Specialist Gummy Smile Corrections
July 29, 2024
Specialist Impacted Teeth & Wisdom Teeth Removal
July 30, 2024Specialist Gum Recessions Corrections
Gum recession is a condition where the architecture and position of the gum line has shifted away from where it should be ideally. This can happen on a single tooth or multiple teeth. The usual signs are longer looking teeth, sensitivity and tenderness or pain on toothbrushing. Gum recession can develop regardless of age and can be a result of periodontitis, trauma, uncontrolled teeth movement or certain bad habits. It is also sometimes coupled with wear facets on the exposed root surfaces.
Management and correction involve surgical mucogingival correction utilising palatal gum grafts (free gingival grafts (FGG) or connective tissue grafts (CTG)), synthetic grafts and biologics such as Emdogain and concentrated growth factor (CGF) or platelet rich fibrin (PRF). This is performed with various approaches like the coronally advanced flap (CAF), modified coronally advanced flap (MCAF), tunnelling and its modifications, VISTA or even pinhole techniques.
Frequently Asked Questions
What should I expect during my first recession consultation?
Our specialist periodontist will first get to know you and understand your concerns and expectations. He will then perform a detailed periodontal assessment and recession examination. He will need to take focused and current xray(s) to better diagnose and prognose. He will then discuss with you about the condition you are having, why is it happening, what to expect moving forward and also the different phases of proposed treatments and costs. You are able to ask him the doubts and questions you might have. We spend over an hour on these visits.
What is gum graft surgery?
There are 2 main types of gum grafting surgery:
ONE is called phenotype modification surgery. The aim is to change the character of a “thin” gum to a “thick” gum in order to prevent further recessions. The horizontal width of gums is thickened and sometimes there is an increase in vertical height too.
SECOND is called recession coverage surgery. The aim is to correct and cover the recession. The vertical height increase is the focus of this surgery and in the process, there will also be an increase in horizontal width.
Both surgeries require gum graft(s) which is usually taken from the patient’s own palate (gold standard) or from commercially available products.
What is the difference between the many techniques (CAF vs tunnelling vs VISTA vs pinhole)?
These refer to techniques used to create the available space for gum graft placement and also protection after. Pinhole and VISTA are generally less invasive than CAF but each technique has its own indication and not every technique can be used in every case. The choice of technique will come down to what will more predictably contribute a better outcome in your condition.
Is the treatment painful?
We place good topical anaesthetic gel before giving the local anaesthesia and are consciously gentle throughout. There will still be a small “pinch” while local anaesthesia is placed but once the anaesthesia has started working, the procedures should be relatively pain-free. The experience differs from person to person but our specialists and dentists will advise you prior and are conscious of any changes or cues you give during the procedure. Post-operatively, you might experience a down-time (slight pain and swelling) for 3-7 days. The discomfort is usually greater from the palate where the graft is harvested but it is reduced when we place the CGF/ PRF (blood product) immediately after surgery. We advise all our patients that they are not supposed to brush on the surgical site up to 3-4 weeks after surgery. Pain is usually well controlled with the painkillers and anti-inflammatories we prescribe after.
How many times do I need to come?
We will review you at least 3-4 times over a period of 4 weeks after surgery to remove stitches, for cleaning and to ensure that the graft is fully stable and healing optimal. Long-term follow up is also encouraged.
What is the success rate?
The success rate depends on the initial condition of the situation. Not every recession warrants a recession coverage treatment and if done, the extent of recession and amount of remaining supporting bone determines the success and percentage of coverage. We usually grade and classify recessions as RT1, RT2 or RT3 recessions (Cairo’s Classification, 2011). The percentage of coverage predicted ranges from 50%-100% depending on the situation. It is very technique and post-surgery healing sensitive hence further detailed care instructions will be given to you prior to and after surgery too.
What post-operative care is needed?
The first 24 hours involve care to prevent over-bleeding. We advise that you avoid hot food and drinks, rigorous rinsing and gargling, straws and sucking actions for the first 24 hours to prevent over-bleeding or reactivation of bleeding. You will need to be on a soft diet, avoid strenuous exercises for the next 7-10 days. We also recommend that you complete the dose of anti-inflammatories, antibiotics (when necessary) and antiseptics which we prescribe. You will need to resist the urge of touching the surgical site with your tongue, finger or any other objects during the healing period.
