Gum treatment

Surgical procedures on the gums

The gingival graft

Gum grafting can be performed to restore sufficient gum tissue around teeth or tooth roots that have been exposed by decay. Dental professionals who are qualified to perform this type of grafting are general dentists for the simplest cases and periodontists for the most complex cases.

Several techniques are used to perform gum grafts and each case must be analyzed by a dentist or periodontist to determine the best grafting technique. In all cases, the grafts come from the patient’s own palate or from an external donor.

  • Free autogenous graft: This is the oldest technique of gingival grafting. It consists in taking the graft from the patient’s palate and installing it on the gum affected by the receding gums. Its main disadvantage is the less aesthetic result, unlike that obtained with other methods. It is also not recommended to use this type of graft in cases where the dental roots must be covered, since the free autogenous graft is mainly used to stop the progression of the dental decay in a minimal way. However, the advantage of this technique is that there is no risk of graft rejection, since the graft is taken from the patient’s own mouth.
  • Connective tissue graft (connective tissue root canal graft): This is a relatively new and versatile technique that can be used in the vast majority of cases requiring a gingival graft. The connective tissue is taken from the superficial gum of the patient’s palate and inserted under the gum adjacent to the teeth that are affected by loosening. Its main advantages are the very aesthetic results obtained, as well as the possibility of re-covering the dental roots that have been affected by gum recession. Also in this case, the patient cannot reject the graft, since it comes from tissue taken from his or her mouth.
  • Allograft: This type of graft is relatively new. A graft from an external donor, which has been previously processed and is very safe, is used to implant it into the gum of another patient who needs to reinforce the attached gum in height and/or thickness. The main advantage of an allograft is that there is only one surgical site, as the graft is not taken from the patient’s palate. It also provides results that are as aesthetically pleasing as a connective tissue graft. However, there is a small risk of rejection of the graft, since it is a foreign body implanted in the mouth of another patient.

The success rate of gum grafts is very high and its effects last for many years, slightly less in smokers.

La gingivectomie

Gingivectomy is a surgical procedure that consists of removing part of the gum. It is performed under local anesthesia with special tools to cut the gum and usually has few complications.

Recent techniques allow for minor gingivectomies to be performed with a soft tissue laser, resulting in even fewer post-operative complications and discomfort for the patient.

There are three main applications for gingivectomy, as described below.

Aesthetic application

Aesthetic gingivectomy removes part of the gum around one or more teeth to harmonize the shape of the gum and improve the appearance of a smile. Removing a line of gum tissue above certain teeth “lengthens” the crowns of these teeth, which are shorter than those of other teeth.

The collection of images below shows how a gingivectomy can be performed for aesthetic reasons. A repeat procedure is possible only a few days, at most a few weeks, after the original procedure, as shown in image E. The difference in the contour of the gums surrounding the central incisors between image B (after orthodontic treatment) and F (final result) is clearly visible.

Treatment of gingival hyperplasia

Gingival hyperplasia is the condition in which the gums grow unusually large, to the point where part or all of a dental crown is hidden under the excessive gums. This is called a false gum pocket and can affect the health of the affected teeth in the medium to long term.

For this reason, a gingivectomy is recommended to remove the excess gum tissue. If the situation remains as it is, the patient is at high risk of developing periodontitis, because the false pockets prevent the patient from cleaning his teeth properly.

Gum overgrowth can be due to several factors, the most common being the use of medications known to generate excess gum tissue, such as certain drugs for epilepsy and hypertension. In such a case, the surgical procedure must be performed again when the recurrence of excess gum tissue is significant enough to increase the risk of developing periodontitis.

Periodontal treatment

a periodontal pocket that may have formed during gum disease. This cleaning procedure is also known as periodontal curettage and is illustrated in the two images below.
En plus de l’esthétisme, si la poche parodontale est profonde, une moins grande quantité de gencive attachée sera disponible après la gingivectomie pour protéger l’os alvéolaire supportant la dent, ce qui pourrait affecter négativement la solidité de cette dent à moyen ou à long terme.Après l’ablation d’une partie de la gencive près de la dent, le patient peut nettoyer cette dent plus facilement à l’aide d’une brosse normale. Cependant, dépendamment de la profondeur de la poche parodontale initiale, l’aspect de la gencive après l’intervention peut être moins esthétique. En effet, si la poche initiale est profonde, la quantité de gencive à enlever sera grande et les dents sembleront plus longues qu’avant l’intervention.

La gingivoplastie

La gingivoplastie est une intervention chirurgicale mineure ayant pour but de remodeler le contour de la gencive. L’intervention permet de rendre un sourire plus attrayant et harmonieux, et elle permet aussi de compléter une gingivectomie qui, à elle seule, ne donnerait pas des résultats optimaux.

La procédure est habituellement effectuée par les mêmes professionnels de la santé dentaire que ceux qui font des gingivectomies, soient les dentistes généralistes et les parodontistes. Une anesthésie locale est nécessaire pour effectuer une gingivoplastie et des outils chirurgicaux spéciaux, ou encore plus récemment un laser à tissus mous, peuvent être utilisés pendant l’acte chirurgical. Les complications d’une telle intervention sont rares et les inconforts post-opératoires sont minimes.

La gingivoplastie est surtout utilisée dans le cadre d’un traitement orthodontique afin de finaliser l’esthétisme du sourire obtenu pendant l’orthodontie. En effet, en déplaçant des dents ayant des couronnes de différentes longueurs, il peut arriver que la ligne du sourire ne soit pas optimale, à cause de la gencive qui contourne les dents de façon irrégulière.

Un professionnel de la santé dentaire peut également faire appel à la gingivoplastie dans le cadre d’un traitement de maladie de gencive. Dans ce cas, elle permet de redonner à la gencive une forme normale après avoir traité l’os alvéolaire déformé, endommagé ou nécrosé.