Root Coverage - Detailed
When the gum has receded beyond the crown, and the root is showing, it is often desirable to re-cover the root surface. This is primarily done for cosmetics, but also if there is root sensitivity. There may also be a lack of attached (hard) gum tissue (See Gum Recession), and the root coverage surgery is designed to correct that problem at the same time.

If there is adequate attached (hard) gum, re-positioning the gum toward the crown can cover the exposed root, using a coronally positioned flap. (If a coronally positioned flap without adequate attached gum is used to cover the root, there will be only muscle at the gum margin and the recession will quickly begin again.) Incisions are made to release the gum, while leaving it connected at the base to maintain an adequate blood supply. The muscle under this flap is freed with a scalpel so the flap can be advanced over the root without any tension. The flap should lie passively over the root before it is sutured in place. Because the root itself has been exposed to bacteria in the oral cavity, it must be thoroughly smoothed of calculus and cleaned. This may be done with curettes and/or finishing burrs, and may be followed by cleansing with citric acid or EDTA. Following root preparation, the flap is sutured in place. Generally there is little post-operative discomfort, although some swelling is normal.
Root recession with adequate
hard gum to reposition
back over defect
Flap has been raised and
muscle released to allow
repositioning of gum over root

Final healing shows complete
root coverage with
hard gum margin
When there is inadequate hard gum and root coverage is desired, a connective tissue graft is commonly done. This procedure is similar to the coronally positioned flap, except that a graft of connective tissue is sutured over the root before the flap is advanced. The flap covers most or all of the graft, and provides blood supply to it. If a graft were just placed over the root without advancing a flap, there would be no blood from the root surface and the graft would die. The flap that covers the graft is able to provide the needed blood supply.
Recession with no hard gum
Incision to release flap
Flap being reflected
Connective tissue graft
Tissue soft and pliable
   
Graft covering roots
Flap brought over graft
and root surfaces
Final healing with ideal
tissue contour.
(Note veneers placed on the two centrals)

 

 
The two most common sources for the connective tissue graft are the roof of the patient's mouth (palate), and allograft material. Allografts are grafts that are taken from a human donor. Both work well, but the allograft has the advantage of not needing the palatal surgery to harvest the connective tissue. This can be especially helpful when a large graft is anticipated. (See Soft Tissue Allograft.)