Gum Grafting With or Without an Adjacent Tooth
Missing teeth have many consequences. Several studies have confirmed that a second premolar occlusion is minimally adequate for function and to prevent fractures due to excessive occlusal forces on the remaining teeth. However, other sequelae can result from missing molars. One of these is trauma to the terminal premolar tooth’s gingiva. Even with judicious brushing, lack of a neighboring tooth increases the risk for loss of a distal papillae and gingival recession. The problem is often worse when a second premolar is missing, in addition to resulting in compromised function and occlusal support.
Today’s case is an example. Our patient presented with significant recession and inadequate attached gingiva on #27 and 28, and with #29-31 missing, as you can see in the first photo. Absence of adjacent teeth caused loss of the papilla distal to #28, which is a necessary component of root coverage during gingival connective tissue grafting. So even though we were able to augment the tissue and achieve partial root coverage for #28 , complete root coverage was precluded, as you can see in the second photo. In addition, lack of a neighboring tooth means that future relapse of recession will be more likely for #28 due to increased abrasive forces when chewing or toothbrushing. Since #27 has its neighboring teeth and its two papillae, we were able to achieve 100% root coverage, and future recession is less likely.
There are many reasons for saving teeth, and for replacing them when they are missing. This is one of them.