Q: I am in the process of having an implant put in. The titanium screw was placed (minus abutment) with bone and gum grafting done at the same time. How long will it be before I can put my suck down (temporary denture) back in? The gum area is still swollen and I’m afraid it will interfere with the healing process and graft (the gum line has been built up and is now over the denture. Is that because of the swelling and it should fit again once swelling subsides?).

A: It could take a week or so until it really heals and shrinks. You should have a soft tissue reline and check in with your dentist to verify the healing is going well. You do not want to put pressure on the surgical area.

Q: How likely it that my gum recession problem can be solved other than with a free gingival graft from my palate? I do not look forward to having 2 wounds–one on the palate and the other at the grafting site. My lower front teeth and my two “eye” teeth have the problem. Can cadaver material or some other synthetic material be a “good enough” substitute? How many millimeters equal a moderate to severe problem and where would the measurement start? I heal quickly.

A: This is difficult to answer without a photo. Yes, cadaver tissue is available. There are some limitations to using this material, but it can be done. We also use a laser, which aids in faster healing. There are no set rules with regard to millimeters. It depends on the patient, and can vary.

Q: I’ve already been told I’m a good candidate for gum grafting due to the recession I’m experiencing. However, on a recent trip to the general dentist for a standard filling, he seems to have nicked the gum tissue in between two teeth – the papilla I’ve learn it’s called – and now my tongue continues to go right there to notice the tiny gap. It’s such a minute space yet very uncomfortable and nerve-wracking! If I go forward with gum grafting, which was talking about around the same tooth, can something possibly be done about this as well?

A: Over time, the papilla may grow back on its own, depending on the severity of the injury. If you are having the area grafted, ask the Periodontist if there is anything they can do to repair the damaged papilla. It might be possible, but it’s not always predictable.

Q: When can I remove gum graft surgical cement? It feels strongly stuck to my gum and it has been a week now. I can’t remove it by forcing it with my tongue. My teeth and gum feels good, like they are healing well, but I am not sure what to do about this cement. I won’t seem my doctor until a week from now. Should I wait until then and keep this cement in my mouth, or try to remove it somehow? Can it become a problem to remove it later?

A: In our practice, we don’t use periodontal packing anymore. With the use of the laser, there is no need. However, I would suggest you call your periodontist to see if the pack can be removed earlier so the healing can progress a little faster. If the periodontist has done extensive surgery in the area in question, then your teeth might be sensitive to cold or hot temperatures if the pack is removed. You might want to discuss using warm salt rinses and possibly a Chlorhexidine rinse. The sooner you remove the packing, the faster you will get back to good oral hygiene control.

Q: I had all my gums grafted 6 weeks ago and just started have a bad taste in my mouth. I had 6 weeks of antibiotics.

A: You had all your gums grafted 6 weeks ago? Did you have bone grafts? Soft tissue grafts? Why were you on 6 weeks of antibiotics? Did you have any oral infections during this time? Do you have a periodontal packing in your mouth? Are you under the care of a qualified periodontist? Did you have any post-operative visits? The taste could be related to an infection in your mouth, or medications that you are taking. I strongly suggest you follow up with your periodontist as soon as possible to find out the source of your “bad taste”.

Q: I had gum grafting done Wednesday and today some of my packing on the teeth are loose should I be scared? Thanks.

A: Generally this is not a problem. However, I would check with your periodontist in the morning and see if they want to re pack the area or leave it alone.

Q: My husband is going through the lengthy process of getting two implants which as you know is quite costly. We are getting lots of denials from the insurance company, but pursuing.  Do you know what the rationale would be for our dentist to have done four gum treatments on the same day for two teeth?  Does that make any sense? Thank you.

A: It is very difficult to know what type of gum treatment was done on the two teeth you are referring to. Was it soft tissue grafting?  Did he have a bone graft?  Ridge augmentation? In our practice, it is not uncommon to perform multiple procedures on the same day depending on the needs of the patient.

Q: When a gingival graft is done and stitches dissolve does that mean that it is healing?

A: If they are dissolvable stitches, they will dissolve whether it’s healing or not. The success of a gingival graft doesn’t necessarily hinge upon the sutures dissolving.

Q: What is the success rate for gum grafting?

A: It’s in the 90%’s. With very severe gum defects, the percentages come down a little bit. In each case, we conduct a clinical examination and photograph the gums to see where we’re starting. Based upon the result we think is achievable, we can predict an outcome.

Q: What can be done about receding gum line grafts?

A: If the graft is receding, you have to have that looked at and perhaps retreated, or maybe the tooth or the area treated weren’t very good candidates for a gum graft to begin with. If the person is a diabetic and doesn’t heal well, it’s difficult. A big plus for the laser is that we can avoid cutting and surgery.

Q: My periodontist in Delaware is recommending conventional skin grafting to correct an area of receding gum. Needless to say I am wary of the procedure and curious to know more about laser surgery as an alternative. Would you say the cost for laser surgery is considerably higher or about the same?  Is anyone in Delaware certified in this procedure?

Thanks for your comments. Dave

A: Dear Dave: Without knowing the details of your situation, a conventional gum graft might be the correct treatment. However, I have done many cases with the laser either in combination with the conventional procedure or as a standalone procedure. The cost in our office is the same. If you contact Millennium Dental Technologies in Cerritos, California, they can refer you to someone certified in Delaware. If you’d like to see me, it’s a quick train ride from Delaware to New York, and there are many trains a day. My office in Manhattan is a short cab ride from Pennsylvania Station. Good luck. Best Regards, Dr. Eric Linden

Q: Is a gingival graft painful?

A: It can be, but with laser, we can laser the donor site to eliminate a lot of post-operative discomfort.

Q: I have to go for gum grafting. I was thinking about AlloDerm. My periodontist told me he uses Muco-graft. What is the difference?  Which is better?

A: I think your Periodontist would be the best person to ask about this. This information should have been part of your consultation appointment. It is important that all your options are discussed with the treating periodontist prior to any procedures commencing so that you have full informed consent.

Q: I have had 3 gum grafting surgeries (3 different areas) and now my periodontist is recommending an additional surgery for one of the areas. I am hesitant because the previous one obviously did not do well. Should another type of gum surgery be performed?

A: Sometimes a secondary procedure is necessary to achieve the best result with grafting procedures. We inform all of our patients in our practice that multiple procedures might be necessary.
Best of luck,
Dr. Eric Linden

Q: How long does it take a gingival graft to heal?

A: Everybody is different. A diabetic or a smoker will heal much more slowly. Some people have a genetic predisposition to heal extremely quickly. Typically, grafts can take several weeks to fully heal. Not that you’re feeling pain all that time, but it can take that long to feel completely normal again.

Q: Can receding gums grow back, or is gum loss irreversible?

A: Generally irreversible without professional treatment. This might include gingival grafting or “lateral pedical grafting” which is moving tissue around to protect teeth, like moving a curtain around to cover windows. We now usually use the laser in conjunction with all these procedures to minimize post-operative discomfort.

Q: Can in office teeth bleaching cause guns to burn off requiring a gum graft?  I lost gum on white, burned area above my tooth caused by the bleaching.

A: Yes, I’m afraid bleaching can have this effect. Needless to say, we don’t practice it in our office, but we can perform gum grafts if needed.