The Subepithelial Connective Tissue Graft

Loss of gum tissue at the base of a tooth is associated with the tooth sensitivity that comes with exposed tooth roots and makes the teeth and underlying bone more susceptible to damage, and many patients with exposed tooth roots are bothered by the way their teeth and gums look. Fortunately, there are reliable solutions in the form of treatments designed to correct the positioning, amount, and quality of the gum tissue that surrounds and supports a person’s teeth. In order to fully understand these solutions, it’s helpful to understand the basic structure and characteristics of the gingiva, or gum tissue. Gingival tissue is made of thick connective tissue that’s covered with epithelial tissue. This epithelial tissue is full of keratin, a fibrous protein that forms a waterproof, resilient, protective layer on the outer surface of the gingivae. The gums themselves are classified in two ways: the free gingiva, which is the margin of gum tissue that cradles each tooth in a snug pocket, and the attached gingival tissue that surrounds and protects the bone and other periodontal tissues. When the free gingiva recedes, the roots of the teeth are exposed to the elements, making them vulnerable and making the gum line appear asymmetrical.

The most common gum graft is the connective tissue graft, which uses the connective tissue below this sturdy epithelial layer to patch areas of gum recession and cover exposed tooth roots. Another type of gum graft, the free gingival graft, includes both connective tissue and epithelial tissue. Both types of grafts harvest this tissue from the palate of the patient and then suture the harvested tissue in place at the area or areas of recession. The subepithelial connective tissue graft is widely used because of its predictable results, its efficacy at providing root coverage, and its aesthetic superiority. Free gingival grafts preceded subepithelial grafts in the world of dentistry; while free gingival grafts were introduced in 1963, connective tissue grafts were pioneered in 1974 and first used to treat gingival recession in 1985. Since then, periodontists have been fine-tuning techniques that improve function and aesthetics, making subepithelial connective tissue grafts the gold standard for treating moderate gingival recession. Subepithelial connective tissue grafts confer a few clear benefits over free gingival grafts, too, including highly predictable and successful root coverage and superior aesthetic outcomes; because these connective tissue grafts are less invasive than free gingival grafts, they also have a shorter, more comfortable recovery time and pose less risk of complications after surgery.

While a subepithelial connective tissue graft is effective for moderate gum recession, it isn’t a viable solution for more severe cases. When gum tissue recession is accompanied by soft tissue loss or loose teeth, this type of graft may provide only partial root coverage, and when there is soft tissue and bone loss combined with loose or malpositioned teeth, it is unlikely that a subepithelial connective tissue graft will provide any coverage at all. Because free gingival grafts include sturdy epithelial tissue, they are more effective when repairing more significant damage and can more successfully support the teeth and bone over the long term. Subepithelial connective tissue grafts are excellent solutions for aesthetic concerns and tooth sensitivity that arises when tooth roots are exposed, and free gingival grafts are best reserved for cases of severe gum recession and other periodontal damage. Any gum graft treatment begins with a periodontal consultation, so see your dentist if you’d like to learn more about ways to restore your gum line and protect your teeth.

Related Article: What is a Periodontics CTG?