Tuesday, September 2, 2014
Post gum graft surgery problems
hello, i had moderate gum recession on my lower two front teeth and was referred to a particular dental surgeon by a friend. she said he could help my teeth by doing a gum graft. after a consultation, we set up the appointment for the surgery. the first day, the sutures started coming untied in my mouth. i went back the next day to have him fix it, and apparently he stretched the graft too tight because it began to tear over the next few days. i went back and he told me "it was fine" when i knew it wasnt. after two weeks i went back and he told me the graft didnt take, which i already knew, so he pulled it out and said wed retry in a few weeks with an artificial graft called Aloederm. my next appoint ment came and we redid the graft. he told me we would use an artificial graft, but he changed his mind because they heal white and dont look normal. i could care less if they look normal, i just want this garbage done with! this time he sutured the graft in quite extensively, criss-crossing the sutures to sort of "seat-belt" in in. once again, ive been following all of his instructions and aftercare, as i cannot afford to have this procedure done again. yesterday i woke to find the graft had pulled off of one side of my teeth and moved to the other. today i did my normal morning saltwater mouthwash, as recommended by my dentist, and found that the graft had pulled away completely, and, once again, is being held by only one suture. my questions are, (1) are gum grafts NORMALLY this problematic and troublesome, and (2) would the difficulty be lessened by using an Aloederm graft instead of my own tissue?
There are three ways to perform soft tissue grafting:
1- With your own tissue but only connective tissue; this requires sutures at the roof of the mouth but it is less painful since the wound is closed during healing.
2- With your own tissue and it requires removal of full thickness of the soft tissue from the roof of the mouth. This leaves the wound exposed and it is generally more painful and tends to bleed more.
Thus, we generally use #1 if we have enough thickness at the donor site to open like a sandwich and remove connective tissue from inside the sandwich. But if we do not have enough thickness we go to option #2.
3- Using a biomaterial (AlloDerm) when there is really limited amount of donor tissue. This also depends on having enough soft tissue at the recipient site to hold the material.
In addition, the type of defect is important for graft survival. Narrow defects with intact tissue at the interdental areas have more chance since the root surface does not have any blood supply and adjacent tissue will help the graft tissue to survive.
Also, anything that will cause the grafted tissue to move during healing such as muscle pulls from inside the lip etc. will affect the healing. That is why we generally show the site to the patient right after surgery and ask him/her not to look at it again during the first week. We know that everytime the patient pulls his/her lip to look at it, there is a big chance that the graft will move.
In summary, given the right indication and right surgical technique, this treatment alternative works very well most of the time.
Binnaz Leblebicioglu, DDS, MS, PhD
Associate Professor of Periodontology
College of Dentistry
The Ohio State University