Gingiva eraser is an operation in which defects are corrected and a natural physiological contour is formed. It helps to eliminate both acquired and congenital anomalies of the oral cavity. During surgery, either gum pockets are removed or missing tissue is built up. Gingival plastic surgery

Indications for gingival plasty

Gingival plastic surgery is necessary in such cases as:

• after implantation;
• mechanical damage;
• deformation;
• deep periodontal pockets;
• exposed roots of teeth;
• uneven edge of the gums;
• pathology of the frenulum of the tongue or lips;
• inflammation during gingival eruption;
• overhanging gum tissue.

Preparing for plastic surgery

Since gingival plastic surgery involves surgical intervention and the use of general or local anesthesia, preparation is a mandatory process. The patient passes along general analysis blood and Rh factor a number of studies on:

• blood clotting;
• the level of prothrombin and sugar;
• HIV infection.

It is also necessary to pass a coagulogram and an ECG. The patient should at this stage warn the attending physician about the existing allergic reactions, sensitivity to certain drugs, serious systemic diseases and taking medications.

Preparation requires abstaining from alcoholic beverages for a week before surgery and from eating a few hours before surgery. Experts strongly recommend drinking vasoconstrictor drugs to prevent heavy bleeding.

On the part of the attending physician, the operated area is cleaned, plaque and tartar are removed. He performs all the manipulations to prevent inflammation of the soft tissues and minimize bleeding. When plastic is prescribed for the treatment of periodontal pockets, a preliminary examination and assessment of the condition of the soft tissue is carried out.

It is thanks to high-quality preparation that the chances of a successful operation and reducing negative consequences increase.

Gingival plasty methods

Depending on the nature of the anomaly, the operation involves the formation or removal of gum tissue. The procedure may include both restoration of bone tissue and cleaning of the bases of the teeth.

In total, there are several of the most common methods of gum plastics:

1. Layered graft transplantation. It is taken from the hard palate and transplanted into the implant site. This method makes it possible to expand the area of ​​attached gums in thickness and width. The peculiarity is that the transplanted gum will differ in shade. This must be taken into account when performing surgery on the area that is visible when smiling.
2. Subepithelial flap grafting. He is taken either from the hillock upper jaw or from the deep layers of the hard palate. After that, the flap is placed in a "pouch", that is, in the space between the layers of the mucosa in the right place. This increases the thickness of the gums.
3. Apical displacement of the pedicled flap. This technique involves the smooth movement of the fixed gum from the top of the alveolar ridge to the surface from the side. Since the flap does not separate completely, having a feeding "leg", engraftment will be faster. This method is able to simultaneously increase the vestibule of the oral cavity.

In total, there are several types of this surgical intervention:

• Gingivoplasty. This is the formation of an aesthetic appearance of the gums. Many people experience periodontal and gingival pockets, when the gum flakes off the tooth, which forms cavities in which food debris accumulates and harmful bacteria multiply. These pockets can be several millimeters deep. There is also a reverse situation, when the gum is strongly raised and exposes the tops of the teeth. This type of plastic is designed to solve all these problems. They run to him and after dental implants. Especially if the implant was implanted in a place where there was no tooth for a long time. Thanks to this procedure, the aesthetic indicators of the dentition are restored.
• Vestibuloplasty. It is needed when, due to periodontal disease or old age, the gum unsightly exposes the roots of the teeth, decreasing in size. The purpose of this operation is to restore the normal appearance and volume of the gums. This is achieved by its dissection and extension.
• Gingivectomy. It is carried out to correct the edge of the gums when removing gum pockets. Thus, the excess part is removed and a new form is given.
• Hood excision. It is performed in case of difficult teething, usually wisdom tooth. Growth is often accompanied by severe pain and inflammation of the gums. At the same time, due to the inaccessibility of the place for cleaning, regular hygiene procedures are not enough. As a result, inflammation of the gums and their increase in size occurs, that is, the so-called hood (tubercle) is formed. Food particles get stuck in it. Thanks to the excision and removal of a part of the gum, it is possible to eliminate the problem and provide free access to the tooth for growth.

Hood on wisdom tooth

Stages of plastic surgery

The operation is performed in a hospital by a dental surgeon. All plastic surgery, regardless of the type, is carried out according to the following scheme:

1. Examination of gums and preparation of the oral cavity. At the same time, carious formations, tartar and plaque are removed. This is an important stage, since all pathologies must be eliminated before surgery. That is why plastic surgery is often performed together with gum curettage.
2. Introduction of anesthetic as the operation is performed under local anesthesia.
3. Removal of part of the gum with a laser or scalpel, or an incision is made and moved to a new location. When there is an acute recession of the tissue, that is, exposure of the root of the tooth, a part of the mucous membrane borrowed from another area is transplanted.
4. Suturing.

Sutured gums during plasty after implantation

Upon completion of the operation, the doctor will certainly prescribe drug treatment to help speed up the healing process. The patient should rinse his mouth, make compresses and baths with medicinal wound healing and antibacterial agents.

rehabilitation period

The duration of the rehabilitation period is individual and depends on the condition of a particular patient. On average, it varies from 2 days to a week. Often, after flap surgery, soft tissues recover within 12-14 days. If the formation of the gums was carried out, then the rehabilitation period will take about 7-10 days.

Recommendations for postoperative oral care

After surgery, the gums may be slightly swollen and sore. This reaction is quite normal. And in order to reduce these manifestations, doctors advise:

• exclude cold, sour, salty, hard, spicy foods;
• stop smoking and drinking alcohol, as they can lead to divergence of seams and inflammatory processes;
• refrain from heavy physical exertion;
• rinse oral cavity antiseptics, such as iodized or sea ​​salt, Miramistin;
• brush your teeth very carefully, without touching the operated area.

Plastic surgery of the gums makes it possible to restore their correct contour from a physiological point of view and make a beautiful smile. She can become effective way treatment of serious periodontal diseases and the key to high-quality dental implantation. If the operation is performed by a qualified doctor, and the patient adheres to all recommendations, then the postoperative period and rehabilitation will be easy.

Most effective method surgical treatment for severe and extensive burns of the conjunctiva and cornea is a mucosal transplant operation. Replacing the dead conjunctiva of the eyeball, the transplanted mucosa prevents the development of simblefarone and at the same time improves corneal trophism. Therefore, the operation of mucosal transplantation is especially indicated for a burn of the eyeball with a deep lesion of the cornea and the limbus region (the cornea takes the form of a porcelain plate).

For transplants use a mucosal flap taken from the patient's lip (according to Denig), or a cadaveric conjunctiva flap, preserved at 2°-4°C (above zero) for 1-4 days. The operation is recommended to be performed in the first hours after the burn (no later than 24-36 hours).

Because mucous lips, transplanted to, later stands out with its red color, and the cadaveric conjunctiva resolves after some time (L.V. Zenkina et al.), some authors suggest using a conjunctival flap taken from the patient from the second for transplantation to the eyeball for severe burns, healthy, eyes (Spat, Lehei). However, this proposal is unlikely to be widely implemented in combat defeats.

Sorsby and Simone were transferred to burnt eyeball shell of the embryo (amnion) and got good results. The question of the advantages of this material for transplantation to the eyeball in comparison with the lip mucosa or cadaveric conjunctiva needs to be verified.

Lip mucosal transplant surgery produced under local drip anesthesia with 0.1-0.25% dicaine solution. Under the mucous membrane of the lower or upper lip, 1.5-2 ml of a 2% solution of novocaine with adrenaline is injected. A strip of the affected (necrotic) conjunctiva is excised concentrically to the limbus. After that, a thin flap of the mucosa is separated from the lip using hemostatic fenestrated tweezers.

Freed flap from the remnants of fiber, lay it on the exposed area of ​​the sclera, thus replacing the remote part of the conjunctiva. The graft should be sutured to the episclera or tendons of the rectus muscles with several thin silk sutures. The edge of the flap should not go over the cornea. If the entire conjunctiva of the eyeball is affected, two flaps should be transplanted, surrounding the cornea with them.

For eyelids enter synthomycin or albucidal ointment and apply a bandage on both eyes for 1 day. In the future, one eye is tied, changing the bandage daily. The sutures from the flap are removed after 5-6 days.

graft usually well takes root, and often there is a significant enlightenment of the cornea. It is possible that the transplanted mucosal flap acts on the remaining nerve receptors as a weak irritant, as a result of which the trophism of the cornea improves and the process of its regeneration is accelerated. In addition, as mentioned, the graft prevents the development of adhesions between eyeball and eyelid at the site where the mucosal transplant was done.

Complex treatment of burns conjunctiva and cornea is performed in our clinic as follows. Along with local treatment (synthomycin or chloramphenicol ointment, cortisone, separation of glues between the eyelid and apple), the patient receives vitamins (A, B1, B2, C) from the very first day, as well as intravenous infusions of 40% glucose solution. If necessary, a Denig operation or other operations are urgently performed (for example, fixing a rubber gasket between the lower eyelid and the apple). In the future, tissue therapy according to V.P. Filatov, as well as paraffin therapy, is prescribed.

At severe corneal burns Attempts were made to surgical intervention not only on the conjunctiva, but also directly on the cornea in the form of non-penetrating (layered) keratoplasty. The idea of ​​the possibility of such an operation for burns of the cornea was expressed at one time by V. P. Filatov and others. In 1956, Levi reported on 7 patients in whom he performed a blind corneal transplant after unsuccessful conservative therapy. The layers of the cornea affected by the burn were excised, and a blind flap of the cadaveric cornea of ​​the appropriate shape and size was transplanted in their place.

flap fixed on the cornea with "glue" of thrombin and plasma. The author believes that in all 7 patients the operation helped to save the eye from death.

We consider it necessary to highlight this section, since it has its own characteristics. Free mucosal grafting is very limited, as it is not possible to obtain enough of it. So, the buccal or lip mucosa can only be used to replace small defects (for example, defects in the mucosa of the eyelids). Such a need occurs in cases of creating a century with a preserved eye. Mucosa from the oral cavity can be used for transplantation into the nasal cavity after excision of scars. The mucosa from the cheeks or lips is best taken with a razor or scalpel, placing a finger under the skin of the cheek or lip (Fig. 81), as a result of which the mucosa protrudes and stretches. The flap should be thin, without a submucosal layer. The mucosa almost always survives well. When transplanting eyelids, the latter should be sutured to prevent their movement and, consequently, the displacement of the graft. When transplanting into the nose, the mucous membrane should be loosely pressed down with gauze.

Very often, surgeons are forced to resort to the replacement of defects in the oral mucosa. Such defects are obtained mainly after the excision of scar bands on it, which prevent the opening of the mouth, movements of the tongue, lips, etc. (Fig. 82). Replacement of defects in the oral mucosa is performed using free skin grafting.

The first one successfully transplanted a skin flap into the oral cavity in 1916 by the Viennese doctor Moshkovich (according to Rauer and Michelson). In the Soviet Union, the first such transplant was made in 1923 by P.P. Lvov.

The skin in the oral cavity takes root very well, but only if the flap is immobilized in the first days, which is a rather difficult task.

In order to fix the graft, a piece of stent (material for dental impressions) is taken, wrapped in gauze and lowered into hot water holding the gauze with a clamp for 2-3 minutes. The stent becomes very soft and sticky. It is taken out and, after it has cooled slightly, it is shaped into a cake and applied to the mucosal defect. After waiting for the stent to harden, it is removed and rinsed with saline. The imprint of the defect is obtained on the stent. Subsequently, a skin flap is cut out, which is applied to the imprint on the stent with the wound surface outwards. To prevent the flap from moving during the reintroduction of the stent into the mouth, it is wrapped around the stent with thin catgut or the edges of the flap are sutured (Fig. 83) over the stent. After that, the stent with a skin flap attached to it is inserted into the mouth in such a way that the wound surface of the skin is in contact with the wound surface of the defect. To keep the mouth open, a plug is inserted between the teeth, which at the same time presses the stent against the cheek. To fix the stent, the buccal mucosa can also be sutured over it.

In the absence of teeth on both sides, it is necessary to resort to the manufacture of special devices that hold the stent.

If a mucosal defect needs to be eliminated in the region of the transitional fold ( vestibulum), then the stent is supported by an aluminum splint fixed to the existing teeth (Fig. 84).

With very large defects in the mucous membrane, when it is necessary to form the vestibule of the mouth, it is possible to make a dental prosthesis, on which an appropriately sized plastic insert is attached, and wrap it with a free skin flap (see jaw deformities).

In the postoperative period, 8-12 days after the removal of the stent from the oral cavity, the mouth should be kept open for another 4-5 days to allow the transplanted piece of skin to get stronger and not shrink. This is especially important in operations for cicatricial contractures of the jaws.

When using a free skin flap to form an eye bed, a pre-prepared plastic liner is wrapped with a skin flap and the eyelids are sutured over it for 10-12 days.

The question of the future fate of the skin transplanted into the mouth or nose has long been controversial. It was assumed that the skin transplanted into the mouth should gradually turn into a mucous membrane and even acquire all the properties of the latter. However, histological studies of pieces transplanted into the mouth, taken even after several years, showed that the skin remains unchanged, retaining all sweat and sebaceous glands as well as hair follicles.

Clinically, we always observe a slightly changed color of the skin transplanted into the mouth: it becomes pinkish, more tender, which is explained by the constant desquamation of the epithelium. On the other hand, hair growth in the oral cavity continues if the flap is taken from where the hair has grown. Thus, it is now considered established that skin transplanted into the mouth never becomes a mucous membrane.

The experience of our clinic and others (E. A. Aleksandrova, N. I. Butikova, and others) showed that skin transplanted into the mouth both in the form of thin flaps and in the form of split (mesh layer) takes root equally successfully.

In some cases, gum plastic surgery is required after implantation. Let's talk about how the build-up takes place, about prices and reviews of patients who have used this service. Doctors recommend it for any mucosal defects and are able to correct the position and volume of soft tissues around the dentition.

Nature does not always endow us with a perfect smile, but most problems today can be solved with simple procedures. So, when implanting a tooth, the patient is guaranteed a perfect smile and the functionality of the row. But there are cases when, after such an intervention, it is necessary to additionally remove aesthetic defects.

Why is the operation performed?

Plastic surgery of the soft tissues of the gums is also called gingivoplasty. It can be done after implantation, simultaneously with it, as well as in other cases of congenital or acquired pathologies of mucosal formation.

A periodontist deals with this method of gum correction and, even before the operation, determines how its edge should look. To do this, he puts marks on the teeth, which show where her position is supposed to end.

Normally, soft tissues fit snugly to the lower part of the crown of the tooth, covering its neck and root. But with implantation, complications and violations of its growth are likely:

• after suturing the tissues, it stretches too much and heals with obvious defects;
• if the temporary prosthesis is placed incorrectly, which leads to constant pressure on the gum and slows down its growth and healing;
• during the recovery period of the mucosa, the patient does not make due efforts to care for the oral cavity, does not adhere to the doctor's recommendations, which leads to injuries and deformities;
• at one of the stages, mechanical damage to soft tissues was allowed;
• implantation was performed after a long absence of a natural tooth, which led to the loss of the alveolar ridge and gingival recession.

Depending on how the operation takes place, patchwork, complete, separate or simple gingivoplasty are distinguished. In each of the cases, special actions of the doctor are assumed and the condition of the patient's tissues is taken into account.

According to the localization of the gum plastic during implantation of teeth, it can cover only one unit (localized) or most of the row (generalized). There is also a separate classification for the correction of gingival growth defects, according to the authors who proposed their own method - according to Egorov or according to Calmi.

Indications and contraindications

We list the most common cases when gingivoplasty is a good choice for treatment:

• too strong layering of soft tissues into units, otherwise this defect is called a "shark smile";
• when the root of the tooth is exposed;
• when different levels of gums form in each individual area and thereby spoil appearance smiles;
• the appearance of an inflammatory process after the implantation procedure;
• the presence of periodontal pockets in periodontal disease or other mucosal diseases;
• congenital pathologies of growth and location of the frenulum.

But it is not always possible to carry out such an intervention and perform gum extension or truncation. There are a number of contraindications:

• blood clotting problems;
• any malignant tumors;
• diabetes;
• violations of the musculoskeletal system;
• alcohol intoxication or drug addiction;
• found an allergic reaction to any of the components of the selected anesthesia;
• some respiratory diseases.

Preparing for gum plastic surgery

Since gingivoplasty involves surgery and the use of local or general anesthesia, you must first prepare for this process. The patient is sent for a series of tests and collection of health indicators:

• general blood test and Rh factor;
• sugar and prothrombin levels;
• on blood clotting;
• the presence of HIV infections;
• coagulogram.

Right now, you can warn the dentist about a tendency to allergic reactions, special cases of sensitivity to drugs, taking any medications, or the presence of serious systemic diseases.

Direct preparation consists of abstaining from alcohol for a week before the operation and from eating a few hours before it (at least two hours). Also, doctors recommend pre-drinking a course of vasoconstrictor drugs to avoid heavy bleeding.

For convenience, it is better to dress in something spacious, and take a reliable person with you who will help you get home after the procedure and ensure your comfort. It will be useful to tune in to a positive result and get rid of fear.

On the part of the doctor, action is required to prevent:

• infection of the operated area, which consists in professional cleaning, removal of plaque and tartar;
• the appearance of inflammation of soft tissues;
• reduction in bleeding.

If gingivoplasty was prescribed for the treatment of periodontal pockets, then it is also necessary to conduct a preliminary examination and assessment of the condition of the soft tissues. High-quality preparation increases the chances of success of the operation and minimizes any negative consequences.

Methods and stages of gum augmentation

Since after implantation, the roots are most likely to be exposed and the volume of the mucosa to decrease, it is the patchwork operation to build it up that is most often chosen. It involves the following steps and actions of the doctor:

1. They give anesthesia, usually local, although in some cases general anesthesia may be preferred.
2. On the treated area, a thorough antiseptic treatment is carried out, disinfecting it as much as possible.
3. On soft tissues, a horizontal incision and two vertical incisions are made, which make it possible to fully open the flap. According to the classics, it is supposed to use a standard scalpel of the right size, but in modern clinics, the laser method is increasingly being used.
4. In the open area, the doctor performs the required actions, which involve cleaning periodontal pockets, removing plaque and calculus from the exposed surface of the tooth, eliminating the infection, if any, and other manipulations.
5. At the end, the flap is closed back and sutures are applied. To increase the volume of soft tissues, one more section taken from the sky can be additionally sewn. It is the mucous membrane from the patient's oral cavity that is most suitable for these purposes, since it has the highest degree of survival.
6. After that, the operated area must be treated with an antiseptic to prevent infection from entering the wound. The patient is given clear recommendations for the care of the oral cavity during the period of restoration and healing of tissues.

This procedure can be done in two ways:

• simultaneously with implantation;
• or after a certain period after complete healing of tissues and osseointegration of the rod.

In the second case, the operation is a little different - in addition to correcting the gums, they also remove the plug from the implant and install a shaper that will make the edges of the mucosa smooth and regular.

How much does such a procedure cost? Usually the price depends on many factors - the level of the clinic, the professionalism of the doctor, the types of anesthesia used and the volume of the area being restored. But saving on this is not worth it, because the quality of the operation should be high enough.

On average, the cost of gingivoplasty in Moscow is around 1,500 rubles per tooth in a simple way. If a patchwork operation is performed, then it will cost 3,500 rubles for a limited area, or 30 thousand rubles for correction of the entire oral cavity.

rehabilitation period

When will the wound heal and after how many days are the stitches removed? It all depends on the type and extent of the manipulations performed, as well as the patient's state of health and the ability of his tissues to regenerate. So, after a patchwork operation, healing occurs after 12 days, and if a gum shaper was used, the process can take up to 14 days.

In the presence of weakened immunity or improper hygienic care of the wound surface, the recovery process may be delayed. Sometimes there are complications, so if you have any unpleasant symptoms and discomfort, you should immediately consult a doctor for examination and consultation.

The doctor must tell you in advance about how the oral cavity should be cared for in the period after gingivoplasty. The following is usually assumed:

• Mechanical effects such as brushing your teeth are minimized, if not completely eliminated. After all, this can break the integrity of the seams and damage soft tissues.
• After each meal, rinse your mouth thoroughly with special antiseptic solutions or iodized sea salt.
• Sweet, spicy, salty, smoked, sour, hard, hot and cold foods are excluded from the diet for the recovery period.
• At least for this period, alcohol and smoking should be abandoned, since the substances contained in them have a particularly destructive effect on soft tissues, which will worsen their healing.
• Limit physical activity.
• The thermal rest of the operated area is important - it can neither be overheated nor supercooled.
• To avoid infection and inflammation of the gums, it is necessary to periodically rinse them with anti-inflammatory and antibacterial agents, which the doctor will prescribe.
• For any pain, you can take painkillers sold in pharmacies without a prescription.
• For better protection against mechanical damage the wound surface wear a special soft cap.

What result should the patient expect?

In this case, you need to pay attention to the choice of an experienced specialist during implantation and gingivoplasty. This is the only way to guarantee a good result, which will lead to the restoration of a perfect smile.

Thanks to the correction of the gum shape, it is possible to achieve an improvement in aesthetic indicators, hide the visible roots of a natural tooth and rods from implants, and protect internal tissues from infection. All this contributes to the health of the oral cavity and a beautiful appearance.

What are the possible complications?

Since surgical intervention, even if all safety rules are observed, is a strong stress for the body, it can result in unpleasant consequences that need to be addressed separately:

• There is a temporary loosening of the teeth, but if after a week it does not go away on its own, then splinting of the row is required. This is done using special fixing elements on the back of the tooth surface.
• Puffiness is normal, but only if it decreases as the tissues heal. In five days, she will talk about the inflammatory process, which should not be ignored.
• Pain is eliminated with the help of special drugs.
• Mucosal bleeding may also be normal, but should be reduced with rinses and solutions.
• Headache as a result of anesthesia.
• Relapses happen with any treatment, and gingivoplasty is no exception. With adverse external influences, soft tissues can again decrease in volume and expose the roots.

Video: how is gum plastic surgery performed?

After implantation, I waited a long time for the gums to heal and fall into place. But this did not happen. The doctor advised gingivoplasty. And only now the smile has become normal and beautiful.

I went through this process twice. For the first time after a long gingivitis, I had to build up the gum. And the second - after implantation, since the mucosa reacted in its own way to the implantation of the rod. The process is unpleasant and painful, but the result is good.

I had implantation and expected that now the smile will be great. But very quickly it deteriorated due to the fact that part of the abutment and the rod became visible. Realizing that this should not be the case, I went to the doctor. I had to endure through one more operation, but now all the tissues are in their place.

Beautiful and healthy smile: gum plastic surgery

In addition to the fact that the appearance of the teeth worsens, this can lead to more serious diseases. Plastic gums will help to cope with this.

What it is?

This is an operation that is aimed at solving any gum defects. This procedure can be carried out in the following cases:

• in the presence of a "shark smile", when the outer part of the tooth is more than half hidden by the gum;
• for the prevention of rooted caries and periodontal disease;
• to eliminate inflammation;
• to improve the structure of the fabric;
• for cosmetic purposes.

Gingival recession plasty

There are periodontal diseases that can cause gum recession. Recession is a condition in which the root system of the tooth is exposed. Moreover, it visually looks ugly, and can also lead to caries or other problems.

In this case, they resort to building up the gums. Recession plasty is a procedure aimed at the area of ​​the oral cavity in order to redistribute the gum to cover the root.

After implantation

Gingival plastic surgery after implantation is sometimes necessary in order to cover the exposed root.

Often, the presented procedure is required in cases where the implant is installed in the place where the tooth used to be.

A properly formed gum will serve not only cosmetic purposes, but will also protect the implant from external adverse factors, which can lead to diseases.

In addition, the presented procedure is aimed at reducing the sensitivity of the teeth, further exposure of the tooth root and improving the aesthetic appearance. In some cases, gum plastic surgery is possible during implantation, at a time.

Against "gum" and "shark" smiles

Therefore, any violations can lead to the following defects:

"Gum" smile

The front teeth are not fully visible, since most of them are covered by the gums.

This pathology is often called a "horse" smile because of the visual similarity. A "gummy" smile is noticeable only when a person smiles.

"Shark" smile

The presented pathology occurs with gingival hyperplasia on the front teeth. The teeth at the same time visually become small and pointed like a shark, hence the name.

Healing after surgery

Depending on the type of plastic surgery, the healing process can take from a couple of days to several weeks. On average, the healing process takes 2-4 days.

After the operation, the doctor will definitely provide instructions and recommendations that should be followed.

They are set individually, but in general boil down to the following:

• reduce physical activity;
• keep calm, rest;
• do not eat solid, hot or cold food;
• carefully observe the rules of gum hygiene.

In addition, during the recovery period, the patient is required to wear a special mouth guard. It serves as a protective factor, which is aimed at the speedy healing of the wound.

The cost of the procedure directly depends on the volume and complexity of the work to be done. The price for gingival plasty during a recession starts from 1000 rubles. An operation in the area of ​​​​the tooth can cost from 500 rubles and more. But flap surgery on the gums will cost over 4,500 rubles.

The operation, even such a simple one, is always scary. And you need to somehow calm yourself before the plastic of the gums. Reviews are perfect for this.

There were exposed roots of the teeth, the periodontist recommended surgery. Terribly afraid, but as it turned out in vain. The operation went well, everything healed quickly, there were no problems. But now there are no problems with an ugly smile, everything has become pretty, pleasing to the eye. Sometimes during the operation it was scary and a little painful when the effect of the painkiller ended. But I don't regret anything.

I had a recession in the lower front teeth. The doctor advised to perform an operation to close the recession of the gums. The operation itself went well, I did not feel anything. However, the next day there was swelling and bruising under the eyes. At first I was scared, but after 2 days everything went away. In general, I am satisfied with the result and the process.

Useful video

In this video you can see how the gum plastic is performed when the root of the tooth is exposed:

Gum augmentation and plasty

When different types of gum plastics are needed. Medical and aesthetic indications for surgery. Types of correction. Postoperative recovery and oral hygiene.

Go directly to:

Gum augmentation and plasty

The gum is a part of the oral cavity that plays a very important role, but it is often forgotten or not given due importance. The gums protect the neck of the teeth from exposure to harmful or traumatic factors, fix the tooth itself, and give the smile a beautiful shape.

Gingival augmentation is a procedure during which the shape of this formation is changed in order to close the exposed area of ​​the tooth, or to correct it around the implant.

The shape of the gums can change after dental interventions, injuries, inflammatory processes (gingivitis, periodontitis) or due to congenital features of the structure of the jaw, its developmental anomalies, which are easily corrected with gingivoplasty. Gingival plastic surgery is able to prevent or eliminate an aesthetic defect and give the necessary appearance to any gum.

Get a consultation in our center:

When is gingival plastic surgery necessary?

Like any other surgical intervention, gingivoplasty has its indications. It is carried out in the following cases:

• Gingival plasty with root exposure (recession). One of the most important and frequently encountered indications for this intervention. Closure of gum recession is necessary to prevent tooth decay, reduce its sensitivity, and reduce the risk of developing infectious and inflammatory complications;
• Gingival smile correction. Exposure of mainly gums, and not teeth, during a smile can confuse both others and the person himself. In such cases, gum plasty will perfectly cope with the elimination of the defect, and additional production of veneers will be able to correct any non-standard situation;
• Gum augmentation during implantation or bone grafting. Produced for the purpose of closing the augmented bone tissue, fixing the implant, eliminating aesthetic defects;
• Elimination of the consequences of gingivitis or periodontitis. In the process of development of these pathologies, the neck or root of the tooth is often exposed. Treatment of gum recession is called upon as a necessary element for getting rid and further prevention of the infectious and inflammatory process.

Methods of gum extension

There are two ways to perform gingivoplasty: using your own flap of the oral mucosa or using a special collagen matrix or barrier membranes.

Patchwork is more common due to the fact that it does not require additional products in the form of a collagen matrix. In this technique, only the patient's own tissues are used:

• An incorrectly located section of the gum is excised, unable to take its original position;
• With a lack of tissues available at the site of excision, a tissue flap is formed from adjacent areas of the mucosa (adjacent gum, palate, inner surface of the cheek);
• The flap or gingival margins are sutured under tension in close contact with the tooth surface using surgical knots.

The use of a collagen matrix is ​​somewhat different. The material is simply tightly sewn to the existing defect, which ensures the subsequent formation of its own tissues on the existing collagen network.

Gingivoplasty for unaesthetic smile forms

There are two common types of smile that do not fit into modern concepts beauty:

Both gingival smile correction and shark smile correction are performed by excising and changing excess soft tissue. This smile and gingival contour are given an aesthetically correct shape.

Also, gingivectomy is used when wisdom teeth erupt or after their removal, with an excess of gum tissue after the installation of a dental implant, bite adjustment, tooth extraction.

Operation progress

Gingivoplasty is conventionally divided into several stages:

1. Intervention preparation. The oral cavity is disinfected with antiseptics or other methods of disinfection. If necessary, the operating field is delimited from the rest of the mucous membrane;
2. Anesthesia. Most often, local infiltration anesthesia is used using any modern painkillers or other anesthetics approved by the allergist. Less often, conduction anesthesia is performed with blockade of the maxillary or mandibular nerve;
3. Dissection of tissues. Incisions are made, excision of excess soft tissues;
4. Direct plastic. It is possible to directly stitch the incision after removing the excess gum, form a flap or use a collagen matrix with their fixation to the surrounding tissues;
5. End of operation. The surgical wound is sutured with surgical sutures.

Such an operation lasts within 30-60 minutes from the beginning of preparation to its complete completion. Plastic surgery using a collagen matrix is ​​on average 10-15 minutes faster. A modern laser can be used to cut tissues, which significantly speeds up the rehabilitation period.

Postoperative recovery

After gum surgery, it is important to follow certain rules to prevent complications and promote the healing process. This process can take from 5 to 20 days, depending on the volume of the operation performed and the individual speed of regeneration.

• Until the end of healing, it is necessary to strictly adhere to the rules of oral hygiene: brush your teeth at least twice a day (do not touch the operation site with a brush), use special solutions with antiseptics;
• In the first 7 - 10 days, you will need to constantly wear a special protective cap;
• For the first 5-10 hours after the operation, it is forbidden to smoke and eat. You can drink after 2 - 3 hours, it is allowed to use only soft boiled or mineral water without gas at room temperature or slightly warm;
• During the entire healing period, it is forbidden to eat solid, spicy, sweet foods. The ban also applies to hot and cold dishes;
• During the entire rehabilitation period, physical activity, flights, diving under water, off-road driving are prohibited.

The swelling should completely subside 3-5 days after the gingivoplasty. If this does not happen or any complications develop (bleeding, enlargement of the operated gum, soreness, fever), then the attending dentist should be immediately notified about this.

The cost of the operation in Moscow

The cost of gingivoplasty varies significantly depending on the clinic, the equipment used, the skill level of the dentist, and the volume of the operation. In various dental centers, gum augmentation or plastic surgery can cost from 1,500 to 20,000 rubles. The main influence on the price is the volume of the operation and the choice of methods for its implementation.

Important! You should know that any, even the most neglected situation on the gums can be corrected and made better and more beautiful. But in some situations, previously performed procedures complicate the process of rehabilitation with old scars. All types of gingival margin reconstruction are directly dependent on the gingival biotype. The thicker the gingival contour, the cheaper and easier the treatment. If the gum belongs to the ultrathin biotype, any surgery will be a test for the patient and the doctor.

How plastic surgery of the gums is done after implantation and not only. Four types of surgery

Gingival plastic surgery

Indications for gingival plasty

Gingival plastic surgery is necessary in such cases as:

• after implantation;
• mechanical damage;
• deformation;
• deep periodontal pockets;
• exposed roots of teeth;
• uneven edge of the gums;
• pathology of the frenulum of the tongue or lips;
• inflammation during gingival eruption;
• overhanging gum tissue.

Preparing for plastic surgery

Since gingival plastic surgery involves surgical intervention and the use of general or local anesthesia, preparation is a mandatory process. In addition to the general blood test and the Rh factor, the patient undergoes a number of studies on:

• blood clotting;
• the level of prothrombin and sugar;
• HIV infection.

It is also necessary to pass a coagulogram and an ECG. The patient should at this stage warn the attending physician about existing allergic reactions, sensitivity to certain drugs, serious systemic diseases and taking medications.

Preparation requires abstaining from alcoholic beverages for a week before surgery and from eating a few hours before surgery. Experts strongly recommend drinking vasoconstrictor drugs to prevent heavy bleeding.

On the part of the attending physician, the operated area is cleaned, plaque and tartar are removed. He performs all the manipulations to prevent inflammation of the soft tissues and minimize bleeding. When plastic is prescribed for the treatment of periodontal pockets, a preliminary examination and assessment of the condition of the soft tissue is carried out.

It is thanks to high-quality preparation that the chances of a successful operation and reducing negative consequences increase.

Gingival plasty methods

Depending on the nature of the anomaly, the operation involves the formation or removal of gum tissue. The procedure may include both restoration of bone tissue and cleaning of the bases of the teeth.

In total, there are several of the most common methods of gum plastics:

1. Layered graft transplantation. It is taken from the hard palate and transplanted into the implant site. This method makes it possible to expand the area of ​​attached gums in thickness and width. The peculiarity is that the transplanted gum will differ in shade. This must be taken into account when performing surgery on the area that is visible when smiling.
2. Subepithelial flap grafting. It is taken either from the tubercle of the upper jaw, or from the deep layers of the hard palate. After that, the flap is placed in a "pouch", that is, in the space between the layers of the mucosa in the right place. This increases the thickness of the gums.
3. Apical displacement of the pedicled flap. This technique involves the smooth movement of the fixed gum from the top of the alveolar ridge to the surface from the side. Since the flap does not separate completely, having a feeding "leg", engraftment will be faster. This method is able to simultaneously increase the vestibule of the oral cavity.

In total, there are several types of this surgical intervention:

• Gingivoplasty. This is the formation of an aesthetic appearance of the gums. Many people experience periodontal and gingival pockets, when the gum flakes off the tooth, which forms cavities in which food debris accumulates and harmful bacteria multiply. These pockets can be several millimeters deep. There is also a reverse situation, when the gum is strongly raised and exposes the tops of the teeth. This type of plastic is designed to solve all these problems. They run to him and after dental implants. Especially if the implant was implanted in a place where there was no tooth for a long time. Thanks to this procedure, the aesthetic indicators of the dentition are restored.
• Vestibuloplasty. It is needed when, due to periodontal disease or old age, the gum unsightly exposes the roots of the teeth, decreasing in size. The purpose of this operation is to restore the normal appearance and volume of the gums. This is achieved by its dissection and extension.
• Gingivectomy. It is carried out to correct the edge of the gums when removing gum pockets. Thus, the excess part is removed and a new form is given.
• Hood excision. It is performed in case of difficult teething, usually wisdom tooth. Growth is often accompanied by severe pain and inflammation of the gums. At the same time, due to the inaccessibility of the place for cleaning, regular hygiene procedures are not enough. As a result, inflammation of the gums and their increase in size occurs, that is, the so-called hood (tubercle) is formed. Food particles get stuck in it. Thanks to the excision and removal of a part of the gum, it is possible to eliminate the problem and provide free access to the tooth for growth.

Hood on wisdom tooth

Stages of plastic surgery

The operation is performed in a hospital by a dental surgeon. All plastic surgeries, regardless of type, are carried out according to the following scheme:

1. Examination of gums and preparation of the oral cavity. At the same time, carious formations, tartar and plaque are removed. This is an important stage, since all pathologies must be eliminated before surgery. That is why plastic surgery is often performed together with gum curettage.
2. Introduction of anesthetic as the operation is performed under local anesthesia.
3. Removal of part of the gum with a laser or scalpel, or an incision is made and moved to a new location. When there is an acute recession of the tissue, that is, exposure of the root of the tooth, a part of the mucous membrane borrowed from another area is transplanted.
4. Suturing.

Sutured gums during plasty after implantation

Upon completion of the operation, the doctor will certainly prescribe medication to help speed up the healing process. The patient should rinse his mouth, make compresses and baths with medicinal wound healing and antibacterial agents.

rehabilitation period

The duration of the rehabilitation period is individual and depends on the condition of a particular patient. On average, it varies from 2 days to a week. Often, after flap surgery, soft tissues recover within 12-14 days. If the formation of the gums was carried out, then the rehabilitation period will take about 7-10 days.

After surgery, the gums may be slightly swollen and sore. This reaction is quite normal. And in order to reduce these manifestations, doctors advise:

• exclude cold, sour, salty, hard, spicy foods;
• stop smoking and drinking alcohol, as they can lead to divergence of seams and inflammatory processes;
• refrain from heavy physical exertion;
• rinse the mouth with antiseptics, for example, iodized or sea salt, Miramistin;
• brush your teeth very carefully, without touching the operated area.

Plastic surgery of the gums makes it possible to restore their correct contour from a physiological point of view and make a beautiful smile. It can become an effective way to cure serious periodontal diseases and guarantee high-quality dental implantation. If the operation is performed by a qualified doctor, and the patient adheres to all recommendations, then the postoperative period and rehabilitation will be easy.

Our expert dentist will answer your question within 1 day! Ask a Question

Gingivoplasty - gum plastic

Gingivoplasty (from the Latin gingiva - gum and plastike - to sculpt) will help get rid of problems such as uneven gum contour, too deep periodontal pockets, gums hanging over the teeth. With the help of gingivoplasty, either excess gum tissue is removed or missing ones are built up.

Since the teeth and periodontal tissues are cleaned from plaque during the operation, the procedure can last quite a long time - about two hours on a segment of 7-8 teeth.

Gingivoplasty is performed in two ways:

• At the final stage of flap surgery.
• On fully healed or not yet manipulated gums - as a separate procedure.

Both methods are considered easy. surgical operations are performed under local anesthesia. Some clinics, at the request of patients, perform gingivoplasty under general anesthesia (in the absence of contraindications).

The most common indications for gingivoplasty are:

• too deep periodontal pockets (gap between the edge of the gums and the tooth) with periodontal disease;
• exposure of the roots of the teeth;
• the need to obtain a good aesthetic effect after flap surgery;
• uneven edge of the gums along the entire dentition;
• gum tissue hanging over the teeth and hiding part of the crown (the so-called "shark smile");
• the need to form a beautiful gingival margin during prosthetics and implantation.

Stages of flap surgery on the gums

Flap surgery is necessary for severe periodontitis and periodontal disease when periodontal pockets become too deep. For this:

1. A horizontal incision is made in the gums in the area that deviates from the gum edge by one to one and a half millimeters. This flap - a thin strip of soft tissue - is removed because such damaged tissue can never fit snugly against the tooth.
2. Gingival tissues are exfoliated from the tooth, mucous from the inner surface of the teeth - too.
3. The plaque and granulation tissues accumulated in the periodontal pockets are removed, the roots are polished.
4. The gums are stretched to the necks of the teeth and sutured. Sutures are placed in the interdental spaces).

Plastic surgery for gum recession and root exposure

With gum recession, flap surgery is also used throughout the entire dentition, only flaps of gum tissue are not removed. On the contrary, the doctor performs a flap graft from another site. For example, from the soft palate. This donor flap is connected to the problem area, then the tissues are sutured. Due to such transplantation, it is possible to completely close the exposed roots.

If the defect is single and localized only in the area of ​​​​one tooth, the procedure is performed differently. Two horizontal and two vertical incisions are made on the periodontal pocket, after which a flap of gum tissue is formed. They close the exposed root.

Procedure after implantation

Gingivoplasty after implant placement is performed on fully healed gums.

What to do after gum surgery

After the procedure, the gums may hurt a little, swell and swell. This is a normal reaction to surgery. To minimize these unpleasant manifestations, after gingivoplasty it is recommended to follow the following recommendations:

• to refuse from bad habits. Smoking and drinking alcohol can provoke divergence of the seams and start inflammatory processes;
• exclude from the diet hard food, salty, sour, spicy, cold;
• rinse your mouth with antiseptic solutions: sea or iodized salt, Chlorhexidine, Miramistin, etc.;
• refrain from physical activity;
• brush your teeth very carefully so as not to touch the operated area.

Photos "before" and "after" gingivoplasty

Healing time

On average, gingivoplasty in the area of ​​​​one tooth will cost patients 2,000 rubles.

The outcome of the operation largely depends on the experience and qualifications of the doctor. On our website you can find a complete catalog of dental clinics that effectively practice such procedures and achieve excellent results.

To eliminate various defects of the facial skeleton and soft tissues of the face, free tissue grafting is widely used in surgical dentistry. There are transplantation of a person's own tissues - autotransplantation; transplantation of tissues from another individual - allotransplantation; transplantation of tissues from a genetically identical person - ieotransplantation; transplantation of animal tissues to humans - xenotransplantation; implantation of artificial materials - metal, biomaterials, etc. - explantation; transplantation of a non-viable graft, which acts as a scaffold and stimulates the formation of new tissue - allostatic transplantation. In general surgery, there are other types of transplantation that are not used in facial reconstructive surgery.

Best by engraftment ability is considered autoplastic sky method. Its success is based on the fact that the fabric, separated from organism, never straightaway does not die and the well-known time keeps alive. Transferred to new soil, she not only remains alive, but also survives. However, the application of the method in the well-known degrees limited because reserves plastic material at autoplasty small. In addition, an additional patient injury when taking tissue from a donor site.

Very successful transplants of tissues taken from people who are genetically identical. For example, from an identical twin.

allogeneic plastic - it is the plasticity of tissues and organs from one organism to another the same kind. Unfortunately, despite many ways decrease in antigenic foreign tissue activity organ transplant attempts often end in failure

due to protein incompatibility of tissues. The best material is tissue taken from a corpse, and not from living organisms, since the antigenic properties of cadaveric tissues are less pronounced.

Xenogenic tissue transplantation - plastic tissue taken from an animal for humans, is not currently successful. It is used mainly to stimulate the regenerative abilities of the tissues surrounding the defect.

Currently, explantation has become widespread - the implantation of inanimate materials - plastics, metal, carbon composites, biomaterials, etc. Explants (implants from a biological point of view) can take root and get used.

Skin plastic. Skin is used as tissue for transplantation. subcutaneous tissue, fascia, ligaments, mucous membrane, muscle, cartilage, bone, nerve, vessel, combined tissue.

Free skin grafting is one of the promising methods of plastic surgery. Three types of skin grafting are currently known, depending on the thickness of the flap.

The first type - a thin skin flap (K. Thiersch) up to 0.5 mm thick - represents the epidermal layer and the upper layer of the skin itself - the growth layer. There are few elastic fibers. These flaps undergo wrinkling due to scarring of the underlying tissue.

The second type is a split skin flap with a thickness of 0.5 to 0.7 mm<рис. 195). В расщепленный лоскут включается еще и солидная часть эластических волокон сетчатого слоя кожи. Этот лоскут стали широко применять, когда появились специальные дер-матомы различной конструкции (Педжета, Колокольцева, Драже, НИИЭХАлИ с ручным приводом и т.д.) (рис. 196).

The third type is a thick flap with a thickness of over 0.8 mm, it includes all layers of the skin. Healing (epithelialization) of the donor site when taking a thin and split skin flap occurs due to the growth of the epithelium of skin derivatives (sebaceous and sweat glands, hair follicles). After borrowing a full-thickness skin flap, the donor site requires plastic replacement.

The use of various types of flap has its indications. During skin grafting, different viability of the flaps was noted depending on their thickness. Thus, a thin flap survives best and a thick one is worse.

In each case, surgeons must consider which method is more beneficial to apply. To close wounds of the face, a split skin flap is most often used; in the oral cavity - a thin flap.

Skin grafting can be primary, secondary, and in the form of skin grafting on granulations.

Primary skin grafting provides for free skin grafting on a fresh wound after an acute injury or on a postoperative wound accompanied by a large loss of skin. Primary free skin grafting is often an integral part of combined reconstructive surgeries. She is can be combined with all types of skin plastics.

In secondary free skin grafting, the skin is transplanted onto the wound surface formed after the excision of various granulating wounds. The granulations must be completely removed. Free skin grafting is more often used in the treatment of burns. As a rule, the skin is transplanted into the face and neck in the form of a single flap according to the shape and size of the defect.

Cartilage transplantation Cartilage is widely used in the practice of reconstructive surgery for the purposes of contouring or supporting plastics. Cartilage is a good plastic material, as it is easily processed with a knife and has special biological properties (it is an avascular tissue that feeds by diffusion of tissue juices) Metabolic processes in cartilage are inactive, and it sufficiently resistant to infection

Cartilage plasty is used to eliminate saddle nose deformity (Fig. 197, a, b, c, d), a defect in the lower edge of the orbit, for facial contouring, etc.

As a rule, costal cartilage is used, preferably from the 7th rib, as it is more accessible for taking and has a size of up to 8-12 cm. Cadaveric cartilage transplantation gives a good effect. It has a low antigenic property and therefore is rarely absorbed Frozen and lyophilized (vacuum dried) cartilage is absorbed somewhat more often

Bone grafting of the jaws, especially the lower one, presents certain difficulties. This is due to the following features: 1) the lower jaw is the most mobile bone, it has finely differentiated functions; it is involved in speaking, breathing, chewing, facial expressions; translational, 3) the jaws are carriers of teeth that are associated with them and with the external environment. Therefore, the development of pathological processes in their area aggravates the postoperative course

Most often, bone grafting of the lower jaw is performed. Depending on the timing of the procedure, primary and secondary bone grafting is distinguished.

By using primary bone grafting replace the defect immediately after injury or removal of a benign tumor of the lower jaw

Secondary bone grafting carried out after a certain period after the formation of a defect, usually not earlier than 6-8 months

In bone grafting, it is necessary to analyze the defect and clearly plan its elimination. After analyzing the defect, it is necessary to decide where the graft will be taken from and what size, what method of fixation will be used

The most important point in the success of bone grafting is the reliability of fixing the graft to the ends of the fragments of one's own jaw. To do this, various “locks” are cut out at the ends of the fragments and in the graft. The graft can also be laid overlay, spread out, etc. Fragments are fixed, as a rule,

as well as isolating it from the oral cavity. The autograft should be taken according to the shape and size of the defect. It is considered to be the most appropriate two places for taking the graft: the rib (V, VI, VII) and the iliac crest. The rib is taken either in full thickness, or a split (lightweight) seedling. If you need a bend in the chin area, then it is better to take the iliac crest.

There are several methods of lower jaw autoplasty - according to Kabakov, Pavlov, Nikandrov, Vernadsky, etc.

After engraftment of the graft, biological restructuring and regenerative processes take place in it. The degree of the latter depends on the function of the graft. 15 days after transplantation, bone destruction begins, reaching its apogee by the end of the 2nd month, then regenerative processes begin to predominate. The bone graft is compacted and thickened.

Autotransplantation of bone has the following disadvantages: 1) it is not always possible to obtain a massive graft; 2) it is difficult to model a transplant of the desired shape; 3) additional trauma is applied to the patient.

Alloplasty of the lower jaw was developed in the most detail by N. A. Plotnikov. He proposed two options for alloplasty: one-stage resection and osteoplasty and secondary bone grafting. As a material, lyophilized grafts are used - the lower jaw or femur, taken from a corpse, frozen to -70 ° C and dried in vacuum at a temperature of -20 ° C. Cold significantly removes antigenic

transplant properties. Bone in ampoules can be stored at room temperature for a long time.

Cadaverous bone preserved with 0.5% formalin solution is also successfully used. Various methods of cadaveric bone preservation make it possible to use orthotopic grafts, i.e. parts of the bone that are identical in anatomical structure to the missing ones. Orthotopic grafts taken from the temporomandibular joint are also used, which allow not only to restore the lower jaw, but also the joint at the same time. Thus, it is possible to achieve an aesthetic and functional effect with end defects of the lower jaw (N. A. Plotnikov and A. A. Nikitin).

In recent years, many surgeons began to refuse alloplasty of the lower jaw with lyophilized bone due to the development of complications (graft resorption without replacement of the newly formed bone, inflammation, false joint formation). This has led to more frequent requests for autoplasty or explantation.

Free grafting of fascia is used as an integral part of the operation for paralysis of mimic muscles (myoplasty, combined myoplasty and fascioplasty, with dynamic and static suspension methods). In these cases, an autofragment of the anterior fascia of the thigh is more often used. Canned fascia can be used for contour plastics in case of facial hemiarthrosis.

Free transplantation of the mucous membrane is used to replace defects and deformities of the eyelids and oral cavity. The mucous membrane is borrowed from the cheek or lower lip.

Free transplantation of adipose tissue is used very rarely, since after transplantation this tissue is significantly reduced in size and often cicatricial processes develop.

Free nerve transplantation has been successfully used for paralysis of mimic muscles (A. I. Nerobeev).

Free transplantation of combined grafts. Combined grafts are called grafts consisting of heterogeneous tissues transplanted in a single block. An example of such a transplant is the plasty of a defect in the nose with a part of the auricle.

In recent years, methods of transplantation of combined grafts (including skin, subcutaneous tissue, muscles, and, if necessary, bone tissue) using microvascular anastomoses have been introduced into reconstructive surgery (A. I. Nerobeev, McKeep). For contour plastics, fascial-fat and skin-fat flaps are used. Complex musculoskeletal and skin-fat grafts using microvascular surgery are used even in jaw plastic surgery.

In various parts of the face and jaws, defects and deformities,

very different in origin, but similar in form, are eliminated in ways based on fundamental os"- new plasty: local tissues, pedicled flaps, Filatov stem and free tissue grafting.