Severe Recession on the Lower Front Teeth, Treated with a Tunnel Connective Tissue Graft
Deep recession on the lower front teeth with thin tissue, no attached gum, and a canine sitting forward of the arch. A tunnel connective tissue graft covered the roots and thickened the tissue. Photographed one month after surgery.
What the Patient Noticed
The gum had pulled well down the roots of the lower front teeth. The roots were sensitive, the teeth looked long, and the tissue that remained was thin and loose, with no firm band of attached gum to protect it. One canine also sat forward of the arch, which puts more stretch on the gum in front of it.
Why This Case Was Difficult
Several things made complete coverage harder than usual: the depth of the recession, the absence of keratinized (attached) gum, the thinness of the tissue, the forward position of the canine, and a shallow vestibule, meaning there was little loose tissue to advance over the roots without tension.
What Was Done
A tunnel connective tissue graft. Instead of a long incision, small openings are made at the gumline and a pouch is created beneath the gum across the teeth. A strip of the patient’s own connective tissue, taken from beneath the surface of the palate, is slid into the pouch against the roots. The gum is then moved up over the graft and held with fine sutures. The patient’s own tissue was used rather than a donor material because this case called for the most predictable option available.
The Result
At one month the roots are covered, the gumline is even, and the tissue is visibly thicker. The graft continues to mature for several months; the color and contour settle further over that time. How gum grafting works explains the technique and the recovery week by week.