Connective Tissue Graft

Periodontist in St. Louis, Missouri

The Procedure

This type of soft tissue grafting procedure is done to cover exposed root structure on teeth. This can decrease sensitivity, improve esthetics, and create a tough barrier of gum tissue which will help to resist further recession. This procedure results in variable root coverage, meaning that 100% root coverage cannot be guaranteed, which may result in incomplete resolution of tooth sensitivity.

Connective tissue grafting will prevent further recession from normal healthy brushing. This results in protecting the bone underneath it. The primary cause of this is thin, inadequate/absent, firm, attached tissue surrounding the tooth/teeth, resulting in the loose lip/mucosal tissue surrounding the tooth. Even with normal proper brushing, this fragile tissue will continue to recede along with the bone that is immediately underneath it. This inadequate loose tissue is also very susceptible for food entrapment, resulting in an infection that can quickly destroy the bone in the area. The procedure is done using local anesthetic, that can be supplemented with nitrous oxide, oral sedation, or iv conscious sedation.

Connective Tissue Graft

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Presurgical Instructions

Please arrive at the office at least 20 minutes prior to your surgical appointment to make any final arrangements prior to the procedure.

Please don’t apply makeup and lipstick around the mouth. If a cleaning is due, it is ideal to have it done within a week prior to the procedure and brush your teeth immediately prior to the appointment is advised.

Take your medications as advised. If taking blood thinners, some aspirins, or fish oil prescriptions, we will contact your Prescribing Doctor for their recommendation on modification. We will inform you of their recommendations before surgery. If you have any questions about your prescriptions, please contact us.

If advised to, begin taking pain reliever about 24 hours in advance (600-800mg Ibuprofen or 1000mg Tylenol, typically for an adult and 200-400mg Ibuprofen for a child; this was discussed in your pre-surgical appointment). The over-the-counter ibuprofen comes in 200mg tablets, and the over-the-counter Extra Strength Tylenol comes in 500mg tablets, so please take the appropriate number as listed above for them to be effective.

If you are having iv sedation, please take the ibuprofen and antibiotic right after the surgery.

No alcohol 24 hours prior to procedure.

Periodontal Post-Surgical Instructions

Wearing Nightguard

If there isn’t any surgical dressing obstructing the use of wearing your nightguard please do so starting day one after your procedure.

Care of The Mouth

• Normal brushing and flossing following the procedure should be followed throughout the mouth except in the area where surgery was performed. It is important to maintain a high level of oral hygiene care after periodontal surgery. This reduces the accumulation of bacteria (plaque), chances of infection, and minimizes unpleasant mouth odor.

• Do not sleep with your hands under cheeks on the side the surgery was done on.

• Do not look at the surgical sites. Keep cheek movements to a minimum.


No heavy aerobics, vigorous dancing, heavy lifting, or physical activity for 1 week.

Oral Hygiene at the Surgical Site

• Don’t do anything that will disturb the surgical sites. Be your own best wound caretaker. Be as gentle as possible for 6 weeks.

• No brushing, flossing or waterpik of the surgical sites for 6 weeks.

• No touching of the surgical sites with fingers, tongue or any other object like cotton swaps, picks, etc.

• Beginning 24 hours after surgery, rinse GENTLY with warm salt-water mixture (1/2 teaspoon of salt into 6-8 oz. of warm water) 3-4 times per day for the first couple of weeks. During the initial 6 weeks please use the prescribed mouth rinse. May use provided rinse to “drool rinse” Turn head side to side and let rinse come out. No gargling, no swooshing & no spitting.

• If a BLUE palatal guard is made for you, please remove the guard, rinse, then place the guard back in. It is only necessary to wear the guard for 1 week. After that, for the following 3 days you can wear it at mealtimes and to bed. After that period of time, please discontinue its use.


It is normal for there to be varying amounts of discomfort for 1-6 days after surgery. How much pain and how long it lasts depends on the extensiveness of surgery done, how long it took, and your unique response to it. Everyone differs in his or her perception of, and response to pain; the pain medication may not eliminate all pain but should make you reasonably comfortable. It is not routine to require narcotics.

• For mild discomfort, alternate 600-800mg of Ibuprofen and 1000mg of Tylenol every 3 hours. For severe discomfort, take 800mg of Ibuprofen and 1000mg of Tylenol at the same time, every 6 hours. If this regiment isn’t managing your pain control, please give us a call.


It is normal to have some oozing for 2-3 days. To prevent excessive bleeding follow these steps:

• If advised, Ceasing/modifying your blood thinner/aspirin/fish oil at the recommended time prior to surgery should have occurred. (If you have any questions concerning this, please call the office).

• Don’t spit, rinse, or use a straw for at least 24 hours after the surgery.

• Avoid strenuous activity for 2-3 days.

• Slow oozing of blood is expected for 2-3 days. It is recommended to place a towel over your pillow and keep your head slightly elevated for the first 3 days.

• If you notice continued heavy bleeding from the roof of the mouth only, apply biting/thumb pressure with a clean, dampened, rolled-up gauze/tea bag/Kleenex directly to the area for 40 minutes.

• If the bleeding is occurring from under the palatal guard, remove it and apply the pressure to the area. When it stops, please place the guard back in. If these attempts are unsuccessful and the bleeding is excessive, please call us.


• Gently apply an ice pack to the side(s) of your face over the surgical area for 10-15 minutes per hour during the first 24-48 hours after surgery.

• Keep your head elevated at night to reduce the swelling. Some Bruising may occur. Minimize the heat of your food for the next 24-48 hours to slightly warm.

• After 48 hours, if still swollen, a moist heated washcloth or heating pad applied to the site will then be effective.

• Swelling typically peaks on the third day and then slowly begins to reduce from there forward. This is also why ibuprofen/ anti-inflammatory is advised to continue to be taken for the first 4-5 days after the surgery.


• For the first 24 hours, restrict your diet to cool soft foods and liquids (ie. milk shakes, ice cream, instant breakfast drinks, junior baby food, Ensure, yogurt, cottage cheese, pudding, jello, applesauce, etc.).

• For the first 7 days, avoid Spicy foods, citrus, alcohol.

• After 24 hours warm foods can be introduced.

• Avoid crunchy foods along with peanuts, popcorn, chips, sticky foods and sucking candies and mints for at least 6 weeks.

• Then for the 3-6 weeks, continue with warm softer foods (ie. Pastas, malts, soups, well cooked chicken, fish, omelets, mashed/baked potatoes, tuna noodle casseroles, meat loaf well cooked vegetables, etc.) and continue to avoid chewing on the surgical side for 6 weeks.

• No tobacco products (cigarettes, chewing tobacco, snuff, etc.) for at least 6 weeks after.

By 6 weeks, unless otherwise advised, you are usually able to eat without any restrictions.

The guard protector

• In some situations, a medical grade superglue may be placed over the harvested tissue site. The material will typically fully dissolve in a week to 10 days.

• If a BLUE thermoplastic palatal guard is fabricated to protect the area where the tissue was harvested, please leave the guard in for 24-48 hours. After this time, it can be removed at your rinsing occasions and placed back in.

• To avoid injury/pain of the harvested area, the guard should be worn at all other times and thought the night for the first week.

• The guard may be cleaned with a brush and COLD water (never hot water, it will melt).

• The guard can be removed after the first week and worn at mealtimes and night if the patient feels it’s necessary for comfort.


Take your medications for blood pressure, heart, anxiety asthma/lung the day of your procedure. If you are having iv conscious sedation, then take them with enough water to get the medication down (less than 3oz.) Bring your inhalers with you. If you are diabetic and having iv sedation, do not take oral diabetic medication or insulin the morning of your procedure. If there are any issues regarding the interruption of your medication, contact your prescribing physician.

Blood thinner medications: (Our office will be consulting your cardiologist. Unless otherwise told, the following recommendations for temporarily discontinuing your blood thinner/s is listed below.)

Dabigatran (Pradaxa)- hold off 48 hours and wait to begin 48 hours after treatment.

Rivaroxaban (Xarelto)- hold off 48 hours prior to the procedure and begin 48hrs after treatment.

Apixaban (Eliquis)-hold off 48 hours prior to the procedure and begin 72 hours after treatment.

Edoxaban (Savaysa, Lixiana)- hold off 48 hours prior to the procedure and begin 48 hours after treatment.

Warfarin (Coumadin, Jantoven)-If instructed, hold off 3 days prior and begin 48 hours after treatment.

*Ticagrelor (Brilinta)- hold off 5 days prior to the procedure and begin 48 hours after treatment.

*Ticlopidine (Ticlid)- hold off 5 days prior to the procedure and begin 48 hours after treatment.

*Clopidogrel (Plavix)- If instructed, hold off 5 days prior to the surgery and begin 48 hours after treatment.

*Prasugrel (Effient)- hold off 5 days prior to the procedure and begin 72 hours after treatment.

*Cilostazol (Pletal)- hold off 3 days prior to the procedure and begin 4 days after treatment.

*Aspirin 325mg or greater- hold off 1 week prior to the procedure and begin 48 hours after treatment.

*Dipyridamole (Aggrenox)-hold off 5 days prior to the procedure and begin 48 hours after treatment.

(*) anti-platelet meds

***Patients with mechanical artificial heart valves cannot stop their anticoagulant medications (blood thinners) without discussion with their cardiologist and the periodontist!!

Supplements are non-prescribed medications. If you are taking any of the supplements listed below, please stop 1 week prior to your surgical procedure.

● Dong Quai (Angelica sinensis)

● Feverfew (Tanacetum parthenium)

● Fish oil

● Garlic

● Ginkgo Biloba

● Ginseng (Panax quinquefolium/Panax ginseng)

● Licorice Root (Giycyrrhiza glabra)

● Red Clover (Trifolium pretense)

● Vitamin E

Commonly prescribed/recommended medications for this procedure (the ones that apply to you are check marked):

__ Ibuprofen (ie. Motrin, Advil): This is usually over the counter. (If can be taken, 600-800mg for adult and 200-400 for a child, every 6-8 hours for at least 4-5 days after the surgery.) This is an over-the-counter medication. It is used to control mild to moderate pain. The medication also has an anti-inflammatory result at surgical sites. It works best when taken before surgery followed by consistent dosing times afterwards. The major side effect of Motrin is an upset stomach. To avoid this issue, take ibuprofen gel caplets with meals, milk, or 2 full glasses of water to lessen this complication. If you are prone to stomach ulcers, take this medication cautiously and discontinue if you have any stomach pain, nausea, or vomiting. Do not take ibuprofen if you have had any allergic type of reactions (itching, swelling, rash, difficulty breathing, etc.). Ibuprofen has been reported to make some people drowsy (1 in 100).

__ Tylenol (Acetaminophen): (Can be taken 325mg-650mg every 4-6 hours) This is an over-the-counter pain reliever that can be taken while breast-feeding. It is contraindicated to those that are allergic to acetaminophen, or those who have a known G-6PD deficiency.

___ Closys®: This is a post-surgical rinse that is initiated 24 hours after surgery. Gently rinse for at least 30 seconds with ½ oz (2 full caps), then spit it out. It should be used 2-3 times a day. This is a non-staining, killing 99.9% germs in the external part of the surgical site. The rinse is used specifically for the surgical site, generally until all of the sutures are removed. Brushing and flossing should occur throughout the rest of the mouth.

__ Peridex (chlorohexidine Gluconate): This is a mouthwash used to kill the bacteria in the surgical area. Take ½ oz. of mouth rinse, swish for a full 30 seconds, or swab the teeth with a Q-tip in the area, 2 times a day, no eating or drinking for 30 minutes afterwards. If instructed, begin this medication 24 hours after the surgery is completed and continue for at least 3 weeks or longer, even if brushing and flossing has been implemented again. Staining of the teeth can occur, which can be polished off.

___ Sinecch ™/Arnica Montana: This medication is used to reduce bruising and swelling that may occur after your surgery. Use as directed on the packaging and you should ideally start the medication 1-24 hours prior to the surgery and finish up 4 days after the surgery. If you are breast feeding, or pregnant, please inform your doctor. Don’t use if you are taking other medications that contain pentazocine (such as Talwin), if you are sensitive to any of the ingredients in Sinecch.

Avoiding tannin containing food products during its use will reduce staining tendencies (ie, red wine, tea, coffee)

Office (314) 842-6151

Dr. Scott Schlueter (636) 492-1756

Dr. Trinity Boszko (314) 221-6832

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