Soft Tissue Procedures
I. Soft Tissue Injuries
When soft tissue injuries such as lacerations occur on the face, gingival tissues (gums), or lining of the mouth they are repaired by suturing. In addition to the obvious concern of providing a repair that yields the best cosmetic result possible, care is taken to inspect and treat injuries to structures such as facial nerves, salivary glands, salivary ducts, blood vessels, etc. The doctors at Premier Oral & Maxillofacial Surgery are well trained oral and maxillofacial surgeons and are proficient at diagnosing and treating most types of facial lacerations.
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II. Soft Tissue Recontouring
These procedures can usually be completed under local anesthetic in the office. Gingivoplasty/Gingivectomies are performed to remove excessive gingival tissue surrounding the teeth/implant due to concerns with hygiene (difficulty with cleaning the associated tooth or implant) and/or cosmetic concerns (to provide better contours around the teeth or implant). This recovery is generally short, approximately 24-48 hours during which time soft diet and limited activity is recommended. Oral hygiene is stressed to maintain the gingival health in the area. Mild analgesics may be prescribed but often over-the-counter analgesics will suffice. At times, depending upon the location of the procedure, antibiotic therapy may be prescribed. Red-tint saliva would be common for the first 24 hours; frank bleeding is very uncommon. Sutures placed will resorb spontaneously without need for removal.
This is a procedure usually completed under local anesthesia where excessive gingiva (gum) and/or muscle is removed and/or repositioned. This will provide for stability of the position of the teeth in the area of the frenum (muscle attachment) that has caused a space between the teeth (usually the upper central incisors). This procedure is also indicated for ankyloglossia or tongue tie. Reducing the frenum (muscle attachment) of the tongue will increase the mobility of the tongue to improve function such as speech and eating. Recovery for a frenectomy is usually relatively short. Generally it requires only 24 hours during which time you will be asked to maintain a soft diet and limited activity. Mild analgesics may be prescribed but often over-the-counter analgesics will suffice. Red-tint saliva would be common for the first 24 hours; frank bleeding is very uncommon. Sutures placed will resorb spontaneously without need for removal.
III. Soft Tissue Grafting
Soft tissue grafting is most frequently performed to replace or build up adequate attached keratinized gingiva (gums) around natural teeth or implants. These grafts are both functional (improved cleanseability and maintain stable gingival and bone structure) and cosmetic (providing natural-appearing gingival contours with good shape and color). Loss of gum tissue can occur due to periodontal disease, tooth loss, infection, or pathology. Two kinds of gingival tissue (gums) exist. One type is non-keratinized, unattached gingiva which is freely movable and the other type is keratinized, attached gingiva. In healthy situations around natural teeth and implants a band of keratinized tissue exists. Keratinized tissue forms a biological seal around teeth or implants and is important for periodontal maintenance, hygiene, and function. Loose gingival tissue, on the other hand, forms a poor seal around the teeth and implants and is susceptible to inflammation which may result in infection when located in direct proximity to teeth, dental implants, and other dental appliances. A potential problem with the lack of attached keratinized gingival tissue is gingival recession which results in the loss of bone and supporting structure eventually leading to a decreased stability and loss of the tooth or implant. Keratinized tissue is also important for dental aesthetics where the loss of tissue from root surfaces or implants and between the teeth and implants can have adverse affects on a persons smile. Because soft tissue shrinkage often follows tooth loss and loss of bone, soft tissue grafting procedures are often needed as an adjunct to reconstructive procedures involving dental implant placement. Keratinized gingival tissue can be replaced using natural and manufactured sources. The palate is a good natural source of keratinized tissue.
Palatal Graft Donor Site
Palatal graft tissue is very firm and well-keratinized. This tissue provides the most predictable results in our hands but does require a second surgical site where the graft is harvested.
Banked tissue is acquired from a tissue bank and has been treated to decrease any reaction from your own surrounding tissues. The benefit of this technique is that it does not have a secondary surgical or donor site, reducing some postoperative discomfort.
Manufactured membranes are man-made and can be utilized in certain situations to promote the normal healing and development of keratinized tissue.
The Procedure for Grafting
The site of decreased gingival tissue is prepared and the free graft from the palate, tissue bank, or membranes is then sutured securely in place. Often times a dressing or type of putty will be positioned over the graft for the first 7-10 days to protect the graft. If the dressing has not come off during the first week of healing it will be removed during the first postoperative appointment.
Recovery for a gingival or soft tissue graft will occur in phases. The initial recovery is generally 48-72 hours. During this time moderate analgesics will be prescribed as needed. A soft diet will be required. Oral hygiene can be maintained throughout the rest of the oral cavity with care not to disturb the surgical graft donor or recipient site. Warm saltwater rinses should be started the first postoperative day, at least three, if not four, times per day. This should be continued for the first three weeks. Commercial rinses should not be used until the final healing phase four to five weeks post-op In the second phase, days 7-10, diet may be advanced as tolerated favoring the surgical site. Over-the-counter analgesics should suffice at this point. Normal oral hygiene is stressed. Extreme care should be taken in the area of the surgical sites not to disturb the dressing or the graft. Again, warm saltwater rinses four times daily are recommended. The third and final phase is the maturation phase of the graft, usually days 10 through 30. During this time a normal diet can be maintained again with some care so as not to disturb the surgical sites. Normal oral hygiene should be maintained including tooth-brushing, even in the area of the surgical site, taking care not to disturb the graft or gingival tissues in this area. Warm saltwater rinses will still be stressed. You can resume normal activity during this time.