Gum Grafting for Receding Gums
When gums recede, part of the tooth root that was previously covered by gum tissue becomes exposed. In some situations the recession can simply be monitored. In others, increasing the amount or thickness of gum tissue may provide meaningful benefits.
This is where gum grafting may be considered.
Gum grafting is not one single procedure, and the goal is not always to completely cover an exposed root. Depending on the individual situation, treatment may be intended to improve root coverage, increase the thickness of the gum tissue, create a more stable band of tissue around a tooth, reduce sensitivity, improve appearance, or prepare an area for other dental treatment.
At MI Dental in Kitchener, the first question is therefore not simply whether gum recession is present.
It is whether the recession requires treatment at all—and, if it does, what treatment objective is realistic.
What Is a Gum Graft?
A gum graft is a periodontal surgical procedure used to add soft tissue to an area where the existing gum tissue is thin, deficient or receded.
The grafted tissue may come from another area of the patient’s mouth—commonly the palate—or, in selected situations, a processed donor or tissue-substitute material may be considered.
The surgical technique depends on the problem being treated.
For some patients, the primary goal is to move or rebuild tissue over an exposed root. For others, the goal is to make the surrounding gum tissue thicker and more resistant to future displacement.
Those are related objectives, but they are not identical.
Root Coverage and Tissue Thickening Are Not the Same Thing
This distinction is important.
Root coverage
A root-coverage procedure attempts to reposition or reconstruct gum tissue over an exposed portion of the tooth root.
This may help:
- reduce the amount of visible root
- improve the appearance of the gumline
- reduce root sensitivity in some patients
- protect a vulnerable root surface
- make the tissue easier to maintain
Tissue augmentation
Sometimes the main problem is not how much root is visible but how thin or limited the gum tissue is around a tooth.
In those cases, grafting may be performed primarily to increase the thickness or width of the tissue rather than to completely cover the exposed root.
A successful graft can therefore provide meaningful clinical benefit even if the gumline does not end up exactly where it was before the recession occurred.
Does Every Area of Gum Recession Need a Graft?
No.
Many areas of recession remain stable for years and may not require surgical treatment.
The decision depends on factors such as:
- whether the recession is progressing
- the amount and thickness of the remaining gum tissue
- root sensitivity
- risk of root decay or wear
- difficulty maintaining the area
- tooth position
- periodontal health
- aesthetic concerns
- planned orthodontic or restorative treatment
If the tissue is healthy, the recession is stable and the patient has no significant symptoms or functional concerns, monitoring may be entirely reasonable.
The presence of an exposed root alone does not automatically mean surgery is necessary.
When Might Gum Grafting Be Recommended?
Grafting may be considered when the clinical benefits of increasing or repositioning the tissue outweigh the disadvantages of surgery.
Common situations include:
Progressive recession
If the gum margin continues to move and increasingly exposes the root, increasing the amount or thickness of tissue may improve stability in an appropriately selected case.
Thin gum tissue
Some people naturally have a thin periodontal tissue phenotype. Thin tissue is not inherently unhealthy, but in certain situations it may be more susceptible to recession.
Root sensitivity
Exposed root surfaces can sometimes become sensitive to cold, brushing or certain foods.
Root coverage may reduce sensitivity for some patients, although complete elimination of sensitivity cannot be guaranteed.
Aesthetic concerns
Recession can make a tooth appear longer or produce an uneven gumline. Root-coverage procedures may improve this appearance where the anatomy allows.
Difficult oral hygiene
In some areas, an extremely shallow or mobile band of gum tissue can make brushing uncomfortable or difficult.
Increasing the amount of stable tissue may improve the patient’s ability to maintain the area.
Orthodontic or restorative considerations
Occasionally, soft-tissue augmentation is considered before or after orthodontic movement or as part of planning around restorative treatment.
The timing depends on the condition of the teeth, their position and the treatment being contemplated.
Can a Gum Graft Completely Cover an Exposed Root?
Sometimes.
But complete root coverage should never be assumed or promised.
One of the most important predictors is the health and support of the tissue and bone between neighbouring teeth.
When the interdental tissues are well preserved and the recession is primarily on the facial surface of the tooth, complete root coverage may be more achievable.
When there has been loss of periodontal attachment or bone between the teeth, complete coverage of the exposed root becomes less predictable.
Other factors can also influence the result, including:
- the depth and width of the recession
- tooth position
- root prominence
- tissue thickness
- the amount of available neighbouring tissue
- previous restorations
- cervical wear or abrasion
- smoking
- plaque control
- healing response
- the surgical technique used
For this reason, the realistic objective should be discussed before treatment.
A procedure can still be worthwhile even when complete root coverage is unlikely.
What Types of Gum Grafts Are Used?
There are several periodontal plastic-surgery techniques. The appropriate method depends on the location and shape of the recession, tissue thickness, neighbouring anatomy and the treatment objective.
Connective tissue graft
A connective tissue graft commonly uses a layer of tissue taken from beneath the surface of the palate.
The graft is positioned beneath or in combination with the gum tissue around the recession defect.
Connective tissue grafting is commonly used when root coverage and increased tissue thickness are desired.
Free gingival graft
A free gingival graft uses tissue taken from the surface of the palate.
Its primary purpose is often to increase the amount of firm, keratinized tissue around a tooth rather than to achieve maximum aesthetic root coverage.
It may be useful in selected areas where very little suitable gum tissue is present.
Coronally advanced flap
If enough suitable tissue exists around the recession, the gum tissue may sometimes be repositioned toward the crown of the tooth.
This may be performed alone in selected circumstances or combined with a connective tissue graft.
Tunnel techniques
With some techniques, a space is carefully created beneath the existing gum tissue and the graft is positioned within that space.
The tissues can then be repositioned to cover or reduce the recession while minimizing some external incisions.
No one technique is automatically best for every recession defect.
Does Gum Tissue Always Have to Come From the Palate?
No.
A patient’s own connective tissue remains an important option because of its biological characteristics and clinical track record.
However, donor-derived or manufactured tissue substitutes may sometimes be considered.
These materials can avoid or reduce the need for a second surgical site on the palate, but they are not necessarily equivalent to the patient’s own tissue in every clinical situation.
Choice of material depends on the treatment objective, anatomy, number of teeth involved and the clinician’s assessment.
What Is the Palate Like After a Gum Graft?
When tissue is harvested from the palate, the donor area also has to heal.
The experience depends partly on the grafting technique and how the tissue is obtained.
Patients may notice tenderness, sensitivity or discomfort from the donor site during early healing. Instructions are usually provided regarding oral hygiene, diet and protection of the area.
The presence of two healing sites—the recipient area and the donor area—is one of the considerations when comparing autogenous grafting with alternative materials.
What Happens During Healing?
The newly positioned tissue needs time to establish a blood supply and integrate with the surrounding tissues.
For that reason, the surgical area should generally be protected during early healing.
Patients may be instructed to:
- avoid brushing or flossing directly over the surgical site temporarily
- use prescribed or recommended rinses when appropriate
- avoid pulling the lip or cheek to repeatedly inspect the graft
- modify diet during initial healing
- avoid smoking
- attend scheduled postoperative assessments
The precise instructions depend on the procedure performed.
The early appearance of the graft can also change considerably during healing. It is therefore not useful to judge the final result during the first several days or weeks.
Can Gum Grafting Reduce Tooth Sensitivity?
It may.
When recession exposes the root surface, the underlying dentin can become sensitive.
Covering some or all of that exposed surface may reduce sensitivity, but sensitivity has several possible causes and the response is not identical for every patient.
A graft should therefore not be presented as a guaranteed cure for sensitive teeth.
Before recommending surgical treatment primarily for sensitivity, other possible causes and simpler management options should also be considered.
What if the Exposed Root Is Worn or Has a Filling?
Recession and cervical tooth wear frequently occur together.
An exposed root may have:
- abrasion
- erosion
- a notch near the gumline
- root decay
- an existing filling
These changes can affect the anatomy available for root coverage.
In some cases, periodontal and restorative treatment need to be coordinated. The ideal position of the gum margin, the condition of the root surface and whether a restoration is required should be considered together rather than treating each issue independently.
Can Gum Recession Return After Grafting?
A graft does not make the tissues immune to future change.
Long-term stability depends on both the surgical result and the conditions that contributed to the recession.
Factors such as traumatic brushing, plaque-related inflammation, smoking, tooth position and ongoing periodontal disease may continue to influence the gumline.
Maintaining the result therefore includes:
- appropriate brushing technique
- effective plaque control
- regular preventive care
- management of periodontal disease where present
- monitoring the treated area over time
The objective is long-term stability rather than assuming that surgery permanently eliminates every risk of recession.
Gum Grafting and Orthodontic Treatment
Orthodontic tooth movement changes the relationship between teeth and their supporting bone and soft tissues.
When a tooth has significant recession, very thin tissue or limited supporting tissue, periodontal assessment may sometimes be appropriate before orthodontic treatment.
In other cases, grafting may be considered after orthodontic movement has been completed.
There is no universal rule that every patient with thin gums needs a graft before orthodontics. The decision depends on the starting anatomy, planned tooth movement and periodontal risk.
Gum Grafting Around Dental Implants
Soft-tissue grafting can also be performed around dental implants, although the objectives and biological considerations differ from treating recession around natural teeth.
Around an implant, grafting may be used to improve tissue thickness, contour or the amount of keratinized tissue.
Because implants and natural teeth attach to surrounding soft tissue differently, treatment planning around an implant should be assessed independently rather than assuming that the same procedure used for a natural tooth will produce the same result.
When Is a Periodontist Involved?
A periodontist is a dentist with advanced specialty training in the gums, supporting bone, periodontal disease and periodontal surgical procedures.
Some recession defects are relatively straightforward, while others involve multiple teeth, significant tissue deficiency, previous periodontal attachment loss or more complex aesthetic and anatomical considerations.
When grafting or advanced root-coverage surgery is being considered, MI Dental may recommend assessment and treatment by a periodontist.
Referral does not mean the condition is necessarily severe. It means the procedure may benefit from the expertise of a clinician whose practice is focused specifically on periodontal treatment and soft-tissue surgery.
Gum Recession Comes Before Gum Grafting
A graft treats the tissue deficiency. It does not automatically explain why the recession developed.
Before considering surgery, it is important to evaluate possible contributing factors such as:
- periodontal disease
- tooth position
- thin gum tissue
- traumatic brushing
- plaque-related inflammation
- orthodontic movement
- frenum or soft-tissue anatomy
- restorative factors
When possible, modifiable causes should be addressed so that the tissues surrounding the graft have a healthier and more stable environment.
For a broader discussion of why gums recede and when recession may simply be monitored, see our guide to gum recession.
Frequently Asked Questions About Gum Grafting
Does a gum graft grow new gums?
A graft adds or repositions soft tissue in an area where additional tissue is needed. The graft becomes incorporated into the surrounding tissues as healing occurs. The objective may be root coverage, increased tissue thickness or both.
Does every exposed root need to be covered?
No. Stable recession without significant symptoms or risk can often be monitored. Treatment depends on the condition of the tooth, supporting tissues, symptoms and likelihood of progression.
Will a gum graft stop recession permanently?
Grafting may improve tissue thickness and stability, but it cannot eliminate every cause of future recession. Long-term maintenance and control of contributing factors remain important.
Can a gum graft completely cover the root?
Complete coverage is possible in some cases but cannot be guaranteed. The amount of achievable coverage depends heavily on the anatomy and periodontal support around the affected tooth.
Can gum grafting reduce sensitivity?
It may reduce sensitivity when an exposed root is the cause, particularly if root coverage is achieved. However, the response varies and other causes of sensitivity should also be considered.
Is tissue always taken from the roof of the mouth?
No. Tissue from the palate is commonly used, but donor-derived or manufactured graft materials may be appropriate in selected situations.
How long does a gum graft last?
A successful result can remain stable for many years, but there is no guaranteed lifetime for a graft. Oral hygiene, periodontal health, tooth position, brushing habits and other factors can affect long-term stability.
Who performs gum graft surgery?
Periodontists have advanced specialty training in periodontal and soft-tissue surgery. Depending on the individual case, MI Dental may recommend referral to a periodontist for assessment and treatment.
Considering Treatment for Gum Recession?
If you have noticed an exposed root, increasing recession or sensitivity near the gumline, the first step is determining why the tissue has receded and whether treatment is actually necessary.
At MI Dental in Kitchener, we can assess the area, discuss whether monitoring or treatment is appropriate, and explain when periodontal referral should be considered.
The goal is not to graft every area of recession.
It is to understand the condition, determine what benefit treatment could realistically provide, and choose an approach that makes clinical sense.
