Connective Tissue Grafting


Many people have some degree of gingival recession. It is one of the most under diagnosed pathologies of the oral cavity. When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. When gum recession is a problem, gum reconstruction using grafting techniques is an option.

When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when the recession is progressive and  reaches the mucosa, the first line of defense against bacterial penetration is lost.

More importantly, recession means that bone loss has occurred. Fortunately, a secondary benefit of gum grafting is bone regeneration. Once the gum tissue is regenerated the lost bone will return.

In addition, gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance to the gum and tooth. Gum recession, when significant, can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root caries and root gouging.

A tissue graft is designed to solve these problems. Treatment involves making an incision around the tooth, relaxing the tissue then inserting new tissue under the recessed tissue. Tissue is taken from the roof of the mouth or sterilized donor tissue (Alloderm) can be used. It is like filling a pita pocket/taco. Healing with either tissue source is the same, i.e., the tissue is resorbed and new tissue regenerated. The result is a gain of gingival tissue and secondarily bone.

Soft Tissue Grafting either can be done around natural teeth for root coverage and increase the gum thickness, or can be done around dental implants that have no or thin gum tissues. several techniques have been used for soft tissue grafting.

  • CONNECTIVE TISSUE GRAFT ( CTG): This technique is used when there is gum recession around teeth and causes cosmetic problems. This technique CTG has the best results regarding root coverage and color-matching the adjacent tissue area. CTG can be used alone or with regenerative materials. oral home hygiene plays an important rule during the healing time and patient compliance as well.
  • FREE GINGIVAL GRAFT (FGG): This technique is used when there is gum recession or very thin gingival tissues around teeth or dental implants. FGGhas the best results for increasing the gingival thickness and attached gingiva to withstand the mechanical or frictional forces during eating. This tissue can be used for root coverage but cosmetic issue is not a concern. also FGG can be used alone or with regenerative materials.
  • ALLODERM: This technique used when there are several teeth( 3+) has gum recessions or the donor site( roof of the mouth)  has thin tissues and will be no enough grafts to cover more than three adjacent teeth. The ALLODERM is a Sterilized human tissue graft. This technique can be used alone or with regenerative materials.