therapy, this would imply that as long as a tooth is moved exclusively within the alveolar bone, soft tissue recession will not develop (Wennstrom et al. 1987).
 
Predisposing alveolar bone dehiscences may be induced by uncontrolled facial expansion of a tooth through the cortical plate, thin gingival biotype without gingival recession are at a greater risk for the future development of gingival recessions. The attention of the clinicians to prevention and careful monitoring should be enhanced.
 
Management of the mucogingival deformities
 
1. Cause-related therapeutic schedule, treatment:
Traumatising tooth brushing technique & para-functional activities
  • Information about the aetiology and treatment strategies of gum recession
  • Oral hygiene instruction
  • Modification of brushing technique with a soft brush
2. Corrective/ rehabilitation phase of therapy (Muco-gingival/ periodontal plastic surgery):
 
Conventional Gingival Transplant  
https://www.youtube.com/watch?v=QtWYxIT9ZGA
 
Gum Recession After Wearing Braces Can Now Be Treated Without Gum Grafting Surgery 
https://www.youtube.com/watch?v=Cod9fYjctSA