Gum surgery

Gingival graft

Gingival grafting can be performed to restore a sufficient amount of gum around the teeth or around exposed tooth root surfaces caused by gingival recession. The dental health professionals who are qualified for this type of transplant are general dentists (for simple cases) and periodontists (for more complex cases).

Several techniques are used to perform gum grafts:

The free autogenous gingival graft: This is the oldest gingival graft technique. It involves taking the graft from the patient’s palate and relocating it where there is gingival recession. The result of this method is less aesthetic than that obtained with other methods. It is not recommended to use this type of grafting when the tooth roots should be covered because this technique only stops the progression of gingival recession minimally. However, the advantage of this technique is the absence of risk of graft rejection, because it is taken from the mouth of the patient.
Connective tissue graft (root coverage grafting with connective tissue): This is a relatively new and versatile technique. The connective tissue is taken from under the gum surface of the patient’s palate and is inserted at the area of gum recession. Its main benefits are the very aesthetic results and the ability to cover exposed roots. With this type of transplant, the patient cannot reject the graft because it comes from tissue taken from his mouth.
Allogeneic gum graft (allograft): this type of transplant is relatively recent. A graft from an external donor, who has been treated and is very safe, is located in the gingiva of another patient. The main advantage of an allograft is that there is only a single surgical site because the graft is not taken from the patient’s palate. It also gives results that are as aesthetic as the connective tissue graft. However, there is a low risk of transplant rejection.

The gum transplant success rate is very high. The beneficial effects of these grafts persist for many years although a little less for smokers.

Before the surgery

Medication

In some circumstances, you may have to take antibiotics before the procedure to reduce the risk of post-operative infection. It is very important to take them as they have been prescribed.

If the surgeon knows the list of medication you are taking and that none of them pose problem for surgery, you must take them at the usual time on the day of your surgery. Bring a list of medication you have taken in the last 24 hours to inform your surgeon.

If you take drugs like aspirin, products containing aspirin, vitamin E, or anticoagulants, it is important to inform your surgeon before the procedure. He or she will determine how many days in advance you need to stop taking them. A consultation with your treating physician may be required to assess risks associated with the discontinuation of medication before your surgery. These types of drugs have a blood thinning effect and inhibit clotting, which causes perioperative complications (more abundant or uncontrollable bleeding during and after surgery).

With the agreement of the surgeon, you can take a sedative if you are anxious to ensure you a good night’s sleep before the surgical procedure. This medication may be prescribed by your surgeon or by your doctor. A patient who undergoes surgery and who is well rested will respond better to the surgery and the postoperative period.

PREOPERATIVE ADVICE

Preoperative advice

Eat a light and nutritious meal on the day of your surgery.

Brush and floss your teeth carefully after eating and before the surgery so that your mouth is as clean as possible. A clean mouth will decrease the risk of post-operative infection.

Wear comfortable and loose clothing with roll-up sleeves in order to maximize your comfort and to facilitate the administration of intravenous medication during the procedure.

If you smoke, you should stop smoking at least a week before your surgery to increase the chances of success of the operation. Alternatives to tobacco, such as patches or nicotine gum, can be a good alternative during this period. It is also advisable to stop smoking completely after your surgery.

The surgeon will provide you written preoperative and postoperative instructions to familiarize yourself with the surgery.

After the surgery

Immediately after the surgery

Arrange for someone to accompany you and drive you home after the procedure, especially if you have taken a sedative. You should not drive a vehicle because you might be drowsy for several hours. It is also recommended to have someone with you upon your return at home to assist you when needed.

It is strongly suggested to get the drugs that have been prescribed to you right after your surgical appointment in order to have them at home if some pain appears or if you must take antibiotics. It is very important to take the medication considered essential by your surgeon and to use it according to the prescription.

Back at home, you will need to follow the instructions provided by your surgeon in order to avoid post-operative complications.

Bleeding

Light bleeding may occur a few hours after surgery. A small amount of blood, mixed with abundant saliva, may seem impressive, but in fact, chances are that this is only a small amount of blood. To stop the bleeding in the mouth, you can apply a gauze or a moist tea bag on the bleeding site and bite into it or apply firm pressure for 20 consecutive minutes. Bleeding should stop by itself.

We recommend that you put a towel on your pillow when you sleep in order to avoid staining the pillow with the small amount of blood that could ooze out of your mouth.

In case of doubt or abundant bleeding, it is always recommended to contact your surgeon.

Swelling

It is normal to see some swelling (oedema) in the face after surgery. For the first 48 hours after surgery, lie with your head more elevated than the rest of the body and apply ice on your face for 15 minutes at a time followed by a period without ice of 15 minutes. You can use ice cubes in a plastic bag, an “ice pack” or a bag of frozen peas. This will not prevent swelling to appear, but it will be less important. The maximum of swelling usually occurs between two and three days after surgery and disappears after 7 to 10 days.

After 48 hours, the ice will not reduce swelling. You can then apply moist heat, with a wet washcloth or a bottle filled with hot water. The heat can be applied directly on your face, where the oedema is present.

Pain and inflammation

Postoperative pain can be controlled by over-the-counter analgesics such as acetaminophen or ibuprofen or medication prescribed by the surgeon. It is recommended to take a first dose of pain medication before you feel any soreness. This will ensure your comfort when the effect of local anesthesia will fade out a few hours after surgery.

Healing time

The healing time after gum surgery varies from one patient to another and depends on the general health of the patient, the extent of the tissue graft or the number of teeth affected by gingivectomy or gingivoplasty, and the motivation to follow the surgeon’s post-op instructions.

Remember that rest is essential to healing. During the first three days after your surgery, especially after a tissue graft, only plan on doing non-strenuous activities (such as reading or watching television). Your surgeon will tell you when you can resume your normal routine.

Diet and oral hygiene

A soft diet is recommended for a few days after the surgery to allow the wound to heal properly. In fact, biting into hard food could undermine the success of the procedure.

A normal diet can usually be introduced from 7 to 10 days after surgery, according to the surgeon’s recommendations. In some cases, the surgeon may recommend to extend the period of soft diet, but this extension is rather rare.

It is important to keep an excellent oral hygiene during the healing of the wound. Keeping your mouth clean will reduce the risk of developing an infection during the healing period. You will, however, have to adapt your tooth brushing in order to not disturb the wound unnecessarily.

Risks and complications

Despite the skills of the surgeon and the precautions taken before and during the procedure, any surgery presents some risks and a potential for complications. Nonetheless, complications are rare and postoperative discomfort is minimal. The success rate of gum surgeries is very high.

Here are a few possible complications:

Postoperative infection: Symptoms of infection include redness, pus oozing from the wound, severe pain that cannot be controlled by analgesics, as well as fever. In this case, taking antibiotics is necessary to stop the infection and prevent a relapse. You should then consult your surgeon to evaluate your condition. In the case of a gum tissue graft, however, it is very rare that the solution to infection is the removal of the graft.
Premature loss of stitches: This complication usually causes no problem if the surgical site is kept clean and if you take care not to disturb it during the recovery. If in doubt, you can contact your surgeon about precautions to take.
Graft rejection: In some cases, it may happen that a graft provided by an external donor is rejected by your body. This complication is not common, but your surgeon may offer an alternative to the treatment if the graft is rejected.

Gingivectomy

Gingivectomy is a surgical procedure that involves removing a portion of the gingiva. It is performed under local anesthesia and does not usually cause any complications.

Recent techniques allow performing minor gingivectomies using a soft tissue laser, which causes much less discomfort and postoperative complications for the patient.

There are three main applications of the gingivectomy:

Aesthetic application: A gingivectomy allows to remove a part of the gum around one or several teeth in order to harmonize the shape of the gingiva and improve the smile.
Treatment of gingival hyperplasia: When the gums are enlarged in an unusual way and hide partly or completely a dental crown, a gingivectomy is recommended in order to remove the excess tissue. If the situation remains unchanged, the patient is exposed to a high risk of developing periodontitis. Gingival overgrowth may be due, among other factors, to medications known to generate a surplus of gingiva like drugs used to treat epilepsy and hypertension.
Periodontal treatment: Within the context of a periodontal treatment, a gingivectomy is used to cut a surplus of gingiva that is not attached to a tooth in order to clean a periodontal pocket that may have formed during gum disease. This cleaning procedure is also known as gingival curettage.

Gingivoplasty

The gingivoplasty is a minor surgical procedure designed to reshape the contour of the gums. It allows improving your smile by making it more attractive and harmonious. It is also a complement to a gingivectomy which, alone, would not give the best results.

The procedure is usually carried out by the same dental health professionals that perform gingivectomies (general dentists and periodontists). A local anesthesia is required to perform gingivoplasty and a soft tissue laser can be used. Complications are rare and post-operative discomfort is minimal.

The gingivoplasty is especially used in orthodontic treatment, to refine the aesthetics of the smile. In fact, when moving teeth with crowns of different lengths, the smile line may not be optimal because of uneven gums.

A dental health professional may also resort to gingivoplasty in the context of gum disease treatment. In this case, this technique can restore the gum to normal form after having treated the deformed, damaged or necrotic alveolar bone.