Periodontal Plastic Surgery

2 GINGIVAL FRACTURES: Epithelial-Connective and Embedded Connective Graft

Periodontal plastic surgery plays a key role in restoring the aesthetics and functionality of the gums, especially in cases of advanced gingival recession. The techniques gum grafts These procedures not only help to cover exposed dental roots, but also to recreate a healthy and stable gingival environment. These interventions are particularly important for preventing long-term complications and improving patient comfort.

Periodontal recession, as that visible in the first photo, significantly exposes the tooth root, increasing sensitivity and the risk of root caries. To restore normal morphology and function, two key steps are performed:

1. Epithelial-Connective Graft: Creation of Keratinized Grafts

The epithelial-conjunctival graft It is a procedure aimed at creating a band of keratinized gum around the affected tooth. This step is essential to stabilize the gum and prevent recurrence of recession.

Indications :

• Severe stripping of the root.
• Absence or insufficient presence of keratinized gum, which compromises resistance to masticatory forces and oral hygiene.

Steps of the Epithelial-Connective Graft :

1. Preparation of the receiving site :
   • An incision is made to create a surgical bed suitable for integrating the graft.
   • Damaged or fragile tissues are removed to maximize vascularization and promote healing.
2. Harvesting of the graft :
   • The graft is taken from the palate, an area rich in epithelial and connective tissue.
   • This tissue is carefully cut to include an epithelial (surface) and conjunctival (sub-lying) portion, thus ensuring its strength and ability to form a keratinized gum.
3. Fixation of the graft :
   • The graft is positioned in the lower part of the root, on the prepared bed, and fixed using fine sutures to ensure its immobility during healing.
   • A protective membrane can be used to protect the graft in cases where initial stability is an issue.

Expected result :
The graft integrates gradually, forming a solid and stable band of keratinized gum. This new gum protects the exposed root and forms an ideal base for the second phase of the treatment.

2. Embedded Conjunctival Graft: Radicular Reattachment

Once a layer of keratinized gum has formed, the buried conjunctival graft It is used to cover the exposed root. This technique aims to restore the aesthetic appearance and reduce tooth sensitivity by completely covering the root surface.

Indications :

• Increased sensitivity of the root.
• An aesthetic request to restore a harmonious gingival contour.
• Prevention of root caries and additional abrasions.

Steps in the Enclosed Conjunctival Graft :

1. Preparation of the receiving site :
   • An incision is made at the level of the newly formed keratinized gum to create a tunnel or subgingival bed intended to accommodate the graft.
2. Harvesting of the conjunctival graft :
   • The connective tissue is taken from the palate. Unlike epithelial-connective tissue grafting, only the connective tissue portion is taken, ensuring better vascularization and optimal integration.
3. Positioning of the graft :
   • The graft is inserted under the gum, covering the exposed root, and sutured to maintain its position.
   • The buried technique reduces the risk of graft exposure and improves its stability.

Expected result :
The recessed conjunctival graft integrates with the surrounding tissues, covering the root and restoring the gum with a natural and harmonious contour.

Advantages of the Combination of Two Gingival Graftings

The combination of epithelial-conjunctive and conjunctive grafts buried in the bone presents several advantages:

• Long-term stability The keratinized gingiva created during the first step provides a solid foundation for conjunctival graft surgery, reducing the risk of recurrence.
• Optimum aesthetics Complete root covering ensures a natural gingival alignment, significantly improving the appearance of the smile.
• Protection of the tooth The coated root is less exposed to irritants such as bacteria and thermal stimuli, reducing sensitivity and the risk of caries.
• Prevention of recidivism The keratinized gum line improves the resilience of tissues against chewing forces and facilitates daily oral hygiene.

Post-operative Care and Follow-up

Rigorous postoperative follow-up is essential to ensure the success of gingival grafts:

• Scarring A rest period of 7 to 14 days is necessary to allow the grafts to integrate. Specific instructions on nutrition and hygiene are given to the patient.
• Regular checks Consultations are scheduled to monitor the healing process, remove the sutures, and assess the integration of the grafts.
• Oral hygiene Appropriate hygiene is recommended to avoid any accumulation of plaque on the grafted areas.

Results and Perspectives

Gingival grafts are reliable and predictable interventions for restoring the aesthetics and health of the gums in cases of advanced recession. By combining the epithelial-conjunctival graft to recreate a keratinized gum and the buried conjunctival graft To cover the root, it is possible to achieve both aesthetic and functional results that are durable and satisfactory. These techniques play a key role in preventing long-term periodontal complications and in improving patient well-being.