Understanding Soft Tissue Dental Grafts
This is Dr. Perry from Farmington Family Dental. Today I'm answering some questions about free gingival grafts. It's a procedure we do at our office that helps repair tissue, and I want to answer some of the most common questions I get asked. By the end of this video, you should be pretty well versed in what it is and why we do it. Please give me a call if you have any more questions.
What is a soft tissue graft?
A soft tissue graft is where we take soft tissue from one part of the body and move it to another part. Usually, in the mouth, we're moving it because we don't have enough of the right kind of soft tissue.
If you look in your mouth, there are two types of soft tissue. Feel with your tongue on the roof of your mouth; notice how tough and solid that tissue is. That's what's called keratinized tissue. Keratin is a protein that the body develops that is very friction-resistant. It's very tough and resilient, like the tissue on the inside of your hand. You can push on it, and it's not going to go anywhere.
The other type of tissue in your mouth is very loose. You can feel that tissue if you take your tongue and go down on the front of your lower teeth and feel up against the inside there all the way at the bottom. Or take your finger; it would be easier to feel it. You'll feel tissue that is loose, that's moving, and isn't attached to the bone or the joints. It's movable. That tissue does a very poor job of sealing out bacteria in and around teeth or implants and preventing the bacteria from going down into the bone.
A free gingival graft is designed to move that heavily keratinized, tough tissue, like the side of your hand, and move it into a place where it needs to be to help restore a seal in and around a tooth or an implant.
Why are soft tissue grafts needed?
Soft tissue grafts are needed when the proper tissue isn't in and around things. The two most common reasons are in and around an implant. Implants rely on the toughness of the tissue around them to form a seal. That seal helps prevent bacteria from going down next to the implant and leaking in, affecting the bone that's holding the implant in place. If there's leaking in and around an implant, we will lose bone. If we lose bone, we eventually will lose an implant because of it. Soft tissue is the main issue with an implant regarding whether it's going to survive or not. It's very important that it has good, tough soft tissue in sufficient quantity and is keratinized, not the loose, flimsy stuff that will let food in.
The second reason we'll do a free gingival graft or move tissue from one area to another usually happens on the lower front. Sometimes people will have receding gums in a specific area. It's not everywhere. This isn't periodontal disease, by the way. It's not an infection process that's causing it. This is a mechanical process that's driving this, where we're having tissue that's getting pushed down further and further on the tooth. It can get to a point where we no longer have any attached tissue, no longer any tough tissue in and around that tooth. We've lost our seal around the tooth, and we will lose bone in and around that tooth, as well as it does on an implant. As we lose that bone, we'll eventually lose a tooth if we do nothing for it.
To keep that from happening and stop that recession, we take tissue from another part of the body and graft it in place. Once we grow that tough, thick tissue in that area, things are okay at that point. That tough tissue reseals the area and helps protect the bone and protect the tooth from further recession. Sometimes we do it preventively to slow or stop the recession where it's at. Other times, we do it to reverse it.
What we're able to accomplish depends on the exact clinical situation. If you want to know more, I can talk with you about that after I've seen your problem and what can be done with it.
Can a soft tissue graft fix receding gum lines?
Unfortunately, no. A soft tissue graft is capable of doing very limited spots when everything else is healthy. The less healthy everything else is side by side, the less likely it is to work, the less likely it is to be successful. In cases where everything is receding, it's better to hold the line where it's at than to try to regenerate the tissue to what it once was.
Unfortunately, that's where it sits. The body won't do miraculous things. It will do good things, but we have to work with the limitations of the body to do that. The best thing for a receding gum line, as in periodontal disease, is treatment where we're stopping the progress of the disease. If we can force it into remission, that's the gold standard. It's the best that can be done there.
Is a soft tissue graft painful?
The sad reality of it is sometimes yes. When it's not painful, it's not painful, and that's great. Typically, the site where we take the soft tissue from, usually the roof of the mouth, we take some of that beautiful tough tissue from up there and move it to wherever we need it.
That soft tissue on the roof of your mouth, where we take it from, depending on how thick that tissue is from the donor site, can be painful afterwards. There are some things I do on my end to help make it more comfortable, but usually, the first 24 to 72 hours is where I'm worried about pain.
I just did one yesterday. There was no pain at the graft site or the donor site. It was down here; it was some soreness that the person was feeling. That's pretty good. Not every case is that way. Most, in fact, do feel a fair bit of pain from the donor site, but not from the graft site.
How long does a soft tissue graft take?
Soft tissue grafts take a couple of minutes to do. It depends on the extent of the site. It could be anywhere from about 35 minutes to about two hours, depending on how large the site is. The healing process takes a minute to do too. I keep you on soft foods for anywhere from a month to three months. It usually takes about two or three weeks for that healing to be done to a point where it's really not sore or really feeling it anymore, but you still can't chew on things that are hard yet. Tough stuff will tear or damage the graft because it's still flimsy.
Why do soft tissue grafting with an implant?
Sometimes people ask me why I would do soft tissue grafting along with an implant. Most people think you put an implant in, and you're done. When implants are placed, to get them looking and functioning well, they need two things. They need bone in the adequate position, and they need soft tissue in the adequate position. Then the implant needs to be placed in the right position and restored properly.
All of those things are critical for the success of an implant. If even one of them is missing, we're running into problems. Those problems usually translate into more maintenance on an implant and a shorter life inside your mouth, a shorter functional life. In most cases, it makes sense to prolong the lifespan of an implant unless you're dying in the next year. I don't know how you know that, but some people do. Unless you're dying soon, it makes sense to prolong the lifespan.
One of the key parts is the quality and quantity of soft tissue in and around an implant. If we have adequate quality and quantity, that will extend the life of any implant. When we place implants, we plan that right from the beginning. From start to finish, we know everything that needs to happen without any surprises along the way.
I think that about wraps up our discussion on free gingival grafts or gingival grafting or soft tissue grafting; they are all names for the same type of thing. If you have any questions or you're interested in talking about or resolving a problem that you have, give me a call. My phone number is (573) 637-4404, or schedule below! Our staff would love to talk with you.