Gum (gingival) recession is often times caused external forces (such as: orthodontics, grinding, clenching, muscle attachments) on thin biotype (thin gingiva and thin underlying bone). Oftentimes, to improve biology, option of gingival graft is presented. The goal is to improve horizontal and vertical thickness of attached gum tissue and thus will stabilize recession. These procedures are called free gingival graft.
>> Speaker 1: This is Dr. Ko. I’d like to take the next few minutes to talk about two slides. This is our two slide series. This patient came to me because we were looking at worsening recession. As you can probably tell from this picture that there is quite a bit of root exposure and then a lot of times along with root exposure, they tend to be an easier accumulation of plaque around the gum, and sometimes we’ll result into some gum disease, sometimes will result to gingival inflammation or bleeding. What we’re trying to set out to improve for her is to actually increase the thickness of gum tissue. There are two types of gum tissue that we’re looking at here in this picture. The lining is actually quite nicely demarcated right here by my cursor, and right above it is what we called non-attached gingival. Basically this tissue moves around, we call these mucosa, so the tissue itself does not bound to bone, and when you pull your lip around the tissue moves around right underneath is what we call attached gingival.
>> Speaker 1: So these are the tightly buttoned gum tissue that basically prevents plaque from going underneath. So think of this as a really strong cuff that does the prevention. When the mucosa moves around, this is really the counterforce. So whenever there’s not enough thickness here, the gum tissue really gets pulled up or down, depending on which jaw you’re talking about. But in this case, the tissue is pulling up and the thin tissue now is getting pulled up further away from the enamel, and then the roots are now getting close. So in this particular case, the patient is one, is having trouble keeping it clean. Second is suffering from some kind of sensitivity, especially to cold. So we take the tissue from the palate and transport it to wherever it needs more tissue, and this is really the result. So going back and forth here, I think this is four weeks after we did the procedure.
>> Speaker 1: The recession seems to be better on both teeth. The tissue, the thickness of tissue now really probably went from maybe one or two millimeters to now about seven. So this healthy tissue is going to prevent the tissue from sliding on further. Unfortunately, it does not cover the roots completely, but you do get about a millimeter of rebound effect. So the recession actually appears to be better. Alright, so that’s basically gingival graft in a nutshell, and this particular procedure is called free gingival graft. If you have any questions, please feel free to give us a call at our office, (508) 478-3800, till next time.
Increased thickness of gum tissue in this young person will provide long term stability of the gingiva and prevent future recession. This is 4 weeks post-op.
There are three types of gum grafts: connective-tissue grafts, free gingival grafts, and pedicle grafts. Connective-tissue grafts are most commonly used because the procedure involves taking a flap of healthy tissue from the roof of your mouth then stitching it over the precise area suffering from an exposed root and gum recession. Free gingival grafts involve the same process as connective-tissue grafts except that the tissue is specifically taken from the palate of the mouth. Lastly, pedicle grafts use the tissue next to the affected tooth in need of repair.
Gum Grafting FAQ
Why is a gum graft necessary?
A gum graft protects the underlying bone and increases the thickness of the “attached gingiva”. When this pink tissue is too thin (less than 2mm), it cannot resist the pull of the moving lip, leading to worsening recession. This procedure helps resolve root exposure and tooth sensitivity.
What is the difference between attached and non-attached gums?
The attached gingiva is pink and tightly bound to the bone, acting as a strong “cuff” to block plaque. Non-attached gingiva (mucosa) is dark red and moves freely with your lip. If there is insufficient attached tissue, the moving mucosa pulls the gum line further away from the tooth.
Where does the donor tissue come from?
Tissue is almost always taken from the patient’s own palate, which is called an autograft. Dr. Ko uses this method 99.9% of the time because it is more predictable and carries a lower risk of infection than processed donor tissue. This requires both a donor and a receiving surgical site.
Will the graft completely cover my exposed roots?
Coverage depends on the graft type; a “Connective Tissue Graft” is specifically designed to cover roots for aesthetics or sensitivity. Conversely, a “Free Gingival Graft” is intended to increase tissue thickness and typically only results in about one millimeter of “rebound” root coverage.
What should I expect during recovery?
The donor site on the palate is typically the most uncomfortable part of the process. It takes about one week for the tissue to mature, during which you must maintain a very soft diet. Most patients recover well after the first week, with sutures usually removed around the two-week mark.
Why are grafts important for dental implants?
A thick band of attached gingiva is critical for the long-term survival of dental implants. If the tissue around an implant is thin or non-existent, it is a significant indicator that the implant may fail in the future. Grafts create a healthy, stable seal to prevent these complications.
What are the main types of grafts Dr. Ko performs?
Dr. Ko performs both Free Gingival Grafts to thicken tissue and Connective Tissue Grafts for root coverage. Free Gingival Grafts transplant both the outer and middle layers of palate tissue. Connective Tissue Grafts “sandwich” only the middle layer under existing gums to blend in naturally while repositioning the tissue for better root coverage.
During a gum graft procedure, the patient doesn’t feel a thing as we use a local anesthetic to keep them pain-free. After the operation, the patient may experience some soreness and slight discomfort, which can be effectively treated with a combination of rest, cold compresses, and, if needed, prescription medication. With proper care, the gum graft will protect the previously exposed root and serve as a healthier gum line, restoring your smile and confidence. Please feel free to contact us to learn more about your gum condition or request an appointment online
