Gingival Graft: Autograft vs. Allograft?

Question:

Tonya asks:

My 12 year old daughter was referred to a periodontist prior to getting braces. A gingival graft was suggested: taking her own tissue from the roof of her mouth to sites #22 and 27 (bottom front). Is Alloderm a good alternative? We want to make best decision: trauma of autograft vs effectiveness of allograft?



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Expert Advice and Comments
drdazar's picture

Gingival Graft: Autograft vs. Allograft?

Answered By: Dr. David E. Azar - New York , NY

Hi Tonya,
Alloderm is an alternative, but studies have shown that donor tissue from the palate has a somewhat better long term durability, and develops a thicker graft. I have seen decent results with alloderm, but my preference is a palatal graft. There are 2 types of palatal harvests, a "free gingival graft" or a "connective tissue graft". Free gingival grafts can be more uncomfortable, while connective tissue grafts do not have too much discomfort. But either one can be well controlled with medication and the possible use of a post operative stent.

Hope this helps.


David E. Azar, DDS, FICOI, MgIDE
New York, NY
http://www.davidazardds.com/

ekusek's picture

I do both, my preference is

Answered By: Dr. Edward Kusek - Sioux Falls , SD

I do both, but my preference is to autograft. The success is more predictable than the allograft. But if there is alot of tissue needed then you must do the allograft, as it is difficult to gain the necessary tissue from the patient's own mouth. There are proten modifiers than will effect the allograft to make it more succesful (Emdogain). If there are muscle pulls, these areas should be taken care of first before grafting. My preference is to have ortho completed first before treating with grafts.
Good luck
Dr Ed Kusek


Dr. Edward Kusek

cgrobins's picture

Gingival Graft: Autograft vs. Allograft?

Answered By: Dr. Cheryl Goren Robins - Millburn , NJ

I too prefer autografts to allografts because I feel that I get better results with the autografts. Sometimes the autograft is not an option, however, and then I will use allografts. They are safe and in the right hands, can be used quite successfully.

As for the timing of the graft, I usually ask the orthodontist which direction that the tooth will be moving. If the tooth or teeth in question will be moved away from the existing bone, then the graft should be done prior to orthodontic therapy as the recession has a high likelihood of increasing. If the tooth or teeth in question will be moved into the existing bone, then you may want to start the orthodontic therapy and just monitor the area. If the situation starts to worsen, the grafting can be done at that time. There are many times when the tooth can be moved into the bone and the area improves without the need for the graft.


Dr. Cheryl Goren Robins
Suburban Periodontics and Implants

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