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Who would benefit from grafts? Gingival recession is presently one of the most common problems that adult dental patients have. There probably isn’t a single day that your hygienists don’t see 3 or 4 patients with recession. (Do your forms have a place to track recession, cervical abrasion and/or abfraction)? Why has recession become a more pertinent issue? 1. Ten years ago, patients expected to lose teeth on a fairly regular basis once they hit 60. Today, this does not happen. Therefore, recession that in the past that was acceptable has too many years to worsen and needs to be addressed early-on. 2. Recession should be considered as a progressive lesion. Sometimes the recession progresses axially and sometimes it doesn’t. What does tend to progress is cemental abrasion and sensitivity. It is common to have as little as 1mm of recession and significant cemental abrasion. Root coverage grafting can diminish sensitivity and risk for cervical decay, but if a patient waits too long treatment can be less successful. How has grafting changed? It is important to keep in mind that the type of grafts done today in the more advanced periodontal practices is different than what was done 10 years ago. 1. In the past, free gingival grafts were the most common type of graft. This type of grafting had its benefits, but also significant limitations. The benefit was gingival augmentation. However, they weren’t aesthetic, they did not cover roots and most importantly they hurt! 2. The new grafts cover and attach to roots, diminish sensitivity and susceptibility to root decay, and are cosmetic. They cause minimal, if any, discomfort. The criteria for grafting has changed dramatically. In the past, grafting was done when: 1. There was progressive recession in an axial direction. 2. There was thin tissue with limited gingiva prior to ortho. 3. There was to be a restorative margin or a partial clasp adjacent to a thin tissue type, with no attached gingiva. Today, the option for grafting is offered to the patient: 1. If recession exists. Patients should know that there is treatment available. 2. When patients already exhibit cemental abrasion. It is advisable to cover the roots before the abrasion gets deeper for a more predictable result. 3. When there is progressive recession. 4. When patients have uneven gingival margins due to recession. It is very difficult to keep these teeth clean and may not be aesthetic. 5. When there is a measurement of 2mm or greater cemental exposure, (even if there is no cemental abrasion). Met Life insurance likes to use a measurement of 3mm. Of course, these numbers are arbitrary. 6. When there is sensitivity to cleanings, temperature and/or sweets. 7. When the patient has root decay tendency associated with recession. 8. Prior to orthodontics, if there is recession or if there is a very thin tissue type with inadequate attached gingiva. 9. Instead of cervical restorations for cementum. Many dentists no longer want to place restorations on the cementum. In fact, patients are commonly referred for removal of these cementum restorations and coverage of the roots with connective tissue grafts. Share this information with your hygienist and staff during an office meeting. Having everyone on the same page is important to be sure that you and the hygienists concur with each other. It will also help staff to be supportive when patients ask questions of your assistants or at the front desk. I hope this information provides some useful guidelines. Please call if you have any questions. Find more about dental pittsburgh at PittsburghImplantsAndPerio.Com.
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