Are There Different Types of Tissue Grafts for Periodontics?

Periodontists are dental specialists who deal with the health of all the tissues that surround and support the teeth, including the bone, connective tissues, and gums. These surrounding tissues are collectively known as the periodontium, which translates literally as “around the tooth.” Some periodontal treatments require surgery while others don’t, and, especially in cases of advanced periodontal disease, patients will undergo a series of procedures in the process of repairing the oral cavity. Periodontists also perform preventive procedures when patients face an increased risk of periodontal disease; for example, patients with particularly delicate gum tissue or patients who brush their teeth too aggressively might benefit from a periodontal procedure that aims to strengthen the gums and prevent gum disease from ever developing at all.

Gum disease is characterized by inflammation. When the gingiva, or gums, are inflamed, the space between the gums and the tooth increases. As periodontal disease progresses, this gingival pocket deepens, creating an ideal resting place for bacteria and plaque to accumulate and fester, and gradually leading to tooth loss, bone loss, and general destruction of the periodontium. Periodontists are tasked with manually and mechanically cleaning the teeth deep within gingival pockets, and they are also responsible for a variety of surgical procedures that repair or restore tissue destroyed by disease. The overarching goal of periodontal treatment is to stabilize the oral health and halt the spread of disease while maintaining as much healthy, natural oral tissue as possible and preventing tooth loss. These procedures often include some type of gingival graft that’s designed to reinforce weak tissue, protect exposed tooth roots, and prevent recession from progressing.

The most widely used types of tissue grafts in periodontics are:

  1. Free gingival grafts
  2. Connective tissue grafts
  3. Pedicle grafts
  4. Alloderm grafts

All of these treatments achieve the goal of reinforcing and supporting weak or damaged gum tissue, but they involve different approaches.

  1. Free gingival grafts: The periodontist makes an incision in the roof of the mouth and extracts a portion of oral tissue, removing both the inner connective tissue and the outer layer of epithelial tissue. This graft tissue is sutured into areas of gum recession, supplementing the tissue and preventing further damage. Free gingival grafts are more invasive than connective tissue grafts, as more tissue is extracted from the palate.
  2. Connective tissue grafts: Again, the procedure begins with an incision in the roof of the mouth; instead of removing a thick layer of tissue, however, the periodontist removes only the connective tissue that underlies the palate, leaving the full epithelial layer, which is sutured back together after extraction. This grafting tissue is used to cover exposed tooth roots and provides superior aesthetic results, making it an excellent choice for the front teeth.
  3. Alloderm graft: If the patient lacks sufficient oral tissue for extraction, or in certain other cases, the periodontist may use processed donor tissue. This tissue is derived from human donors and processed to remove all living cells while maintaining its protein structure, creating an acellular matrix that serves as a scaffold for the patient’s own cells.
  4. Pedicle graft: The periodontist may be able to use a flap of gum tissue that’s adjacent to the area of recession, lifting the flap before rotating it into place at the base of a nearby tooth. This is only an option when there’s plenty of healthy gum tissue near the area of recession, which is rarely the case; gum recession almost always affects more than one tooth.

If your dentist suggests that you might benefit from gum grafts, or if your periodontist recommends them as part of a more comprehensive treatment, consult with your periodontist to determine which approach is best for you. Each has its own benefits and limitations, but careful research and good habits will ensure satisfying results.

Related Article: How painful is CTG; continuous tissue graft?