Gum Grafting

When to avoid

• Active, untreated gum disease (periodontitis) at the site, until it has been treated and the gums have healed
• Plaque control that remains inadequate despite instruction
• Medical conditions that make elective oral surgery unsafe, such as a recent heart attack or stroke or an uncontrolled bleeding disorder, without medical clearance

Possible risks

• Pain, soreness, and swelling in the first days, often most noticeable at the palate donor site
• Bleeding from the graft or donor site, which can occasionally be heavy
• Bruising near the treated area
• Infection, which is uncommon
• Graft failure, when the graft does not gain a blood supply and separates from the tooth, often seen as a large white patch of tissue coming away
• Incomplete root coverage, or some recession returning over time
• A free gingival graft that heals paler, thicker, or bulkier than the surrounding gum

Who needs extra care

• Smoking is associated with less root coverage and fewer fully covered roots, particularly after connective tissue graft procedures, and tobacco-cessation support is commonly offered as part of planning
• Anticoagulant or antiplatelet medication is reviewed before surgery, and any change is coordinated with the prescriber
• Certain heart conditions, such as a prosthetic heart valve or a history of infective endocarditis, call for antibiotic prophylaxis before procedures that manipulate the gum tissue
• Poorly controlled diabetes is associated with slower healing, so surgery is usually planned alongside efforts to improve glucose control
• A forceful or horizontal scrubbing brushing technique that contributed to the recession is usually corrected before surgery, because it is associated with recession returning after grafting
• A thin palate, or recession on many teeth at once, can limit how much tissue the roof of the mouth can supply, which may favor a donor-tissue substitute or treating the areas in stages

1. At the exam we measure the recession, the thickness of the gum, and the band of firm gum around each affected tooth, and go over your medical history, medications, and tobacco use
2. We look for what caused the recession, such as gum disease or brushing too hard, treat any active gum disease first, and review your brushing technique with you
3. If you choose oral conscious sedation, you take the pill at the time we set and arrange for someone to bring you to the appointment and take you home. For the surgery itself, local anesthetic numbs the area
4. The exposed root surface is cleaned, and a small incision prepares a flap or pocket in the gum next to the recession
5. For a connective tissue graft, a small piece of tissue is taken from beneath the surface of the roof of your mouth, leaving the outer layer in place
6. For a free gingival graft, a thin strip of surface tissue is taken from the palate instead; for a pedicle graft, gum beside the tooth is moved over the root while it stays attached; donor tissue from a tissue bank may be used in place of palate tissue
7. The graft is positioned over the exposed root or thin area and stitched in place, and the gum flap is often moved up to cover it
8. A single graft usually takes about an hour, and treating several teeth takes longer
9. About a week later we see you again to check how the graft is healing, and further visits continue until healing is complete

Enamel covers only the crown of a tooth. The root is covered by a thinner layer of cementum over dentin, which contains tiny channels leading toward the nerve, so once the gum recedes and the root is exposed, hot, cold, and sweet foods can trigger sharp sensitivity, and the softer root surface is more prone to decay.

• A graft rebuilds the soft tissue over the root or thickens thin gum. It is placed against a prepared bed of tissue and held with fine stitches, and over the following days and weeks it takes up a blood supply from the tissue around it and joins with the surrounding gum.
• In a connective tissue graft, tissue from under the surface of the palate is laid over the root and covered by a flap of the person's own gum, which is usually moved up toward the crown of the tooth (a coronally advanced flap). A free gingival graft keeps its surface layer, so it adds a band of firm, keratinized gum (the tougher gum tissue that holds up to brushing and chewing) where the gum is thin or the band is narrow. A pedicle graft stays attached to its original site along one edge, which keeps its blood supply intact while it is moved over the root.
• Donor-tissue substitutes such as acellular dermal matrix act as a scaffold that the person's own cells and blood vessels grow into, so no tissue has to be taken from the palate.

• Healing takes about one to two weeks on average, and longer when several areas are treated
• Bleeding usually stops within 24 to 48 hours, swelling can last three to four days, and some bruising may appear
• Most people return to work or school within one to two days after a gum graft
• Aftercare usually includes soft, cool foods, an antibacterial mouth rinse, and keeping the toothbrush and floss off the graft until the dental office clears normal cleaning there, often at the follow-up visit
• Hard, crunchy, or spicy foods are usually avoided until the graft has healed, and exercise and heavy lifting for at least the first week
• A follow-up visit about a week after surgery checks how the graft is healing
• Contact the dental office promptly if you notice heavy bleeding, pus, or a fever over 101°F (38.3°C)

• Monitoring mild, stable recession with a gentler brushing technique and regular dental checkups
• Desensitizing toothpaste or fluoride varnish to reduce sensitivity of exposed roots
• Tooth-colored bonding resin placed over an exposed root surface (dental bonding)
• Orthodontic treatment for misaligned teeth, which may let the gum margin improve over time
• Gum disease treatment, such as scaling and root planing, where periodontal disease is driving the recession

• About 9 in 10 U.S. adults had gum recession of 1 mm or more on the outer surface of at least one tooth in 2009–2014 national survey data[4]
• Receded gum tissue does not grow back on its own, and Cleveland Clinic describes gum graft surgery as the most predictable and long-lasting treatment for gum recession[2]
• An American Academy of Periodontology workshop consensus found that all the root coverage procedures reviewed significantly reduced recession depth, with connective tissue grafts giving the best root coverage outcomes[7]
• An updated Cochrane systematic review of 48 randomized trials found that acellular dermal matrix may give the outcomes closest to those of a connective tissue graft among donor-tissue substitutes[6]
• In controlled trials followed for 5 to 20 years, connective tissue grafts combined with a coronally advanced flap maintained low remaining recession and high rates of complete root coverage[10]