Gingival Tissue Grafts - Research Paper Example

? A Case Study with Discussion on Gingival Tissue Grafts Due Introduction The issues associated with dental issues are becoming more and more prevalent in modern society. Painful and unpleasant dental conditions are not atypical of the dental experiences of many average citizens. Many people are diagnosed with generalized chronic mild to moderate periodontitis and localized severe periodontitis, or some variation every day. Even those patient’s that maintain good oral health, brushing, and flossing habits and , also, may not use tobacco or alcohol, and, always, visit the dentist regularly, still can be effected. It is often necessary to have surgery to correct these types of problems; fortunately, there are a number of treatment options available. Many people, as in the case study provided, suffer from other health conditions, like hypothyroidism and hypercholesterolemia; these conditions and needed medications must be considered when reviewing treatment options. Fortunately, most conditions and their related medications, will not threaten or prevent one from receiving the surgical dental treatment needed to repair gingival recession. Background What exactly is gingival recession and what causes it? The most concise definition of gingival recession is, “exposures of root surfaces due to apical migration of the gingival tissue margins and gingival margins migrate apical to the cementoenamel junction” (Pradeep, Rajababu, Satyanarayana & Sagar, 2012). In other words, the gums climb away from the teeth exposing more of the tooth surface or potentially the root itself. The results of which include painful infections, sensitivity to hot and cold, development of dental caries, aesthetic unpleasantness,, and, potentially, tooth loss. The cases of gingival recession increase in numbers and severity as people get older. There is a growing majority, nearly, 90% of adults, who are over the age of 50, have had or are having issues with gum recession (Johal, Katsaros, Kiliaridis & et. al., 2013). There are a number of conditions and causes that can result in gingival recession. Obviously, periodontal disease, which can be contributed to by Diabetes, for example, genetics, and dental habits can make a difference. In this patient’s case she, also, has a specific disadvantage when it came to dental problems, hormonal changes and imbalances, like those that accompany menopause, can contribute to instances of gingival recession. There are other contributors to gingival recession, including physical trauma to the mouth and gums, erosion of gum tissues due to chemical or medications taken, malpositioning or poor positioning of teeth, along with other genetic predispositions and outside influences. There are a different means of classifying the different kinds of recession; the most popular is the “Miller Classification” system. There are 4 classes within the Miller system. Class I, details a dental condition where the tissue loss is marginal and there is no internal bones loss currently present. The second, Class II, the recession extends beyond the MGJ, mucogingival junction, but with limited or no bone loss. The third, Class III, the recession extends well beyond the MGJ and shows loss of bone and soft tissues. Class IV represents the most severe recession and loss of bone and soft tissue (Kumar & Surendra Masamatti, 2013). This system is both, diagnostic and prognostic, studies both hard and soft tooth surfaces, and is the first determinant in deciding the best sort of grafts the patient is a candidate for (Lee, 2008). There are three different treatment disciplines that can successfully treat gingival recession. Pocket Depth Reduction: This procedure involves the folding back of gum tissue and manually removing the bacteria found in the pockets. The gum tissue is stretched across the root surface, effectively diminishing or eliminating the existing pockets (Tonn, 2012). Regeneration: This procedure helps the body to regenerate bone and new tissues. In this procedure the surgeon folds back gum tissue and manually remove all of the bacteria. Then a membrane, graft tissue, or tissue stimulating protein are applied to encourage the patient’s body to regenerate it own new tissue in that area (Tonn, 2012) Soft Tissue Grafts: Soft tissue is harvested from the hard palate (roof of the mouth); this tissue is stretched over the exposed roots and receding gums. This process can also be accomplished by using donor tissues from a tissue bank (Barack, 2008). Discussion It is the latter, soft tissue gingival tissue grafts, which most people option to have performed. Of all the different approaches it is the most common and, generally, offers a few different styles of the procedure most often practiced by oral surgeons; connective tissue, free tissue grafts, and pedicle grafts. Connective Tissue Grafts: This procedure is the most common approach used to cover exposed roots. A flap of skin is removed from the hard palate (roof of mouth). The subepithelial connective tissue from under the flaps extracted. It is then stretched over the existing gum tissue. This covers and surrounds the area of exposure (Tonn 2012). This is a two-layer graft that will cover the exposed roots (Redwoods Periodontic). Subepithelial connective tissue grafts is considered the most predictable of procedures that offers the greatest cosmetic coverage. The procedure gained its popularity in the 1980s. The most important discovery that earned the procedure “clinical predictability” was use of the bilaminar flap, which guaranteed optimum vascularity. It ensures the greater likelihood of both the graft site and harvested locale will heal nicely and with the greatest cosmetic appearance (Grover, Yadav, Yadav & Nanda, 2011). Free Tissue Grafts: This process is very similar to the connective tissue grafts. It still calls for the removal of tissue of the roof of mouth. However, instead of making the flap being cleared of interior tissue, the transplanted tissue is sewn directly over the area of most exposure. This protocol is often optioned when a patient has very thin gum tissue to begin with (Tonn 2012). The thicker harvested tissue applied will also aid in thickening the patient’s natural gum tissue. This thickening also makes these areas more resistant to future breakdown. However, because of that extra thickness added this area of gum may appear paler than the surrounding tissue. For individuals whose major focus of the repair is restore aesthetics then this procedure may not be the first choice. However, from a repair perspective this procedure is generally successful. This procedure does not always cover exposed roots; however it is ideal at adding width to the apical gums bearing the recessions (Redwood Periodontic). Pedicle Grafts: This procedure does not rely on the tissue taken from the palate of the patient. It focuses on the tissue around or near the tooth that is in need of repair. A flap is made, called a pedicle, which is sliced so that one edge remains attached. The gum tissue are then stretched to cover the exposure and then sewn not place. This process only works well when the patient has an ample amount of available gun tissue (Ton, 2012). Again it is the connective tissue graft that is most commonly performed and preferred by many patients (Khuller, 2009). According to professional the surgical sites heal quickly, are the least painful for most patients, and provide results that are remarked as being most aesthetically pleasing ( Kumar, Sood, Masamatti & et. al., 2013). Of course, it is necessary to mention that, although, this procedure, like many medical procedures, can treat and improve the immediate recession of gum tissue, however there are no guarantees that a tissue graft procedure will help prevent a relapse of a treated graft site or the development of similar conditions in other dental locations (Tonn, 2012). When a patient has furcation, which refers to the amount of bone loss in the area, it is classified by number. Many people suffering gum recession also suffer from class II furcation in, at least, one tooth; this means that there is some loss of bone and pocketing in the area, which can be shallow, moderate, or deep. There are a number of different approaches to improve this particular problem, including odontoplasty, root resections, and guided tissue regeneration. In fairness, because of the difficulty of maintaining the surgical areas and protecting it from continuing damage, many patients and dental professionals will consider the option of a synthetic replacement for such teeth, as opposed to multiple repair procedures (Claman, 2010). The past decade has seen many refinements and innovations n the dental fields in relation to periodontal disease and it characteristic side effects, like gum recession (Grover, Yadav, Yadav & Nanda, 2011). The continuing prevalence of periodontal disease, general dental decay, gum recession, and tooth loss can be painful, embarrassing, and can impeded some individuals quality of life. Many dental patients will not seek out dental care until the issue has become unbearable and the lack of quality dental care can, also, be a deterrent. That said, innovations are being pursued to make the dental experiences that people have are more efficient, successful, and stress free procedures, which required less and less pain, risk factors, and invasiveness of the procedures. Most people do not brush and floss as often as they should or visit their dentist regularly. Many of the people who are already who are already suffering from the effects of periodontal disease or other similar dental issues will wait until problem becomes too painful or too aesthetically displeasing to tolerate. However the key to dental conditions is early identification, immediate treatment, and efforts needed to prevent further dental problems, as much as possible (Tonn, 2012). However, that is not the reality of most people’s behavior. There needs to be greater measures instituted to aid in the psychological phobias and deep seeded fears that can keep people from going to a dentist no matter how badly they may need to see one. Some people are so affected by the statistical reality that they feel that, for one reason or another, be it a side effect of disease, genetic predisposition, bad hygiene, or a reaction to medications, something bad will likely happen to the quality of their natural teeth at some point in their life (Tonn, 2012). They option to have all of their natural teeth removed and substituted with synthetic alternatives these patients might option for dentures or, for those who can afford it, permanent dental implants. However, this is an extreme measure and most dental professionals today are dedicated to salvaging natural dentition when at all possible. Conclusion Regardless of good hygiene, regular dental visits, avoidance of alcohol and tobacco products, and properly treated medical conditions cannot guarantee anyone freedom from future dental problems. In the end we live in 2013, an era of innovations, advancements, and technologies, yet people’s dental health continues to diminish. This is unacceptable. Implementations from the dental community to lessen dental phobias and improve patient relations are essential. Between innovation and patient education it could result in many patients seeking the appropriate treatment when needed an, perhaps, even before extreme, invasive measures are needed. The goal is for every patient to have the good fortune of a positive prognosis or better yet no conditions to diagnose to begin with. References Barack, D. (2008). [Web log message]. Retrieved from http://blog.dentalprofessionals.com/?p=13 Claman. (2010, August 10). Furcation involvement: Diagnosis and treatment. Retrieved from http://www.dent.ohio-state.edu/courses/d664/2010/FurcTx10ForCarmen.pdf Grover, A. S., Yadav, A., Yadav, P., & Nanda, P. (2011). Optimizing gingival biotype using subepithelial connective tissue graft: A case report and one-year followup. Hindawi Publishing Corporation Case Reports in Dentistry, 1-3. Johal, A., Katsaros, C., Kiliaridis, S., & et. al., (2013). State of the science on controversial topics: orthodontic therapy and gingival recession (a report of the angle society of europe 2013 meeting). Progress in Orthodontics, 14(16), 1-5. Khuller, N. (2009). Coverage of gingival recession using tunnel connective tissue graft technique. The Journal of Indian Society of Periodontology, 13(2), 101-105. Kumar, A., Sood, V., Masamatti, S. S., & et. al., (2013). Modified single incision technique to harvest subepithelial connective tissue graft. Journal of Indian Society of Periodontology, 18(5), 676-680. Kumar, A., & Surendra Masamatti, S. (2013). A new classification system for gingival and palatal recession. The Journal of Indian Society of Periodontology, 17(2), 175-181. Lee, M. (2008). Gingival Recession, Retrieved from http://www.bsperio.org.uk/undergraduates/pdf/20_081249_gingival_recession-bsp.pdf Pradeep, K., Rajababu, P., Satyanarayana, D., & Sagar, V. (2012). Gingival recession: Review and strategies in treatment of recession. Hindawi Publishing Corporation Case Reports in Dentistry, 1-6. Tonn, E. M. (2012, August 20). Gum tissue grafts. Retrieved from http://www.webmd.com/oral-health/guide/gum-tissue-graft-surgery?page=2 Redwoods Periodontic. (n.d.). Soft tissue grafting. Retrieved from http://www.redwoodperiodontics.com/pdf/softnews.pdf Read More