Greffe de gencive - Cabinet spécialisé en parodontologie et implants dentaires à Nice

Periodontology

Gingival graft

Periodontal plastic surgery, also known as mucogingival surgery, encompasses techniques aimed at improving soft tissues: the gums.

Mucogingival surgery combines various techniques of gum grafting.

Their goal is often to treat gingival recessions.

What is a gingival recession?

A gingival recession is a retraction of the gums — a localized destruction of the soft tissues covering the roots of the teeth.

What causes gingival recession?

Recessions are multifactorial, meaning many factors contribute to their development.

Promoting factors include:

Thin gingiva
Low height of keratinized tissue
Malpositioned teeth
Proximity of labial frenula

Triggering factors include:

Gingival inflammation
Overzealous brushing
Certain orthodontic movements
Oral piercings
Improper dental restorations
Nail‑biting
Bulimia or anorexia

What are the consequences of a gingival recession?

Loss of protection: The gums serve as a barrier and provide bone protection. As gums recede, they thin and often become less protective, leading to underlying bone resorption. The tooth support is thus compromised. Moreover, sensitivity and root exposure make hygiene more difficult and increase the risk of periodontal disease.

Tooth sensitivity: When gums recede, the roots are exposed and unprotected. They may become sensitive to cold, heat, or sweet foods.

Root erosion: Exposed roots are vulnerable to bacterial, chemical, and mechanical stress, which can erode and damage parts of the root surface.

Visual elongation of the tooth: As more of the root becomes visible, the teeth appear longer. (Note: the actual tooth length does not change; the gum level changes.)

How are gingival recessions treated?

The treatment of gingival recession is primarily surgical.

A graft of gum tissue is added to increase thickness, then the gingival tissues are repositioned to cover the recession.

Microsurgical, minimally invasive techniques have evolved significantly in recent years. These techniques often yield more aesthetic, reliable outcomes with reduced discomfort.

With such methods, postoperative pain is typically described as mild discomfort.

What grafting techniques are commonly used?

There are many techniques and variations, but two stand out:

Free gingival graft:

The traditional method involves harvesting gum from the palate, preparing the recipient bed, and placing it onto the area needing coverage.

While relatively simple, it has drawbacks: the donor site remains open during healing, causing postoperative discomfort. The graft may not fully cover the recession and often has a whitish color after surgery.

Connective tissue graft (tunnel technique):

In the most advanced techniques, only the thin inner layer of tissue from the palate or around the wisdom teeth is removed..

The graft is taken with a single incision, leaving the palate almost intact and protected for healing.

Then, after carefully preparing a tunnel using microsurgical instruments, the graft is slid under the gum with a suture to the area where tissue is missing.

This is the most technically demanding procedure, but it offers many advantages. The donor site is protected, the transplanted gum is also covered, and the aesthetic result is immediately pleasing after surgery.

It typically causes only minor postoperative discomfort.

The grafted gum thickens the tissue and helps prevent recurrence. Recession coverage results are high — with approximately 80% coverage on average, and 50% of patients achieving complete (100%) coverage. Since there is no external incision, the aesthetic outcome is excellent.

Connective tissue graft by tunnel technique

Can biomaterials replace graft harvesting?

It is possible to use collagen‑based substitutes to avoid harvesting tissue. However, their results are generally inferior to using a harvested graft.

Given advances in graft harvesting techniques and their relatively mild postoperative effects, autologous grafts are often preferred.