• Periodontal Surgery—Soft Tissue Graft

    (Guided Tissue Regeneration)

    Definition

    Periodontal disease often refers to bacterial plaque and infections around the gum and tooth root. It can happen around one or several teeth. In some cases, the gum tissue is damaged or shrinks. In its more advanced stages, surgery to create new gum tissue (and even bone growth) can be done. There are several techniques used to encourage new gum growth using donor tissue, man-made material, or tissue from the roof of the patient’s mouth.
    Periodontal Disease
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    Reasons for Procedure

    This surgery is needed to:
    • Cover tooth roots that are exposed, which can lead to bone loss and decay
    • Reduce tooth sensitivity
    • Even out gum tissue due to recession
    Not all grafts are successful over time. The level of disease and your personal care routines will affect success.

    Possible Complications

    If you are planning to have periodontal surgery, your dentist will review a list of possible complications, which may include:
    • Tooth sensitivity
    • Changes in gum appearance; uneven gum line
    • Graft failure
    • Bleeding
    • Reaction to the sedation medicines (eg, light-headedness, low blood pressure, wheezing)
    • Infection
    • Swelling
    • Nausea and vomiting
    Factors that may increase the risk of complications include:
    • Smoking
    • Other health conditions, like diabetes

    What to Expect

    Prior to Procedure

    • Tell your dentist of any recent changes to your health, medicines, allergies, or supplements.
    • Take your prescription medicines unless your dentist says otherwise.
    • Talk to your dentist about any medicines you take, including over-the-counter medicines. You may need to avoid certain medicines as advised by your dentist.
    • You may be asked to take an antibiotic prior to having surgery.
    • Sometimes sedative medicines are used to make you more relaxed during surgery even though you are awake. If you are undergoing conscious sedation, you will be asked to not eat for at least six hours before surgery. Otherwise, you can have a normal diet.
    • Arrange for a ride if you are having sedation.
    On the day of your surgery:
    • Remove contact lenses.
    • Wear comfortable clothing.
    • Bring paperwork as directed.

    Anesthesia

    A local anesthetic will be used near the affected gum area.
    Your dentist may recommend conscious sedation. You will be awake, but will have no anxiety during the surgery.

    Description of Procedure

    This surgery is usually done in an outpatient setting. You do not need to stay overnight. If you are undergoing sedation, the dentist or nurse will place an IV in your arm to deliver medicine. Your heart rate, blood pressure, and breathing will be monitored during and after the surgery.
    The periodontist will numb the affected area with a local anesthetic delivered through a needle. The periodontist will make a small cut in the roof of your mouth and remove surface and/or connective (under the surface) tissue. This is the donor tissue that will be used for the graft. This area will then be stitched closed.
    The new tissue flap will be repositioned on the damaged gum line and stitched into place. A dressing will be applied. A piece of mesh is sometimes placed between the gum and tooth to encourage growth.
    If there is not enough donor tissue available on you, tissue from another person or man-made materials may be used.

    How Long Will It Take?

    The time it takes to complete the surgery depends on the level of damage and how much of the gum areas are affected.

    How Much Will It Hurt?

    You may feel mild discomfort while the periodontist numbs the affected areas for surgery, but you will not feel pain during the surgery. Medicines can help control pain and anxiety before, during, and after the surgery.

    Post-procedure Care

    At Home
    Healing will take place over the next 4-8 weeks. When you return home, do the following to help ensure a smooth recovery:
    • Rest as needed.
    • Take medicines as directed. Over-the-counter medicines for pain, like ibuprofen , may be used.
    • Apply ice to the side of your cheek for 20 minutes at a time to reduce pain and swelling. Wrap the ice in a towel. Do not place the ice directly on your skin.
    • Drink plenty of fluids.
    • Eat small amounts of soft or pureed foods.
    • Do not smoke, rinse your mouth, or use a straw.
    • Apply dressings or gauze to the area as directed to absorb blood and saliva.
    • Do not exercise for a few days as directed.
    • Do not drive if you took any sedative or narcotic pain reliever.
    • Be sure to follow your dentist’s instructions carefully.
    • Follow-up with your periodontist or dentist as directed.

    Call Your Dentist

    After arriving home, contact your dentist if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, a lot of bleeding, or any unusual discharge from the surgical site(s)
    • Pain and swelling that is not controlled with the medicines given
    • The dressing or stitches become loose or are uncomfortable
    • Loose tissue
    • Continued swelling after 48 hours
    • Other new symptoms, allergic reactions, or concerns
    • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which last for more than two days after leaving the dentist's office
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Academy of Periodontology http://www.perio.org/

    American Dental Association http://ada.org/

    National Institute of Dental and Craniofacial Research (NIH) http://www.nidcr.nih.gov/

    CANADIAN RESOURCES

    Canadian Dental Association http://www.cda-adc.ca

    The Canadian Dental Hygienists Association http://www.cdha.ca/

    Health Canada http://www.hc-sc.gc.ca/

    References

    American Academy of Periodontology website. Available at: http://www.perio.org/ . Accessed April 19, 2010.

    Carson De-Witt R. Periodontal disease. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=1034 . Published September 1, 2009. Accessed April 21, 2010.

    National Institute of Dental and Craniofacial Research (NIH). Periodontal (gum) disease. National Institute of Dental and Craniofacial Research (NIH) website. Available at: http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm . Accessed April 19, 2010.

    Pre and postoperative instructions for periodontal surgery. Kathie L. Davis website. Available at: http://www.kldaviesperiodontist.com/images/WEB%5FPRE%5F%5FAND%5FPOST%5FOP%5FINSTRUCTIONS.pdf . Accessed April 19, 2010.

    University of Maryland Medical Center. Periodontal disease. University of Maryland Medical Center website. Available at: http://www.umm.edu/patiented/articles/what%5Fprocedures%5Ftreatment%5Fof%5Fperiodontal%5Fdisease%5F000024%5F8.htm . Accessed April 19, 2010.

    6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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