Need for Gum Grafts Before Implant Placement Questionable

Need for Gum Grafts Before Implant Placement Questionable

Q: My dentist told me I have enough bone, but I don’t have enough gum for implants. He wants me to have gum removed from my palate and sewn onto the area that needs the implants. Is this really necessary?

A: Your answer is in my head, but allow me to rant a bit about something that irks me personally about the dental profession. (I promise it’s relevant to my answer; I won’t go off on tangential topics such as: “Why do waiters get on their knees now a days to take your order while resting their order pad on the table? Are we now too lazy to stand as Homo sapiens? When a patient tells me their needs, I don’t plop down and take a knee.)

What bugs me most about practicing dentistry in Florida is the un-ethical practice of doctors badmouthing other doctor’s treatment. According to the ADA rules of practice, this act is in complete violation of the ethical practice of dentistry and aligns with the “do no harm” clause. The doctor’s goal is to address the patient’s chief complaint, verbalize their findings and then refer the patient back to the original doctor. If the patient refuses to return to the original practitioner, care should be taken not to criticize the previous doctor’s work.

Example: I had completed a full mouth implant reconstruction years ago on a patient that invested in her mouth an amount equal to a ninety day luxury cruise on the Mediterranean. A periodontist had a look at her months later and made a whole hoopla that she should have had a mouth full of gum grafts where the implants were placed.

Hogwash I say; hogwash! (Why would one need to wash a hog anyway?)

For years periodontists claimed that all implant sites should have a thick, leathery type of gum called keratinized mucosa, normally found on the palate and at the gum line of perfectly healthy teeth. They felt this would hinder bone loss and failure of the implants. Unfortunately for the patient, an uncomfortable expensive surgery is needed to sew palate gum onto the implant sites.

In the latest edition of the International Journal of Oral Implantology Volume 12(1):13-22, a five-year study showed an actual INCREASE in bone loss around implants that had keratinized mucosa.

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