How easily do stitches come out of connective tissue grafts?

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Connective tissue is the material inside the body that provides structure and support, often serving as a bridge that connects two other types of tissue together and keeps them strong.

There are four types of connective tissue: loose connective tissue, dense connective tissue, cartilage and other. Loose connective tissue supports the skin and other membranes, provides fat for insulation and energy storage and sustains the organs of the lymphatic system. Dense connective tissue is made up mainly of strong collagen fibers that support the lower levels of the skin and connect tissue types to each other, such as tendons that connect muscle to bone and ligaments that connect bone to bone. Cartilage serves mainly to cushion the joints and is found in such places as the outer ear, in the nose and larynx and between the ribs and breastbone. The other category of connective tissue includes bone, blood and lymphatic tissues, which help transport nutrients and produce immune cells.

A connective tissue graft is a procedure used to replace missing or receding gum tissue in the mouth and is the most commonly used procedure for treating root exposure. Gums can recede due to gum disease, trauma from excessive tooth brushing, excessive tooth grinding or clenching, tooth position or simply genetics. A periodontist, a dentist who specializes in gum disease, will recommend a graft if there are root exposure-related problems like plaque or decay on the root, hypersensitivity, or for cosmetic reasons if a patient is unhappy with the way his or her gums look. Sometimes a connective tissue graft is recommended to support the teeth if a patient requires other dental work, such as crowns or implants.

In a connective tissue graft, a periodontist will cut out a flap in the roof of the mouth, or palate, and remove some of the connective tissue (that bridges the surface tissue to the bone) from under the flap. The flap is then stitched back down. The tissue that was removed is called subepithelial connective tissue. The periodontist then uses this transplanted tissue to support the gums surrounding an exposed root by stitching it into place. A periodontal dressing, a material similar to modeling clay, will be used to protect the grafted tissue for the first few weeks of healing. The benefit of performing the graft in this way is that although it requires stitches at the roof of the mouth, since the wound is closed during the healing process, the procedure is less painful.

Within one day of the surgery, a white streak can be seen on the surface of the surgical site. The stitches, or sutures, should be intact. By the third day, the graft area should become reddish as new capillaries begin to form, and blood vessels bring additional blood supply and nutrients to the site. At this point, if the graft is rejected by the body, usually because the graft shifted in some way, it will become clear. During the next few days, the graft becomes more and more pink as the connective tissue fibers do their work. After two weeks, the graft should be blended into the surrounding gums and the self-dissolving sutures should be gone. This means that the stitches should be absorbed into the mouth painlessly without necessitating medical intervention to remove them. It should take four to eight weeks for the tissue to heal completely, depending on how much tissue was removed and grafted.

Connective tissue grafts have a very high success rate. However, some risks include excessive bleeding from the donor site at the roof of the mouth, and in the case of graft rejection, the gum recession can become even worse. Smokers have been found to have a lower success rate with connective tissue graft procedures.

Resource by Will

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