Do I need a graft to build up the gum before getting a bridge?

I had a upper molar extraction done on March 12, 2010. The same day the dentist installed a temporary bridge to prevent my teeth from shifting. Now, 4 months later, the extraction site has a crater in it still (but is healed) and the dentist is recommending skin graft surgery to fill in the hole so that the bridge won’t have a space between the fake tooth and the gumline. I’m a single mother on a very limited income. It was hard enough to gather the money for the bridge. The skin graft will cost another $1200.00 that I do not have. Should I give the gums more time to heal so that they may “drop down” more or do I need to go ahead with the skin graft? My dentist is saying I shouldn’t wait for he is worried about the temp bridge breaking, even though I’m not chewing on that side at all. I really appreciate your advice on this situation.
– Tonya from Oregon

Tonya,
I can’t give you a definitive answer, not being able to examine you personally, but I have some thoughts that may be helpful.

I’m not sure why this gum tissue needs to be built up. We do that often in the front, but it is for esthetic reasons. You say this is an upper molar. Not knowing anything different, I would guess it’s an upper first molar. Anyway, this tooth may not be that visible, which makes me question the need for the graft. Just knowing what I know, if I were doing it, I’d just build the pontic (the false tooth) bigger so that it rests on your gum where it is. That would accomplish the same thing as building up the gum to meet the pontic. And being in the back of your mouth, it wouldn’t be that noticeable, unless you have a wide smile.

There is a bridge technique called the “ovate pontic” technique, where we intentionally create a crater in the gum tissue and the pontic nestles snugly in that crater. The tissue surface of the pontic is made convex – in the shape of the end of an egg – which is why it is called an ovate pontic. Since the surface is convex, it is very easy to clean, and it also makes it look like the false tooth is growing out of the gum.

Related information:
Read the pros and cons of a dental implant compared to a bridge.