Soft Tissue Grafting: Treatment for Gum Recession

Why Is Gum Grafting Needed?

Gum recession occurs when the gum tissue pulls back from the tooth, exposing the root surface. The most common causes include:

• Tooth position – Roots that sit outside the protective bone are more vulnerable
• Gum disease (periodontitis) – Bacterial infection that destroys supporting tissues
• Aggressive brushing – Hard bristles or scrubbing technique that wears away tissue
• Insufficient protective tissue – Less than 2 mm of keratinized gum tissue leaves your teeth unprotected

Dr. Yant will recommend gum grafting when your protective gum tissue is deficient (less than 2 mm), when you're planning orthodontic treatment that could cause recession, when implants lack adequate attached tissue, or when recession prevents proper cleaning or causes cosmetic concerns.

For a comprehensive understanding of gum recession, its causes, and how to know if you need treatment, read our full article: Understanding Gum Recession.

Treatment Options

When gum recession requires surgical treatment, soft tissue grafting is the gold standard. There are three main types of gum grafting surgery. Dr. Yant will recommend the one that best fits your specific situation; every recession site is unique.

Choosing the Graft Material

Regardless of the surgical technique, you and Dr. Yant will discuss which type of tissue to use:

Managing palatal discomfort: If your own tissue is used, Dr. Yant will provide a protective palatal stent (a custom-fitted appliance for the roof of your mouth) to wear continuously for the first 3 days, then during meals for comfort. Additionally, a long-acting local anesthetic called Exparel can be placed at the palatal site during surgery, providing up to 72 hours of numbness, which covers the most uncomfortable phase of healing.

Option 1: Free Gingival Graft (FGG)

Best for: Areas with little to no protective tissue and a strong muscle pull. The goal is to build a thick band of attached, protective tissue.

How it works: A piece of tissue (both the surface layer and the underlying connective tissue) is taken from the roof of your mouth and placed directly onto the treatment site, where it is sutured in place. During healing, the top layer of the graft may turn white and peel off. This is completely normal and expected. The deeper layers are what generate the new protective tissue.

What it looks like after: The healed graft will be a visible, thick, pink band of tissue that looks and feels different from the surrounding gum. It won't be a perfect cosmetic match, but that's okay. The purpose of this graft is protection, not appearance.

Staged approach: If root coverage is also desired but the muscle pull or missing tissue makes coverage impossible as a first step, the FGG can be done first to build a stable tissue foundation, followed by a separate root coverage procedure 3 or more months later.

Option 2: Connective Tissue Graft (CTG)

Best for: Areas where the goal is both to build protective tissue AND cover exposed root surfaces.

How it works: Using a minimally invasive technique (either a tunneling approach or a technique called VISTA), Dr. Yant carefully lifts the existing gum tissue away from the root and bone to create a pocket. Connective tissue from the roof of your mouth (or donor tissue) is then placed inside this pocket over the exposed root. The overlying gum is repositioned to cover everything.

What it looks like after: This is the big cosmetic advantage of the CTG. Because the graft is placed underneath your existing tissue rather than on top of it, the final result is virtually indistinguishable from your original gum tissue in color, texture, and contour. Most patients (and even dentists) cannot tell the area was ever treated.

Option 3: Pedicle and Pinhole Techniques

These techniques reposition your existing gum tissue to cover the exposed root without using graft tissue from the palate. They can be appropriate when you have enough local tissue volume and the primary goal is root coverage. However, outcomes are generally less predictable than with a connective tissue graft, because there is no additional tissue bulk added to stabilize the result.

What to Expect: Results and Recovery

Goal 1: Building Protective Tissue

When your own tissue is used, building thick, protective keratinized tissue is essentially guaranteed, with a success rate of approximately 98%. The small number of failures are almost entirely caused by things that happen during the recovery period, not by the graft itself:

• Smoking or vaping within the first 2 weeks: Any form of nicotine (cigarettes, vaping, chewing tobacco) constricts blood vessels and will destroy the graft tissue. This is the single most common cause of graft failure.
• Pulling on your lip to look at the site: It's tempting, but this disrupts the blood supply that's keeping the graft alive.
• Brushing the treated area too soon: No brushing at the graft site for the first 2 weeks. Dr. Yant will prescribe a chlorhexidine rinse to keep the area clean instead.
• Biting into food with treated teeth: Cut food into small pieces and chew on the opposite side.
• Contact sports or trauma: Avoid any risk of facial impact for at least 2 weeks.

Other factors that can reduce the amount of tissue generated (without necessarily causing complete failure) include continued nicotine use after the first two weeks, uncontrolled diabetes (HbA1c above 8%), bleeding disorders, immunocompromised states, and a history of cocaine use (which permanently damages small blood vessels).

The Most Important Thing to Know

Once the new protective tissue has been established, it is permanent. With proper brushing and regular dental care, this tissue will last for the rest of your life. This permanence is one of the most compelling reasons to choose your own tissue over donor material.

Goal 2: Root Coverage

Covering exposed root surfaces is a separate goal from building protective tissue, and the results depend on a different set of factors. Full root coverage is not always possible, and Dr. Yant will discuss what is realistic for your specific situation before treatment begins.

The four main factors that determine how much root coverage is achievable:

If root coverage is your primary goal, this should be discussed openly at your consultation so that Dr. Yant can assess the anatomy of your specific recession and give you a realistic picture of what is achievable.

Your Recovery Timeline

Questions to Ask at Your Consultation

1. Which type of surgery do you recommend for my situation, and why?
2. Do you recommend my own tissue or donor tissue? What are the trade-offs for my specific case?
3. Is root coverage realistic for my recession, and if so, how much coverage can I expect?
4. Is there a muscle pull or anatomy issue that might require a staged approach?
5. What should I expect for recovery, and how long before I can return to normal activities?
6. Will I need to stop any medications or supplements before surgery?

Sources

This guide is based on peer-reviewed research published in leading dental and medical journals, the same sources used in periodontal residency training programs.

• Araujo, M. G., & Lindhe, J. (2018). Peri-implant health. Journal of Clinical Periodontology, 45(Suppl. 20), S230–S236.
• Brännström, M. (1963). A hydrodynamic mechanism in the transmission of pain-producing stimuli through the dentin. In Sensory Mechanisms in Dentine (pp. 73–79). Pergamon Press.
• Cairo, F., et al. (2020). Coronally advanced flap and composite restoration. Journal of Clinical Periodontology, 47(3), 362–371.
• Chambrone, L., et al. (2018). Root coverage procedures for treating recession-type defects. Cochrane Database of Systematic Reviews, (10), CD007161.
• Chambrone, L., & Tatakis, D. N. (2015). Periodontal soft tissue root coverage procedures: a systematic review. Journal of Periodontology, 86(Suppl. 2), S8–S51.
• Herrera, D., et al. (2018). Acute periodontal lesions. Periodontology 2000, 78(1), 68–80.
• Jepsen, S., et al. (2018). Periodontal manifestations of systemic diseases. Journal of Periodontology, 89(Suppl. 1), S237–S248.
• Lieblich, S. E., & Danesi, H. (2022). Liposomal bupivacaine use in periodontal surgery. Oral and Maxillofacial Surgery Clinics, 34(1), 115–124.
• Pini-Prato, G. P., et al. (2018). Long-term evaluation (20 years) of subepithelial connective tissue graft plus coronally advanced flap. Journal of Clinical Periodontology, 45(7), 864–874.
• Sullivan, H. C., & Atkins, J. H. (1968). Free autogenous gingival grafts. Periodontics, 6(4), 152–160.
• Zadeh, H. H. (2011). Minimally invasive treatment by vestibular incision subperiosteal tunnel access. International Journal of Periodontics and Restorative Dentistry, 31(6), 653–660.
• Zuhr, O., Bäumer, D., & Hürzeler, M. (2014). The addition of soft tissue replacement grafts in plastic periodontal and implant surgery. Journal of Clinical Periodontology, 41(Suppl. 15), S123–S142.