Connective Tissue Grafting

When recession of the gingiva (“gum”) occurs, the body loses a natural defense against both bacterial penetration and trauma. In addition, gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance to the gum and tooth. Gum recession, when significant, can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root caries and root gouging. When gum recession is a problem, gum reconstruction using grafting techniques is an option.

Of all the procedures at the disposal of the periodontal plastic surgeon, none has more far-reaching ramifications than the connective tissue graft. Not only is it more comfortable for the patient and produces a better color match, but also is more predictable in its ability to cover root surfaces. There are many modifications to the initially reported technique. The one that we have refined and now use can be described as the minimally invasive subepithelial tissue graft (MIST) graft. It is appropriately named minimally invasive, because a single incision is made in the palate, and this is sutured closed, and the gum tissues in the areas of recession are only separated from the teeth rather than removed. Because no incisions are made on the outside of the gums, there is no scarring and the color match is excellent, therefore you can often not tell that a procedure was done, except that the root is now covered. This procedure enables us to predictably enhance the cosmetics of our cases by reestablishing the symmetry of the smile and can be used in conjunction with restorative dentistry to create an optimum result.