Gum Grafting for Gum Recession: Methods and the Healing Process

Gum recession is the downward migration of the gum tissue covering the tooth root, exposing the root surface. We have previously covered what this condition is and the stages it goes through. In this article we focus on a frequently asked question: can receded gum tissue be brought back, and which methods are used in treatment?

Do Receded Gums Come Back on Their Own?

Gum tissue that has receded is not expected to return to its former position on its own. On the other hand, progression can be halted in most cases, and in suitable cases surgical methods exist for covering the root surface again. Treatment planning therefore pursues two aims together: removing the cause of the recession and, where needed, covering the exposed root surface. The result of a covering procedure carried out without addressing the cause may not be maintained in the long term.

The Cause Is Addressed First

There is usually more than one factor behind gum recession, and these need to be identified before treatment begins:

• Hard brushing and incorrect technique: Horizontal brushing under pressure can mechanically wear the gum margin.
• Gum disease: The inflammatory process affects the supporting tissues. For details, see our articles on periodontitis and gingivitis.
• Tartar build-up: Hardened plaque is a constant source of irritation at the gum margin; regular tartar cleaning is the first step in treatment.
• Alignment and bite problems: The bone and gum covering the root of a tooth positioned outside the arch may be thin.
• Clenching and grinding: Excessive forces can affect the resilience of tissue at the gum margin. Our article on teeth grinding covers this subject.
• Thin gum biotype: Inherited thin, minimally keratinised gum tissue is more prone to recession.
• Lip and cheek attachments: Muscle attachments inserting close to the gum margin can continuously pull the tissue downwards.
• Smoking: A factor that affects tissue blood supply and the healing response.

Approaches That Do Not Require Surgery

Not every recession needs surgical treatment. If recession is limited, has stopped progressing and there is no aesthetic concern, monitoring may be preferred. During this period the following apply:

• Correcting brushing technique: A soft-bristled brush and gentle, circular movements without pressure are recommended.
• Professional cleaning and root surface debridement: The first-step treatment where gum disease is present.
• Managing sensitivity: An exposed root surface is sensitive to hot and cold stimuli; our article on tooth sensitivity may help here.
• Night guard: If a grinding habit is present, a night guard may come into consideration.
• Measurement at regular intervals: The amount of recession is recorded so progression can be monitored.

What Is a Gum Graft?

A gum graft is the placement of tissue taken from another site, or produced ready-made, into the affected area in order to cover an exposed root surface or thicken gum tissue that has become thin. The tissue is most often taken from the inner surface of the palate. The aim is not only appearance; covering the root surface can reduce sensitivity and seeks to improve the resilience of the tissue in that area.

Connective Tissue Graft

Connective tissue taken from beneath the surface layer of the palate is placed under a gum flap raised at the recession site. It is among the methods frequently used where root coverage is required. Because the donor site is closed, healing there generally proceeds more comfortably.

Free Gingival Graft

Tissue taken from the palate together with its surface layer is placed directly at the target site. The primary aim is less root coverage than increasing gum thickness and the width of keratinised tissue.

Pedicle (Sliding) Grafts

Part of the gum tissue in a neighbouring area is slid over the recession site while its blood supply is preserved. It depends on there being sufficient tissue in the adjacent area.

Tissue Substitute Materials

Where taking tissue from the palate is not appropriate, or where wide areas are to be treated, tissue bank derived or manufactured matrix materials may be considered. This avoids creating a second surgical site.

Tunnel Technique

An approach in which the graft is placed into a tunnel created without an incision at the gum margin. It may be preferred in cases with recession on several adjacent teeth.

How Is the Procedure Planned?

Gum inflammation is expected to be under control before a graft is carried out. During planning, the amount of recession and the condition of the gum triangle between the teeth and the supporting bone are assessed. Where the tissue between teeth is preserved, the outcome expected from root coverage is more predictable, whereas if there is also bone loss in the neighbouring area the degree of coverage may be limited. This assessment allows expectations to be discussed realistically before the procedure.

What Should Be Considered During Healing?

Protecting the graft site in the first days directly affects the result. Your dentist's advice varies from person to person, but the following headings usually stand out in this period:

• The surgical site is not brushed for the stated period; cleaning continues with the mouthwash your dentist recommends.
• Soft and lukewarm foods are preferred in the first days, and hard or grainy foods are avoided.
• Disturbing the area with the tongue or fingers is avoided.
• Smoking is among the leading factors that adversely affect tissue healing.
• Appointments given for suture removal and follow-up are kept.
• Where tissue has been taken from the palate, some discomfort at the donor site lasting a few days is usual.

Soft tissue healing is largely complete within the first weeks, while maturation of the tissue and settling of colour match can take a few months.

Gum Recession and Implants

Because advanced gum disease also affects the supporting bone around a tooth, it is among the leading causes of the process leading to tooth loss. When implant treatment comes onto the agenda after tooth loss, gum health becomes decisive once again: the thickness and quality of the soft tissue around an implant are among the factors affecting the long-term result. Grafting to thicken gum tissue may therefore come into consideration before implant planning. For the period afterwards, see our article on implant aftercare.

Not to Be Confused With Gum Aesthetics

Gum recession concerns gum tissue moving back. The opposite picture, in which too much gum shows when smiling, is a separate subject requiring a different approach; see our article on gummy smile.

Summary

Receded gums do not return on their own, but progression can be halted in most cases and grafting methods exist for covering the root surface in suitable cases. The first step in treatment is addressing the cause of the recession. The choice of graft is determined by the amount of recession, the condition of neighbouring tissues and gum thickness, and the expected outcome varies with those same factors.

This article is for general information. The cause of gum recession and the treatment approach that suits you are determined by clinical examination.