Periodontists please help: Gingival Graft Procedure Questions

Hello to all who read this,

This is my first post on this group, and I want to thank those of you
that can help me out in advance :-)

I am 22 years old and a non-smoker, and have questions on a procedure
that my dentist has told me I need. I apparently need a graft to treat
teeth # 20 through #28. I know that a picture can only tell you so
much, but hopefully I can get an idea of what I should do about my
recession, in other words what would you do if you were my periodontist
and what should I ask my periodontist before having the surgery... Here
is a picture of my teeth. <p><a
href="http://members.aol.com/mp1984/dental";>
http://members.aol.com/mp1984/dental</a></p>

I have consulted with three periodontists and this is what each one has
said:

Periodontist # 1 - grade II - mucogingival involvement for teeth #'s
20, 21, 22, 23, 24, 25, 26, 27, 28. No attached keratinized tissue.
High frenum attachment. Probing depths were 2-3 mm. Bone levels
generally within normal limits. Correction by means of subepithelial
connective tissue graft. (He mentioned using alloderm; is that what
subepithelial connective tissue graft means?)

Periodontist #2 - Does not want to use alloderm like Periodontist #1
and wants to do only teeth 23, 24, 25, 26. and worry about the rest at
a later time... Wants to use my own tissue for these.

Periodontist #3 - This periodontist contact was via E-mail with the
attached picture above... He says he does not like to use alloderm
because he does not like the long term results (being that I am 22). He
mentioned that the bone on the front surface of these teeth is very
thin and has also receeded and that this is a permanent change.
(Doesn't this contradict Periodontist #1 that says bone levels normal?)
He also mentions that it is important to get rather large amounts of
thicker connective tissue in order to have tissue that will hold up
without further problems.

Now concerns of mine are:

Does the delicate mucosa need to be brought up over the grafted tissue
to allow it to heal?

Alloderm vs. my own tissue?

Should I have a free gingival graft procedure done on top of the
existing tissue and then later moving it up and covering more of the
roots? Possible complications of this?

How often do patients have this procedure done on 8 teeth?

Possible causes of this? I had braces from 96'-99' but my gums were
fine after they were removed... other causes? Will it happen again
after the surgery?

What can be done to help get ATTACHMENT of the tissue to the root
surface, (I have heard of "biological material" used as part of the
surgery) since I would like this to be a long lasting change that will
function normally.

Do I need to ask about bone grafting/splinting? What is this?

I really appreciate any information you can give me as to how
complicated of a procedure I need, what I should ask, etc. What I
thought was a simple surgery now has become a whole research project
for me, is it safe to say I have at least 3 problems to fix? 1) Gum
recession, 2) no tough, thicker, non-movable gingival tissue, 3) soft
mucosal tissue has quickly receeded and possible thinning bones?

Hope the picture helps, and again thank you very much in advance.

Michael

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