Gum growth over exposed bone

Discussion in 'Dental Archive' started by robertphillips1820@yahoo.co.uk, Apr 6, 2006.

  1. Guest

    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)?
     
    , Apr 6, 2006
    #1
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  2. Bill Guest

    wrote:
    ________________________________


    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
     
    Bill, Apr 6, 2006
    #2
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  3. wrote:
    Are you sure you're looking at bone and not a covering membrane placed
    by the surgeon?

    Steve

    --
    Mark & Steven Bornfeld DDS
    http://www.dentaltwins.com
    Brooklyn, NY
    718-258-5001
     
    Mark & Steven Bornfeld, Apr 6, 2006
    #3
  4. Guest

    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?
     
    , Apr 6, 2006
    #4
  5. Guest

    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.
     
    , Apr 6, 2006
    #5
  6. wrote:

    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

    --
    Mark & Steven Bornfeld DDS
    http://www.dentaltwins.com
    Brooklyn, NY
    718-258-5001
     
    Mark & Steven Bornfeld, Apr 6, 2006
    #6
  7. Dave King Guest

    On Thu, 06 Apr 2006 19:39:01 GMT, Mark & Steven Bornfeld
    <> wrote:
    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
     
    Dave King, Apr 6, 2006
    #7
  8. Dave King wrote:
    Thanks, Dave!

    Steve


    --
    Mark & Steven Bornfeld DDS
    http://www.dentaltwins.com
    Brooklyn, NY
    718-258-5001
     
    Mark & Steven Bornfeld, Apr 6, 2006
    #8
  9. Guest

    >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.
    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.
     
    , Apr 6, 2006
    #9
  10. Guest

    >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.
    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.
     
    , Apr 6, 2006
    #10
  11. Dave King Guest

    On 6 Apr 2006 13:55:27 -0700, ""
    <> wrote:
    Some graft resorption is expected and yes, overfilling is the way to
    do it.
    A free graft wouldnt work. A pedicled graft is another story since it
    never losses its blood supply.
     
    Dave King, Apr 7, 2006
    #11
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