Results!

Stitches out - results time

Time for those pristine after photos. Remember what this looked like through the healing phase (if you were brave enough to look at those pics). It was puffy, red, sore, weird white bits, general horribleness. And it turned out like this. 

The photo was taken about 1 month post-op.

I still have recession on the front lower teeth, but that's OK. The surgeon told me that I could not expect tooth coverage here because of the lack of bone support.

There was some notching on my front left tooth (right on the picture) from where the stiches were pressing down on the gum tissue while healing and left some sharp edges. The surgeon tells me this will smooth out over time and the gum should also creep down the tooth.

Update: In 2019, it's still holding up well. The notching on my front left tooth has completely smoothed out - this took about 6 months. 

Gum graft diary: Day 8 & review appointment

Time for a check-up

I went back to the surgery today for a checkup and was told that everything looks like it is healing nicely. 

The surgeon tightened up all of the loose stitches for me. Not sure exactly what she did, but it seemed to be a case of adding more of the composite that is gluing my teeth together underneath the stitch so that it holds tight.  

My next appointment is in 2 weeks time.  The normal protocol is for stitches to be left in for 4 weeks after AlloDerm, which is longer than for a gum graft with your own tissue.  However, the periodontist said that the stitches are not really active after 3 weeks, it is mainly a precaution. 

Gum graft diary: Day 7 & exercise

Things look ugly

The contrast between the pink gum and the white donor tissue is even greater today.  As before, my top arch looks much worse than my bottom arch.  On the top arch, the gums are still swollen and cover large parts of my teeth - on the bottom, they have shrunk back down.  Swelling on the outside of my face is much better and there is only a little left. 

Today's theme: Exercise

If you don't love exercise, then the post-op instructions to take it easy will not have bothered you.  

On the other hand, I am sure there are others out there like me who need a daily hit of endorphins, and skipping so may gym sessions is a real struggle.   I did, however, spend a ton of time researching the issue so that I could find an excuse to get back to exercise faster.  Here's what I found:

• Post-op instructions vary in terms of the length of time you need to rest, from around 4-7 days specifically for alloderm - sometimes less for grafts with your own tissue.  My surgeon recommended 7 days off exercise and I will stick to it. Yours may suggest something different - so best to pay attention. In the case of alloderm, I feel you need to be extra-careful because it needs to be (mostly) covered by your own gum tissue if it is going to take. Otherwise it will just degrade, so you need to avoid anything that might put it at risk.
• Longer-term, exercise can help healing. OK, the evidence comes from cuts on people's arms, but the mechanisms are probably similar - through promoting blood flow and spikes in hormones that are beneficial for healing. This doesn't mean you can skip the rest stage, but you can feel better about easing back into an exercise regime once that rest period is over.
• Ease into activity. Low impact options like stationary bikes can be introduced sooner compared to higher impact exercise. With contact sports, you will obviously need to wait longer.  Obviously, do not engage in activity where there is any risk of being hit in the face.

This was the most frustrating part for me, although I know a lot of people will welcome the rest.  What are your thoughts? Let us know in the comments!

Gum graft diary: Day 6 - post-op pictures & mouthwashes

Keeping things clean

The swelling is finally starting to go down. This is now an awkward part where I feel fine and want to go out, but my diet is still restricted and I still have scary-looking stitches in my mouth. 

My top arch looks much, much more terrifying than my bottom arch. I believe this is because the Gengigel I've been using to help speed up healing (more on this below) can sit there longer against the gums due to gravity, whereas it's harder to keep it up against the top arch. 

Let's look at pictures and you can decide for yourself.




*** Warning! Look away now if you don't want to see post-op pictures!! ***







I figured that since my periodontist asked me to send her photos of the loose stitch, we are now at a stage where the graft is a bit more stable and I can take other photos. 

I'm sorry if these are gross, but as I said, a healing graft is not pretty.  Hopefully these will help someone else who is looking in horror at their own graft site.

Bottom arch: The gums are darker pink/red rather than the pale anaemic pink from before. The gum contours are starting to settle back down but are still a bit higher than where they will end up. You can still see a little bit of the white from the AlloDerm around the edges of some of the gums, but most of it seems to be incorporating nicely. The gums are definitely still puffier than usual. Some of the stitches are now looser because the swelling has gone down. 

Bottom arch - day 6

Top arch: This looks much worse to me, even though the recession was actually far less severe on my top teeth! The white parts will hopefully become incorporated into the gums and much as it is tempting to try to remove them I know I must leave them be.  Urgh, but they are extremely gross!  If I hadn't seen this kind of situation before on my previous graft in 2012 I would be panicking that the graft has failed here. From experience, it will start to look better over time. Just be gentle with it! 

Top arch - day 6

So, on to the reason I think my bottom arch looks better than the top:

Today's theme: Mouthwashes

I found that using Gengigel Gel really helped to soothe my mouth whenever it was feeling hot, tight, dry or sore. The gel is easy to use and thick enough that it seems to last in the mouth for a good while. Gengigel has been shown to help speed up healing and reduce inflammation - as I mentioned above, my bottom arch looks so much better than the top, and I think it's because of this (it is much easier to keep the gel against the gums in the bottom arch). 

I also used the Gengigel Mouthrinse to make sure I could get the product into all nooks and crannies. This stuff helps to heal gums!  I would not be without the two Gengigel products. 

Antimicrobial rinses

You should be given some kind of medical mouthwash to use, since you won't be brushing your teeth for a while. According to my surgeon, this is the part that patients find the hardest. 

For my first surgery in 2012 I was given Corsodyl mouthwash. The active ingredient is Chlorhexidine, which is considered the gold standard in antimicrobial rinses. Most normal mouthwashes only kill surface bacteria and don't last in your mouth. Chlorhexidine is different in that it binds to your tooth surfaces so it remains active for longer.

The main drawback is that it stains your teeth!  This can be easily removed with a normal cleaning at your dentist though.  It can also make food taste weird. 

Enter this guy - Curasept which I was given for my second surgery in 2017. Soooo much better!  Definitely ask your surgeon if you can have this instead, or buy it for yourself if they give you Corsodyl.  Seriously, it is so much better.

It has the same active ingredient as Corsodyl, but includes an anti-staining system so that your teeth stay white. 

For both mouthwashes, you shouldn't use toothpaste at the same time because the sodium lauryl sulphate (SLS) can neutralise the active ingredient. 



Other rinses

Aside from the medical rinses, you can use good old salt water (1/2 teaspoon in a cup of warm water). This can help with swelling and is a natural disinfectant.  I find it quite soothing and like to alternate with the Gengigel. 

Don't use regular mouthwashes though - especially not anything with hydrogen peroxide in it (like Peroxyl), as this can interfere with the blood clots and slow healing. 

Gum graft diary: Day 5 & stitches

Sutures, sutures

The swelling is still hanging around but is not any worse. Still painful and sore in places where the stitches have been pulling particularly hard.  Graft is mostly pale pink and white; however, one tooth is particularly painful and the grafted area there is red.  

Even though the AlloDerm graft should ideally be completely covered by your own gum tissue, all the movement caused by the swelling can mean that parts of it get exposed.  You will notice this as white bits that stick out behind the pink gum tissue.  

This is OK - a little bit of exposure (maybe 1mm or so - you may even get away with more). Those exposed white bits can eventually be incorporated into your own gum tissue just like the rest, and you will see them gradually get pink as they become vascularised. Be gentle with them to increase their chances of survival, otherwise they can get knocked off - in which case they definitely won't be incorporated into the gums.  For AlloDerm patients, compliance with post-surgical care (soft diet!) is more important than for those with connective tissue grafts (grafts that used their own mouth tissue).

Today's theme: Stitches

Your stitches will go through a lot in the first few days while they cope with the swelling. The graft will pull against them and look puckered, with horribly uneven edges because the tissue is only held down in the places where the sutures have been placed.  As the swelling goes down, things may look uneven because the stitches aren't straining to hold such big puffy gums any more, and bits of the graft may become exposed. A few of the stitches may become loose as well.  

You will have two layers of stitches:

• Graft sutures: The lower layer of stitches holds the grafting material in place inside the pouch created for it underneath your gums. They will probably also put some glue-like material in there (Emdogain) that helps to stimulate tissue regeneration.
• Surface sutures: The second layer of stitches holds your gums over the graft. For alloderm, this is particularly important as the donor material should not be exposed to air.  

I was impressed with the method my surgeon used. She glued all of my teeth together at the top to create anchors that she could sling the stitches around. The glue is just a little dot of white/clear liquid between each tooth, a bit like composite filling material.  I think it looks really neat, and the stitches are straight and line up with the gaps between my teeth. 

I don't remember my surgeon back in 2012 doing this.  Maybe he did and I didn't notice, but the stitches certainly look nicer this time around. 

My loose stitch!

However, one of the bonds between my teeth popped off so the stitch is hanging loose. My periodontist asked me to send a photo - on this basis she said it was probably fine and I should just leave it.


She left the ends of the stitches quite long as well - apparently to give a bit more room for flexing if needed.  My previous surgeon back in 2012 cut the stitches short, so that seems to be a personal preference.