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 denuded by decay. Dental health professionals who are qualified to perform this type of grafting are general dentists for the simplest cases and periodontistsfor 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 of 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 need to be covered, as the free autogenous graft is mainly used to stop the progression of dental decay in a minimal way. However, the advantage of this technique is the absence of the risk of rejection of the graft, because it 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-cover the dental roots that have been affected by gum recession. Also in this case, the patient cannot reject the graft because it comes from tissue taken from his or her mouth.
- Overlay graft with allogenic tissue(allograft): This type of graft is relatively new. A graft from an external donor, which has been previously treated 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 no only one surgical site, because the graft is not taken from the patient’s palate. It also gives results also aestheticsthan the 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.
A gingivectomy is a surgical procedure that removes 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 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 those 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 a part or all of a dental crown is hidden under this excessive gum. A false gum pocket is then said to form and it can harm the health of the affected teeth in the medium or 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.
The growth of the gum can be due to several reasons factors, the most common being the use of medications known to generate excess gum tissue, such as certain medications 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.
A gingivectomy performed as part of a periodontal treatment consists of cut excess unattached gum tissue to a tooth in order to clean a periodontal pocket
that may have formed during gum disease. This cleaning procedure is also known as periodontal curettage and is illustrated with the two images below.
In addition to aesthetics, if the periodontal pocket is deep, less attached gingiva will be available after the gingivectomy to protect the alveolar bone supporting the tooth, which could negatively affect the strength of that tooth in the medium to long term.After removing some of the gingiva near the tooth, the patient can clean that tooth more easily with a normal brush. However, depending on the depth of the initial periodontal pocket, the appearance of the gum after the procedure may be less aesthetic. Indeed, if the initial pocket is deep, the amount of gum tissue to be removed will be large and the teeth will look longer than before the procedure.
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.