Autograft vs Donor Graft
A gum graft is a piece of tissue that is used to surgically replace missing gum tissue. These grafts are used in periodontal surgery to sculpt and augment the gum tissue around the roots of teeth that are exposed due to gum recession. During a gum tissue graft surgery, a strip of gum tissue is usually removed from inside the patient's mouth. Four types of gum grafts are used to reverse gum recession, preserve jawbone, and create an aesthetically appealing gum line. The graft can come from you or a surgeon might decide to use alloderm, which is an allogenic graft made from laboratory-prepared donor tissue. The main difference between using your own tissue and alloderm is that you will have less healing time with alloderm, but there is a slightly higher chance of your body rejecting alloderm than if the surgeon uses your own tissue.
Types of grafts
As an alternative gum graft, the lateral pedicle graft is used when there is an abundance of healthy gum tissue next to the damaged area. Three sides of neighboring flaps of gum tissue are cut and carefully placed over the area of missing gum tissue. It is then sutured in place until the graft heals. These sutures are removed at a follow-up in-office appointment within two weeks of surgery. The gum excision site is left open and can be very painful during the seven-to-ten-day healing period. If a person does not have enough acceptable gum tissue for extraction, a gum graft made from donated human skin may be used. The acellular dermal matrix graft, known as alloderm, is not always successfully implanted into oral tissue.
Another gum graft is called a sub-epithelial connective tissue graft. Gum tissue from a healthy donor is removed from under the palate surface in the mouth. A small incision is made before the periodontist removes a thin piece of gum tissue, then the donor site is closed with dissolvable sutures. It is possible to harvest enough tissue during an augmentation surgery to repair damaged gums from multiple teeth. This procedure is less painful than other graft operations because the donor site is not exposed during the healing process. Most periodontal surgeons prefer to use gum tissue taken directly from the patient because graft failure is less likely.
A third type of graft is called a free gum graft. The top layer of tissue is removed from the palatal surface and the donor excision site is left open until healed. Only a small amount of usable gum tissue can be collected during this operation. A free gum graft is used to repair the gums around a single tooth.
What can you expect during the procedure?
After arriving at your appointment, you will be escorted to the procedure room. Local anesthesia will be used to numb the area where the gum transplant procedure will be performed.
In rare cases, your periodontist may allow you to undergo general anesthesia so that you can be unconscious during the procedure. This is usually not recommended due to the risks associated with general anesthesia. Depending on your individual needs, your periodontist will do one of the following. Gingival grafting is a procedure specially designed for this problem, with the aim of repairing the damage that has occurred, recovering the appearance of the gums and preventing other ailments that can be generated as a result of retraction. For this purpose, three types of tissue can be used, always taking into account the cause of the recession and the dentist's criteria:
- Connective tissue: in this case, if we are talking about a gum graft alternative, the tissue to be graft is extracted from the palate, separating the sub-epithelial connective tissue, which is what will be used to make the graft. The rest of the palatal tissue is reimplanted where it was removed from;
- Gingival free: the tissue extracted from the palate is also used, but it is implanted in its entirety in place of the gum to be repaired. This method is frequently used when the gums, in addition to being receded, are too thin and need to be thickened;
- Gingival pedicle: A piece of gum (pedicle) from the same tooth that will be repaired is used to perform the graft. Instead of cutting it completely, it is cut only partially, so that later the tooth can be surrounded and stitched so that it holds its position. But for this it is necessary that the patient retains enough gum tissue;
- Tissue bank: Sometimes the palatal tissue needed to perform the gum graft can be obtained from a tissue bank.
In some cases, instead of resorting to a gingival transplant, a drug based on biological proteins and growth factors is used to regenerate the lost periodontal tissue.