Fig 1aPeriodontist are well known to be expert in gum ad soft tissue management besides their essential role in periodontal disease treatment.

One of the procedures that are often requested to periodontist is coverage of exposed dental roots. Most of the time patients seek the help reporting dental sensitivity but also concerns about esthetic appearance of their smile. Generally speaking these are the two most important requests and also indications for soft tissue management and treatment. For the sake of classification we can divide these two occurrences in a functional and an esFig 1bthetic defects. In the first case the patient would be complaining about dental sensitivity to cold foods, drinks as well as during tooth brushing procedure. In the second circumstance, the patient has concern about the appearance of their teeth but doesn’t necessarily refer sensitivity. It is possible though that the two situations can occur at the same time.

Fig 2a One option to treat these conditions would be to cover the teeth with resin fillings of complete crown coverage. The second, more biologically driven, would be moving or adding gums and to avoid dental materials. Under specific criteria, the so-called muco-gingival surgery (dental plastic surgery of the gums) can restore both root recessions and reduce sensitivity. A numerous list of techniques and materials can be employed to increase the amount of soft tissues (gums) that were lost and that resulted in recession. The different techniques available are carefully selected by the periodontist according to the specific characteristics of the clinical scenario. These plastic surgeries can be executed with the help of a microscope magnification associated with micro instrumentation in order to apply a minimally invasive approach. Generally speaking, muFig 2bco-gingival surgery for root coverage is either based on a translation of adjacent tissues or an installation of grafts. These can be collected from the patient’s oral cavity, from tissue banks, made artificially or derive from animals. The most described and validated graft in the scientific literature is the one taken from the patient’s own palate (connective tissue graft). Despite its popularity and performances, not every patient has sufficient amount or accepts to have a second incision in their mouths for the purpose of obtaining the graft. For these reasons the other aforementioned materials can serve as alternatives of connective tissue grafts. They can be purchased by Fig 2cthe periodontist in dedicated packages and they can be used during surgery.

The usual pain experience is limited since it is a plastic and refined procedure, ideally characterized by a minimally invasive sequence. If a restorative plan is not necessary, muco-gingival grafting represent the most natural and biologic approach to solve esthetics and sensitivity problems.

Besides teeth, soft tissue augmentation can be performed also around implants on in edentulous areas to increase stability, esthetic and function.

 

– By Lorenzo Mordini DDS, MS

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