Inform Consent

Informed Consent for Subepithelial Tissue Graft Surgery

Diagnosis: Teeth are surrounded by two types of tissue, gingiva and mucosa. Mucosa is cheek like tissue, and does not adhere to the roots of the teeth or underlying jaw bone very well, as compared to gingiva, which is more fibrous tissue. Gingiva, at the gum line of the tooth/teeth or as the only gum tissue that is adhering to the rootsof the tooth/teeth is much more likely to recede, causing more root of the tooth/teeth to show and causing a loss of the underlying jawbone around the tooth/teeth. Having a good amount of jawbone around the tooth/teeth is essential, as it is the jawbone that holds the tooth/teeth in place. The gum just covers it over.

After a careful oral examination, radiographic evaluation and study of mydental condition the Dentist has advised me that I have an insufficient amount of attached gingiva (firm gum tissue) around my tooth/teeth. I understand with this condition gum recession may occur. In addition, for fillings or crowns with edges under the gum line, it is important to have sufficient width of firm, adhered gingiva to the roots of the tooth/teeth to withstand the irritation they maycause. Gingiva also improves the appearance and protects the roots of the tooth/teeth.

Recommended Treatment: The Dentist has recommended that Subepithelial Tissue Grafting (gum grafting) be preformed in some areas of my mouth. Local anesthetic (commonly called Novocain) will be administered as part of my surgery. Gum grafting involves the excision (removal) of a thin strip of gingiva from thepalate (roof of the mouth) to be transplanted in the donor site, then sutures will be placed on the palate. The existing gum tissue around the teeth to be grafted will be excised back, and the transplanted gingiva from the palate will be sutured in place and existing gum tissue sutured over the graft tissue. The sutures on the palate fall out in about 2-3 days, and the sutures around the graftedtooth/teeth fall off in about 3 to 4 weeks. About 1/3 of the time, generally 3-4 weeks after the graft is done, it is necessary to “refine” the area like a scar revision, usually using a dermatology type carbon dioxide laser.

Expected Benefits: The purpose of Subepithelial Tissue Grafting is to create an amount of attached gum tissue adequate to reduce the likelihood of gum recession. It is alsohoped to cover back up some of the exposed root(s) of the tooth/teeth.
** Do not expect the entire exposed tooth root caused by existing gum recession to be totally recovered with this surgery. That may not happen.

Principal Risks and Complications: A small number of patients (usually around 5%) do not have the graft “take”. The usual causes are excessive shrinking of the graft tissue whilehealing the first couple of weeks, smoking, or the patient knocking the graft loose during the first week. So it might be necessary to do the graft over again after about three months to allow the surgical sites to heal up first. Usually, but not always a second graft will “take”.

Sometimes complications may result from the gingival graft or from anesthetics or drugs. These complications include butare not limited to post-surgical infection, bleeding swelling, pain, facial bruising, transient (on rare occasion permanent) numbness of the jaw, lip, tongue, chin or gum, jaw joint pain or muscle spasm, cracking or bruising of the corners of the mouth, restricted ability to open the mouth for several days or weeks, impact on speech, allergic reactions, accidental swallowing of foreign matter,transient (on rare occasion permanent) tooth looseness, tooth sensitivity to hot, cold, sweet or acidic foods. The exact duration of any complication cannot be determined, and may be irreversible.

Alternatives to Suggested Treatment: Alternatives to Subepithieal Tissue Graft include:
1. No treatment – The likelihood of gum recession and subsequent jawbone loss around the tooth/teeth is...