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Medical Forum / General / Dentistry / April 2006Gum growth over exposed bone
Hi, About four months ago, it was necessary for me to have a bone graft in my upper jaw to facilitate implants (due to an injury rather than decay). Unfortunately, the existing gum had to be stretched a little too much, and pulled back to expose the graft once the swelling dissipated (I'd estimate 1.5 x 0.75 cms of exposed bone). As the area was considered too large for the margins of the gum to come together, my oral surgeon drilled some small holes in the graft to facilitate the blood supply and to create 'islands' of gum, the idea being that they'd merge together and cover the graft. Three months later though, there is still very little coverage of the bone, Some gum has indeed grown in and around the drill holes, and around the margins of the graft, but this shows little sign of coming together further. My question is how long should this process take, and realistically how long can the bone remain exposed? The bone graft still seems be in good condition (with a good blood supply) even though it has been exposed for a long time, as my oral hygiene is very good and the rest of my gums are healthy. Assuming the gum will not heal by itself, what are the options to restore this area (forgetting about the implants for the moment)? > Hi, > [quoted text clipped - 18 lines] > the options to restore this area (forgetting about the implants for the > moment)? ________________________________ How many follow-up visits did you have with the surgeon? What did they tell you at each follow-up visit when it became obvious that there was very little coverage of the bone? This sort of situation requires frequent observation and evaluation. - dentaldoc I'm having regular follow-ups (every couple of weeks). My surgeon thought the original gum outgrowths might have been too far apart to merge together so drilled a few additional holes However, whilst they've also filled with gum, there still isn't a great deal of coming together. I'd imagine this isn't an hugely common procedure, but is it an established one? > Hi, > [quoted text clipped - 18 lines] > the options to restore this area (forgetting about the implants for the > moment)? Are you sure you're looking at bone and not a covering membrane placed by the surgeon? Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 It's certainly bone - a covering membrane was not used. A solid chunk of bone was used, so I'm assuming a membrane wasn't necessary to protect gum in-growth into the area. > It's certainly bone - a covering membrane was not used. A solid chunk > of bone was used, so I'm assuming a membrane wasn't necessary to > protect gum in-growth into the area. Bone grafts are usually protected with some kind of membrane--the early ones were non-resorbable, but obviously resorbable membranes are more convenient. Bone grafts are occasionally used in a block, but I hear this more in terms of reconstruction (eg. after jaw resection in cancer surgery) than I do related to implants. it is easier to shape the ridge area using macerated graft materials--either real bone, artificial bone, or a mixture of both. Certainly the membrane is more important if primary closure of the gum cannot be achieved, but even then it seems pretty routine. I'm no oral surgeon. But to my mind if there is exposed bone after 4 months something is amiss. Would Dave care to comment? Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> It's certainly bone - a covering membrane was not used. A solid chunk >> of bone was used, so I'm assuming a membrane wasn't necessary to [quoted text clipped - 14 lines] > >Steve Exposure isnt the end of the world but that portion of the graft may be nonvital. If it isnt closed now at 4 months it will never close. Did your surgeon mention sliding some tissue over to help close it? Simply resuturing will not help. A good periosteal layer closed primarily is the best membrane. Dave > Exposure isnt the end of the world but that portion of the graft may > be nonvital. If it isnt closed now at 4 months it will never close. [quoted text clipped - 4 lines] > > Dave Thanks, Dave! Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >Exposure isnt the end of the world but that portion of the graft may be nonvital. More bone was put in than necessary to allow for resorbtion, so one would assume a certain amount of the graft is expendable. There doesn't actually seem to be any sign of resorbtion yet (after 4 months), which I'm not sure is a good or bad sign. >Did your surgeon mention sliding some tissue over to help close it? It was mentioned early-on, but I got the impression my surgeon was talking more in terms of a free graft from the roof of my mouth (I should mention the graft is at the front of my jaw). Would that make sense? Anyway, thanks all for replies. >>Exposure isnt the end of the world but that portion of the graft may be nonvital. > >More bone was put in than necessary to allow for resorbtion, so one >would assume a certain amount of the graft is expendable. There doesn't >actually seem to be any sign of resorbtion yet (after 4 months), which >I'm not sure is a good or bad sign. Some graft resorption is expected and yes, overfilling is the way to do it. >>Did your surgeon mention sliding some tissue over to help close it? > >It was mentioned early-on, but I got the impression my surgeon was >talking more in terms of a free graft from the roof of my mouth (I >should mention the graft is at the front of my jaw). Would that make >sense? A free graft wouldnt work. A pedicled graft is another story since it never losses its blood supply. >Anyway, thanks all for replies. >But to my mind if there is exposed bone after 4 months something is amiss. Quite so, hence the enquiry ;-) However, x-rays of the graft seem to indicate that it's integrating, and probing the holes indicates the presence of a good blood supply in the graft. That's possibly why my surgeon is not unduly pessimistic, although I feel he's overly optimistic that the gum will eventually heal over. >Certainly the membrane is more important if primary closure of the gum cannot be achieved I think my surgeon was originally confident of closure, but unfortunately the incision pulled apart before the two edges healed, perhaps because there was some localised inflammation that pulled things out of shape. I didn't ask why a membrane wasn't used. |
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