RESOURCES Periodontology Implant Dentistry Regenerative Procedures Gum Grafting When the gums are thin and weak due to a lack of tough attached tissues, recession can occur. Many feel that when this occurs the area may be more susceptible to bacterial penetration and trauma. When gum recession is a problem gum reconstruction using grafting techniques is an option. When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession reaches the mucosa (loose, moveable tissue), the first line of defense against bacterial penetration is lost. In addition, gum recession often results in root sensitivity to hot and cold foods as well as an "long in the tooth" appearance to the smile. Also, gum recession, when significant, can predispose the area to root decay and gouging as the root surface is softer than enamel. A gingival graft is designed to solve these problems. Free gingival epithelial graft Tissue is taken from the roof of the mouth and placed over the exposed root extending it laterally onto adjacent soft tissue. Root coverage is predictable; however, the graft does not always blend in with adjacent gum. Its appearance is unnatural. This may not be a problem, if accomplished in the posterior regions or lower jaw, because the area will rarely be seen. Its shortcoming is the uncomfortable and sometimes painful nature of the healing process. Subepithelial connective gum graft Connective tissue is taken from under the gum on the palate (roof of the mouth). This tissue is placed under a flap in the area needing root coverage. Only the underlying connective tissue is removed from the palate; therefore, a painful open wound is not present as with the free gingival graft discussed previously. This technique offers better esthetics due to better color matches. Bone Grafting A bone graft is a surgical procedure that replaces missing bone with material from the patient's own body (autogenous bone) or an artificial, synthetic, or natural substitute. The graft not only replaces missing bone, but also helps your body to regrow its own lost bone. This new bone growth strengthens the grafted area by forming a bridge between your existing bone and the graft material. Over time your own newly formed bone will replace much of the grafted material. Bone grafts are needed when part of your body is missing bone. This missing portion of bone is frequently called a �bony defect�. Examples of jawbone defects are: defects which occur following tooth extraction; generalized decrease in quantity of jawbone from trauma or long-term tooth loss; defects surrounding "old style" dental implants; defects resulting from cysts or tumor surgery. Onlay Bone grafting The solid slab graft consists as strong cortical bone which functions as a splint over the fracture site in addition to providing a stimulus for the formation of new bone. It is internally fixated. Allografting Allograft can come from many types of bones in many different forms. Allograft is usually removed from organ donors and placed in bone banks. Bone banks make sure the bone graft is sterile by testing it for diseases such as hepatitis and AIDS-just like testing done in a blood bank. Because it is not taken from the patient, it does not contain any living cells, and therefore has fewer chemicals to stimulate growth of new bone. The disadvantage of an allograft is that it may not always grow as well or as quickly as an autograft, but a bone-growing protein can be added to the area to make up for what the bone graft lacks. The advantage to using allograft is that the patient does not have to donate the bone graft. This makes the surgery shorter, and there may be less pain afterward. The allograft carries a very small risk of transferring infectious diseases even though it is rigidly tested. membranes A procedure in which a membrane is placed over the bone defect site. This membrane encourages new bone to grow and also prevents the in-growth of fibrous scar tissue into the grafted site.

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