Gum Recession can be ugly and can also be a sign of gum disease.
Building gum back in 2022 is often very difficult, and many family dentists would not have the experience to be able to do something like this.
There are several ways to build gum back, and most are variations on a similar theme- the gum graft (or we call it a connective tissue graft – because it sounds more clever!)
In this video, I’ll show you when this treatment works really well and in those situations where it is not that great.
Okay. So luckily these two things with the right advice and the right kind of techniques are usually quite easy to get under control. And once you have these under control, the gums often shrink back a little bit. Okay? So here’s a photo of a guy who came in. He wanted to improve the look of his smile, and you can see that the gums look really irritated and red. So we can’t do any veneers until the gum disease has sorted itself out. So we went through a course of gum treatment. The gums shrunk up because, during the gum disease, they were all inflamed. So they all shrunk back and it revealed these ugly black triangles between the teeth. So I’m not gonna talk about black triangles so much today. I’ll do another video on that. But this is an example where once you treat the gum disease, all the inflammation goes away.
And quite often things can actually look a little bit worse, than when we started. Now, let’s talk about those cases, which we can treat the gum recession for. So the recession is this okay? As you can see in this photo, the gum is much higher on one tooth than it is on the other teeth. And this can be caused by either gum disease, or it can be caused by aggressive brushing, or people who’ve got very thin gums or have got very delicate gums. So their gums tend to recede a little bit more quickly. Now the problem is there’s not enough thickness of gum. Okay? A lot of people think that there’s a problem with the height of the gum and it is the height of the gum. But the reason that the gum has shrunk up is that it was thin, to begin with, and something like gum disease or over-aggressive brushing or orthodontic treatment, or, or some kind of other factor has come in. And because the gum is thin, to begin with, the gum has been weakened and it shrinks up. Now the way that we can differentiate, whether it’s something that is treatable and something, which is not predictably treatable, is by looking in between the teeth. Okay? So in this photo, you can see that the gum goes all the way up in between the teeth, but in this photo, which is
A different kind of disease. The gum has shrunk between the teeth. So we’ve got these big black triangles and gaps between the teeth and the gum looks much flatter. So what this is actually telling us is, has the bone between the teeth been lost? And if the bone between the teeth has been lost, it turns it into a much more complicated situation compared to if it’s something like this, where there’s loads of bone between the teeth and the gum in front of the tooth has been lost. So I’m not gonna talk about those situations where everything’s been lost because that’s aggressive gum disease. And it’s, I don’t know of a really good way that we can rebuild a bone like that. Okay. So let’s now focus on, what can you do if you’ve got this gum recession and we’ve got these bony peaks between the teeth, right?
The simple answer is some kind of tissue graft. Okay. So a tissue graft is where we take gum from somewhere else in the mouth. It’s usually the roof of the mouth and it can be near the front and the back. Okay. And there are different qualities of gum. So if you speak to a Peronist and this is the kind of dentist who you need to see about this kind of stuff is a Peronist and they’ll be able to look at the defect, okay? The word we use for this is a defect, the gum recession, and advice on the best type of tissue graft, right? And there are, there are tens of different types of tissue, grafts, and techniques available. And essentially what you’re doing is taking good gum from somewhere else, the roof of the mouth or the back of the mouth, or, or somewhere at the bottom and taking it and putting it underneath the existing gum and stitching it all together and letting it take in that position.
Okay. So the good advantage of this is there’s nothing, uh, nothing foreign being introduced, it’s all your own stuff. And we know that this works quite well. There’s a whole bunch of things that need to be taken into account for this, but let me show you exactly what we did for this case that showed you at the beginning. Now, this lady wanted to improve the look of her smile as a whole. And when you are looking at a smile, you need to get a couple of things, you know, really important, um, sort of markers to improve the look. So the bottom of the teeth has to be in a nice arc. It has to follow the lower lip line. And then the tops of the teeth have to be nice and symmetrical. And the arch, the gum makes above each tooth has to be right for that particular tooth.
Now, the problem was that the gum is too high on this side. Whereas on the other side, the gum’s not too bad. I’ve got a feeling. This lady was left-handed, uh, and when she’s brushing her teeth, she just put more force on one side than the other. And that’s what caused the gum session. So what we did, as we lifted the gum. Okay. Be very careful not to break the gum in between the teeth. Okay. This is really important. If we want any of this kind of stuff to work, any kind of bone, graft, implant, uh, bone grafts, or tissue grafts like this, then it’s all reliant on the amount of good quality blood supply in the area. Okay. So we do a special kind of what we call incision to lift the gum, but not breaking any kind of contact with the gum going in between the teeth.
Then we take the gum from the roof of the mouth. We thread it underneath. Okay. And I’m gonna show you what this looks like straight away afterward. And this is what we end up with. It looks horrible. And a week later, it doesn’t really look much better, but it’s going in the right direction, but give it enough time. And then we actually get good quality gum around the teeth again. Okay. And all we’ve really done is increase the thickness of the gum by increasing the thickness. We’ve got good, healthy gum. We’ve got good blood supply in the, in the area. And then we went on to improve the look of the teeth with porcelain veneers. And that’s how we got this, you know, lovely harmonious results. So these kinds of tissue grafts are really common when we’re doing implants at the front of the mouth.
Because again, we have the same problem when the tooth is removed, the gum shrinks back and we lose the thickness of gum in that area. So we have to do bone grafting and tissue grafting for implants in the aesthetic zone. Exactly like this. So I mentioned earlier in that video that you need to see a periodontist for this kind of stuff. I’m not a periodontist, but I do a lot of implant surgery. So therefore I’ve built techniques that will help my patients with these kinds of problems. And if you are thinking about this kind of stuff, then I’d recommend seeing either an implant surgeon, who’s got loads of experience in this kind of stuff or a periodontist who has experienced just because they’re a periodontist doesn’t mean they have experience. So always look at it before and after photos. And the truth is, you are not gonna know as much as a periodontist from a 10-minute YouTube video.
There are loads of different techniques, and different types of gum grafts because there are loads of different types of situations that people are in. Okay. I’ve really oversimplified this by just saying, look at the gum in between the teeth, but that is an important factor. So go seek someone who has the experience. You can tell this by before and after photos, and just by speaking to them, they should fill you with confidence that there is something which is possible. That’s going to improve the thickness of your gum and therefore reduce this recession. So I hope you found this video useful as always, you know, if you’ve got questions, or comments, leave them below. I do read every one and I will try and answer everyone’s as well. And if you’ve got any specific questions about this kind of stuff, you know, put them below, it could inspire a video in the future. So until next time, take care.