Can Gum Grafts Fail?

I am a Dentist in Kitchener, ON, and each week I like to explore a question that I commonly get at my Kitchener Family Dental office. This week, I'd like to discuss whether or not gum grafts fail. In doing so, I'll outline potential reasons for treatment complications and adverse outcomes.

So, I'll be rolling out a bunch of "can _____ fail?" posts for different dental treatments over the coming weeks. Unfortunately, in Dentistry (like most industries) likelihood of failure is rarely, if ever, discussed. I think most of us believe that talking about these things will "blow the case" and nobody will accept treatment. For those in providing products and services in other realms, they are similarly reluctant to present information that could cause them to lose a sale.

But, to me, people need to understand how treatments can fail because it is a really important part of understanding how to maintain what they've paid for. Dental treatment is really expensive. If I provide a $2000 service to you and don't tell you how to keep it in good function, then I've done you a disservice.

So, let's get into gum grafts, today. First, I'll get into what gum grafts are. Then I'll talk about how they can fail and, in doing so, we'll learn about how to best maintain the success achieved through gum grafting.

What is a Gum Graft and what does it do?

There are a few different types of gum grafts and I won't get into the fine details here. We don't need to understand the histology of gum grafts to understand their indications, benefits, and how best to maintain them. We simply need to understand why they're necessary and what they can help us to achieve.

So, Gum Grafts are a treatment to reverse gum recession. Recession occurs when your gum levels move down your tooth root. When you experience gum recession, it may expose more sensitive parts of the tooth. You may notice a gradual increase in sensitivity to cold over time. Gum grafts involve placing new gum tissue to permanently re-cover exposed root surfaces.

This treatment can be provided by your Kitchener Dentist or you may be sent to your local Periodontist, or gum specialist.

What causes Gum Recession?

The same things that cause gum recession can cause post-grafting recession, or graft failure. Here are some common causes of gum recession:

• Tooth grinding and clenching. When your teeth are interlocked during grinding and clenching you can begin to exert lateral, side-to-side forces. These forces can lead to gradual loss of bone and gum tissue from around your teeth over time.
• Aggressive tooth brushing. Some people really scrub their teeth during brushing. The key to effective, non-harmful brushing is low-force, hi-repetitions (or "reps"). Some people have discovered that they can get a nice clean feeling quickly (low "reps") by brushing with heavy force. The problem with this approach is that you lose gum tissue as recession occurs over time.
• Mis-positioned Teeth. If you have one or more teeth that are too far out (i.e. toward your lip/cheek) or too far in (i.e. toward your tongue), you will likely have low gum attachment or recessed gums on that side of the tooth. There is nothing the patient is actively doing that causes this type of recession.

What do you get with Gum Grafting?

Gum grafting treats gum recession. It does so in 2 ways:

1. Increased coverage of tooth roots.
2. Thickening of existing gum tissue to reduce likelihood of future recession.

Your Kitchener Dentist or Periodontist (Gum Specialist) will tell you that they can't guarantee long-lasting root coverage with grafting. Often times you get great results and long lasting root coverage, but not always. What is more predictable is a long-lasting thickening of the gum tissue that stops recession in its tracks.

Can Gum Grafts fail? (How best to preserve your gum grafting long-term!)

Yes, gum grafts fail sometimes. Understanding what causes failure is critical to understanding how to achieve success. Many of the factors that lead to failure are the same things that lead to gum recession in the first place. If a heavy-handed toothbrushing technique lead to your gum recession, then transitioning to a more gentle technique will help to ensure graft success and new attachment. If your initial gum recession was triggered by heavy lateral forces from grinding your teeth, wearing a protective night guard post-grafting will help to protect your investment and improve treatment outcomes.

Smoking is probably the most harmful habit with respect to long-term success of gum grafts. Smoking damages blood supply to the gums and the blood supply carries nutrition to help grafts heal. Without that nutrition, gum grafts fail.

Now, we discussed recession due to tooth position above. If you simply graft over the exposed root of a mis-positioned tooth, you will have a 100% failure rate. You haven't changed the conditions that led to recession in the first place. So, in these cases, your Dentist should first improve tooth position with conventional braces or Invisalign. Once ideal tooth position is achieved, a gum graft will be much more likely to succeed.

How often do gum grafts fail?

It is difficult to determine the rate at which gum grafts fail. Generally, the success of a grafting procedure depends on the type of recession being treated and the condition of surrounding gum tissue.

Generally, if the recession is minimal (1-2mm), and there is no loss or recession of the gum tissue that extends in between teeth then you are likely to have a very high success rate. That is, you can expect root coverage (a full reversal of recession) almost 100% of the time.

In other instances, the recession may be moderate to severe (i.e. 3-5mm) but with no loss of gum tissue from in between teeth and these conditions still favour successful root coverage with grafting in the majority of cases.

When recession occurs and gum tissue is lost from in between teeth, it is usually and indication that underlying bone has been lost too. In these instances, long-lasting root coverage with grafting is very unlikely. Under these conditions, gum grafts fail more often.

What does a failing graft look like?

After a gum graft, your Periodontist (Gum Specialist) will typically cover the treatment site with a surgical dressing or covering. This is solely for protection during healing. Success in grafting depends on gum tissue already at the graft site connecting with grafted tissue and supplying it with blood and nutrition. When this doesn't occur, graft tissue can die off and gum grafts fail.

Here are 3 signs you may notice when gum grafts fail:

1. Tissue Sloughing or Shedding. Healthy gum tissue is pink and firm. If large amounts of your graft appear white or even grey, it may signal dead or necrotic tissue. This gum tissue will typically look like it's peeling away from the tooth roots.
2. Early loss of the Surgical Dressing. If your surgical dressing or membrane comes off before your Periodontist removes it, your graft may be damaged during eating and brushing causing failure.
3. Root Re-Exposure. When gum grafts fail, they may peel away, or recede from, root surfaces. You will notice exposure of these surfaces and gradual recession over time.

What happens if a gum graft fails?

If a gum graft fails, chances are the failure can provide you with some information about what went wrong.

Gum grafts fail (in some cases) because post-treatment instructions weren't followed but they can also fail for many other reasons too. Gum grafts have a higher failure rate in patients that don't always heal well (i.e. due to Diabetes or other immune disorders).

Gum grafts fail (often) because poor conditions weren't detected in advance of treatment. This may be a lack of sufficient supporting bone tissue. This may be because of abnormal tooth position that doesn't favour graft success.

You can always re-graft a site. However, if the reasons for initial failure aren't well understood future failures are just as likely. Generally, your Dentist or Periodontist can learn from the initial failure and make changes or recommendations to improve the conditions for remedial graft success. They may also recommend re-preparing the site followed by a healing period prior to secondary grafting.

Thanks for reading today! More on gum grafts to come in the next few days!

By Dr. Kyle Hornby, Kitchener Dentist

If you would like to gain a second opinion about gum recession, please give us a call at (519) 576-8160 or request a consult with me here.

This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your Kitchener Dentist or other qualified healthcare provider with any questions you may have regarding a dental condition or treatment.