Gum Graft/Transplant for Dental Implants… Is It Necessary? IT IS ONE OF THE KEYS TO SUCCESS!
When talking about dental implants most people focus on the bone alone. The bone sets the tone, but the (gum) tissue is the issue. I get 100s of questions asking if a gum graft should be done at the same time or if I can fix an implant that has threads exposed on the outside.
There are different kinds of gums in your mouth. There is tight, durable and firm gum tissue. Then there is loose gum tissue that is called “mucosa.”
Think of it like this. On the palm of your hand that skin is very durable because it contains a lot of keratin. You can beat up your hands and they do not start bleeding and peeling. Imagine if you had the skin on the inside or outside of your eyelids on the palms of your hands! You could imagine that your hands would be in pretty bad shape!
Around teeth or implants we want to have that thickened durable gum tissue we call keratinized tissue. Some of that keratinized tissue is physically “attached” to the teeth and bone while some of it is just part of the pocket. The “attached” gum is the absolute best.
If you do not have enough gum tissue you will notice that the gum recedes around your implant causing pain, inflammation, and the threads of the implants will become exposed. Even simple tooth brushing will cause the gum to recede away. As the gums recede away, the bone will as well causing peri-implantitis/peri-implant mucositis. These are chronic conditions that almost always lead to permanent implant problems and likely implant loss.
Prevention: This is prevented by planning for this to happen and knowing the diagnosis of your anatomy !!!!!! keep in mind that some people have genetically thin and genetically thick gum tissue. Just like hair some people have more than others!!! Some people have extra muscle “frenum ” that pulls on the gum constantly… Eventually pulling it off the tooth or implant
If you do not have enough gum tissue At the time of surgery this can be corrected by borrowing gums from the inside part of your mouth and just moving it to the outside. I call this an apically positioned flap …just relocating good gum into the areas of bad gum. I do this every day. This is by far the best, easiest and cheapest approach. It needs to be done at the time of surgery typically before the dental implant crown or bridge is put on. Often times the frenum needs to be cut as well so that it no longer pulls.
They can also be corrected by taking gum from the roof of your mouth either behind your upper wisdom teeth or right on the palate and stitching it onto or under the gum of the implant.
Recession happens because of trauma or plaque. Brushing your teeth too hard is trauma, bad crowns or fillings also cause gum recession. It also occurs on people with a shallow cheek pouch vestibule. The connective tissue with in our gums provides a strong defense against inflammation. If the gum around your implant becomes inflamed it will feel painful, sensitive and look red.
Gum recession affects up to 88% of people >65 yrs // 50% of people 18-64 yrs on their natural teeth. If you start off with thin gums then they may only get thinner with implant treatment. It is best to plan for progressive thinning so that you do not lose your implant.
Bottom line is having a gum graft or gum repositioning surgery will always help prevent problems. In my clinical practice I am always repositioning gum tissue or taking from one area and transplanting to another. I do not want to see my patients end up with problems. Basically implants have to be over engineered with bone and tissue to make them last as long as possible since they are not permanent.
This is a complicated topic for sure!
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry