When gum grafts fail, they may peel away, or recede from, root surfaces. You will notice exposure of these surfaces and gradual recession over time.
If your gum graft failed, you'll probably notice a large patch of white tissue that has come off of your tooth. Its lack of color means that the gum graft lost blood supply and is dying.
Signs of Gum Graft Failure
A failed gum graft can be easy to detect. Your periodontist will inform you of signs to watch out for, such as a large patch of white tissue or the graft appearing to be falling off. When this happens, it means the transplanted tissue has lost its blood supply, leading to its “death”.
You can always reattempt to have your gum graft redone. You need to wait at least 3 months after your failed gum graft to make sure the tissues have properly healed and matured after your initial surgery. An attempt to redo a gum graft too soon won't allow you to have the most optimal response.
Following your gum graft in Toronto, your periodontist isn't likely to let you eat for a full 48 hours following surgery. This is because biting and chewing could tear the stitches or dislodge the graft.
Patient may experience pain, described as a constant dull ache or sharper pain during mastication or speaking (movement of oral and peri-oral tissues). Patient experiences anxiety over procedure and perceived lack of success.
The bleeding usually stops on its own, but light pressure with moist gauze or a black tea bag can be applied if necessary. The gum graft is held in place with very delicate sutures and takes 5-7 days to attach firmly.
These failures rarely cause pain however do cause psychological distress to the patient. It was important to reassure the patient at this stage that such failures can occur. Fortunately they are rarely complete failures and some keratinised tissue cells remain.
This white material is usually granulation tissue, a fragile tissue composed of blood vessels, collagen, and white blood cells. Granulation tissue is a normal part of your body's healing process and is not cause for concern.
It will get red and puffy, then white or gray with sloughing for up to two weeks. The tissue will change to pink or the natural color of your gums as the area heals.
Gum graft healing
You will know that the graft is healing when the swelling subsides and the soft tissues are shrinking. Your gum tissue will begin binding to the root surface and bone. Then, new blood vessels will begin to form to enable blood flow to the graft. This stage takes four to six weeks from surgery.
If you're brushing for too long or applying too much pressure, or even if the bristles on your brush are too hard, you can cause gums to recede. But overzealous brushing can also cause irritation, bleeding and gum peeling. To avoid these problems, choose a brush with softer bristles and use a gentle, circular motion.
The gum tissue will undergo changes for the next 1-2 weeks. The graft color may change from pink to white. This is NORMAL. Then the color will change to red and then back to pink as the swelling decreases.
Graft failure can be caused by factors such as: Poor formation of the graft union due to problems with anatomical mismatching (when the rootstock and scion tissue is not lined up properly), poor grafting technique, adverse weather conditions and poor hygiene.
Rejection is supported by the presence of recipient lymphocytes, preferentially T-cells, and the absence of donor cells in blood and marrow. Graft failure may also be due to other causes, such as viral infections, specifically, cytomegalovirus (CMV), human herpes virus type 6 (HHV6) and parvovirus.
With a gum graft, you can expect it to remain in place for a lifetime, but you will need to take care of your oral health on a daily basis. This means brushing with a soft-bristled toothbrush and being mindful of how much pressure you're using while brushing.
If large amounts of your graft appear white or even grey, it may signal dead or necrotic tissue. This gum tissue will typically look like it's peeling away from the tooth roots.
This black discoloration of the gums is due to dead tissue, or necrosis. This is a serious health issue, with symptoms that can also include bleeding gums, strong pain, and a foul smelling mouth.
For soft tissue “gum” grafts, the site(s) may appear white during the healing process (up to 2 weeks), this is normal and not a sign of infection. The tissue will change to a pink color as it heals.
It's never too late for gum grafting as long as the patient has sufficient gum tissue to harvest for the graft. However, the success rate of the procedure may be lower in cases where the patient has advanced gum disease or other underlying health issues that can affect the healing process.
At this point, a clinician not familiar with the healing of a free gingival graft might mistake this presentation as a dead and/or failed graft. In addition, patients will frequently complain of a bad smell and indicate their graft is “dead.”
Gum Grafting Takes a few Weeks to Heal and Pay Off
It takes a few weeks to heal and swelling to subside, and during that time the graft will adapt to the area. After that, it will take another few weeks to see the full benefits — the restored appearance of the gums.
Post-surgical instructions. Your connective tissue grafts are very fragile and will not be 100% effective if disturbed. Please refrain from stretching your lips and cheeks to view or show the graft site. If your graft is disturbed in any way, you run the risk of having your graft fail.
The color of the graft may vary from pink to white. This is completely normal. The color will shift to red and pink as the swelling subsides. Some patients may take a long time to complete the gum graft healing stages.
If you use your own tissue, the most teeth you can typically graft at once would probably be somewhere in the neighborhood of 7-8 teeth. With alloderm, you could graft every single tooth in your mouth in one sitting!