I am a 30 year old male. I don't smoke and except for having Cerebral Palsy, I'm in good health. Approximately a year and a half ago, I had a gum graft. The procedure went fine, but part of the graft was loose. My periodontist thought the frenum was pulling too much so he did a frenectomy. He was happy with the result and almost all of my roots were covered. A month or so ago, to my horror, I saw that all the gum tissue where I had my graft was gone. I called my periodontist and he wants to do another graft. When I went in to have him look at the area, I asked him what caused this. He told me that as far as he was concerned, I did everything he told me to do as far as the aftercare went and that he didn't know why the gum graft failed. I know you can't examine me obviously, but do you have any thoughts? Thanks!
As you clearly understand, it is very difficult for me to guess what went wrong.
I would need to know, where exactly in your mouth the graft was placed (I guess it was the upper front area since you tell me that the frenum was pulling. This can, however, be the case also in other areas). I also would need to know what kind of graft was placed and by which technique. To me it is, moreover, unclear how the healing went. You tell me that the graft was placed a year and a half ago, then a frenectomy was done (when was this?), and the result was good. But now, suddenly, the graft is gone. Did you have check-ups during this time? Did you go to the hygienist during this time period?
Pictures would be valuable (preferentially before and after the procedure, and now).
Often gum retraction occurs in areas where there is very little bone under the gum to begin with. In such areas the long-term result of grafting is not as good as it is in areas where there is enough bone adjacent to the retraction area. The result also depends on many other variables such as the position and alignment of the teeth, the shape of the inter-dental papillae in the treatment area and, in the frontal area, the possible habit of breathing through the mouth (this dries the teeth and gum tissue and reduces the capacity of the tissues to resist plaque).
If the periodontist told you that you did everything as instructed and that the failure was not due to faulty after care then, in my mind, the reason must be in the choice of technique or in the execution of the procedure (in my opinion, the frenum pull should have been treated before or in conjunction with the graft procedure).
I suggest that you accept the new procedure only if the periodontist can explain to you (and to himself) what went wrong, and if he changes the procedure so that these reasons are eliminated.
Sometimes and in some situations the grafted gum just does not stay in place and disappears after a period of time (see above). This happens even if the procedure is done meticulously and with great skill. In such cases there is, in my opinion, no use of trying to do the graft again.