As options for treatment planning continue to increase, it is critical for clinicians to stay on top of the ever-changing techniques. Gingival recession presents both an esthetic and a functional concern for patients. With current techniques, coverage of exposed roots can be achieved predictably provided there is no loss of interdental bone or soft tissue.

 

     Connective tissue grafts, introduced in the 1980s, were considered to be the “gold standard” for treatment of gingival recession. However, this procedure requires harvesting palatal donor tissue, and in spite of significant refinements in surgical techniques, many patients remain fearful of palatal surgery and resist recommendations for treatment of root exposure and gingival deficiencies. Additionally, there may be inadequate palatal tissue volume as well as anatomical or medical concerns that rule out this area as an acceptable donor source.

 

     AlloDerm (LifeCell, Branchburg, VA), an acellular dermal graft introduced in 1994 for treatment of burn patients, has been demonstrated to be an effective alternative to palatal connective tissue for root coverage grafting. The absence of blood and cells prevents graft rejection and also eliminates the capacity of this allograft to carry pathogens.

 

     At Trillium, we have found that palate-less grafting is a great service for some of our patients. Repeated palatal grafting can lead to scaring or even paresthesia on the palate.  For children, patients with a gag reflex, patients on blood thinners, and a variety of other patients, eliminating the need for a second surgical site (i.e. the palate) to do gum grafting around teeth can be a great benefit. The handling characteristics of AlloDerm are superior to palatal connective tissue. AlloDerm is consistent unlike patient palatal tissue which can vary based on body mass or age or systemic health. Also, Alloderm grafting allows for multiple teeth and sites to be treated in a single visit. With Alloderm there is no need to remove tissue from the palate, a procedure that is painful and can result in complications.