Gum graft surgery, also known as gingival grafting, is a specialized dental procedure that restores gum tissue receded from the tooth surface. This recession exposes the sensitive tooth root, which can lead to various problems. The procedure involves placing new tissue over the exposed area to cover the root and rebuild the gum line. Its purpose is to stop the progression of gum recession, protect the underlying bone and tooth structure, and restore a healthy appearance.
The Dental Specialists Who Perform Gum Grafts
The professional who performs this precise procedure is a Periodontist, a dentist with advanced training in the supporting structures of the teeth. Following four years of dental school, a Periodontist completes an additional three years of focused residency training in periodontology. This extensive training covers the diagnosis and treatment of gum diseases, as well as complex surgical techniques like gum grafting and bone regeneration.
General dentists manage a patient’s overall oral health, which includes cleanings, fillings, and routine examinations. When a general dentist identifies moderate to severe gum recession, they usually refer the patient to a periodontist for specialized assessment and treatment. This referral pathway ensures the patient receives care from a professional whose expertise lies specifically in managing the soft tissues and bone surrounding the teeth.
Clinical Reasons for Needing a Gum Graft
The most common reason for needing a gum graft is gingival recession, a condition where the gum tissue pulls away from the tooth. When the root surface becomes exposed, patients often experience heightened sensitivity to hot, cold, or sweet stimuli. This sensitivity occurs because the root surface, which is softer than enamel, contains tiny tubules that lead directly to the tooth’s nerve.
Recession also poses a significant threat to the structural integrity of the tooth and the jawbone. The exposed root is particularly vulnerable to decay and physical damage from aggressive brushing or abrasion. Furthermore, if the recession is left untreated, it can lead to the progressive loss of the supporting bone tissue around the tooth.
Gum recession can be triggered by various factors, including genetics, aggressive tooth brushing, smoking, and periodontal disease. Beyond the functional and health concerns, many patients seek a graft for aesthetic reasons, as receded gums can make teeth appear abnormally long, creating an undesirable “toothy” smile. A gum graft addresses these issues by covering the exposed roots and restoring the natural contour of the gumline.
Techniques Used in Gum Grafting
The periodontist selects the grafting technique based on the unique characteristics of the patient’s recession defect and the thickness of their existing gum tissue.
Connective Tissue Graft
The most frequently used method is the Connective Tissue Graft, which is considered the gold standard for covering exposed roots. For this procedure, a small flap is created on the roof of the mouth, and the connective tissue layer underneath is harvested and then placed over the receded area.
Free Gingival Graft
Another option is the Free Gingival Graft, which is often chosen when the patient has naturally thin gums that require increased thickness for resilience. This technique involves taking a small piece of tissue directly from the surface layer of the palate and suturing it onto the site of recession. This method is especially effective for augmenting the band of firm, keratinized tissue around the tooth.
Pedicle Graft and Allograft
The Pedicle Graft is an alternative method that does not require harvesting tissue from the palate, instead using tissue adjacent to the tooth needing repair. A flap of neighboring gum tissue is partially cut, leaving one edge attached to maintain its blood supply, and then stretched laterally or coronally to cover the exposed root. For cases where harvesting tissue from the patient’s palate is not feasible or when large areas need treatment, the specialist may use an allograft, which is medically processed donor tissue from a tissue bank.
Recovery and Post-Procedure Care
Initial recovery from a gum graft typically takes between one to two weeks, with complete healing and maturation of the tissue taking several weeks to months. Managing discomfort is achieved with prescribed pain medication and by applying ice packs to the cheek near the surgical site for the first 24 to 48 hours to minimize swelling. Patients must maintain a diet of soft, cool foods for the first week, such as yogurt, scrambled eggs, and smoothies, while strictly avoiding anything hot, crunchy, or spicy that could disrupt the graft.
Oral hygiene requires significant modification during the initial healing period to ensure the graft successfully integrates with the existing tissue. Patients are instructed not to brush or floss the surgical site until cleared by the periodontist, often relying on a specialized antimicrobial mouthwash to keep the area clean. Strenuous activity should be avoided for at least the first week, as increased blood pressure can lead to excessive bleeding or swelling. Follow-up appointments are scheduled to monitor healing, remove sutures if non-resorbable ones were used, and confirm the long-term success of the procedure.