Connective tissue gum graft

This case demonstrates a tunneling procedure for gingival grafting. The exposed tooth root surfaces will be covered with the graft as well as simultaneously increasing the zone of attached tissue to prevent further periodontal breakdown / gum recession in the future.

The gum recession was caused by traumatic tooth brushing. The signs of this are abrasions on the tooth roots which are the visible notchings. This is typical when one brushes their teeth in a seesaw, side to side motion and or uses a medium to hard toothbrush. To prevent this, a soft toothbrush should always be used with the proper up and down motion. In this case, not only has tooth structure been lost, but also most of the gum tissue leaving cheek tissue around the tooth. This is not a stable situation and if not grafted, continued recession is expected. Both a connective tissue gum graft, and tooth brush technique modification will be part of this patient’s treatment plan. The graft is used to stabilize the area and regenerate lost gum tissue over the root surfaces. The toothbrush modification is also necessary to prevent the original trauma that created this situation originally.

Following anesthesia, a dissecting incision is made between the gum and tooth. The gingiva still remains attached at the tips of the papillae (the gum in-between the teeth). This creates a pocket or tunnel. The harvested graft, usually from the roof of the mouth, is placed inside this tunnel. The graft will receive nourishment from the gingival tunnel walls. If successful, the graft will integrate within the tunnel and attach to the tooth root surfaces. Initially following the graft the area will look thickened but will typically self correct with time. If complete root coverage is not achieved with this procedure additional supplemental procedures can be used to enhance that, such as a semilunar graft.

Post operatively there can be mild to moderate discomfort where the graft is placed. This is usually mitigated with Ibuprofen / Acetaminophen. However, there can be moderate to severe pain in the roof of the mouth where the tissue is harvested from. An acrylic palatal stint can be made to cover this donor site while the tissue is healing. This works like a band-aid on a skinned knee and allows the patient to eat and speak normally while it is place. The pain is also managed well with stronger pain medications such as Hydrocodone. Use of a palatal stint and Ibuprofen is usually sufficient to manage any discomfort resulting from this procedure. The connective tissue harvested from the palate regenerates completely without any scarring.

About Jack Wasserstein, DDS

I am a Periodontist in Valencia CA and I have been in private practice in since 1990. I am blessed to be able to say that my work is also my play. I hope to share my insights, with you, that I have cultivated over the last 20 years.

, ,

22 Responses to Connective tissue gum graft

  1. Jackie H. November 22, 2010 at 3:04 pm #

    How long should one wait to eat solid foods after this type of surgery. How long is the healing process?

  2. Jack Wasserstein, DDS November 22, 2010 at 9:08 pm #

    A soft food diet is recommended for one week is recommended following this procedure. The length of healing depends on whether the donor tissue is harvested from the roof of the mouth or acquired from a tissue bank. When the tissue is harvested from the roof of the mouth healing takes place over 7-10 days, pain can be moderate to severe but can be mitigated with a special retainer for the roof of the mouth and pain medications. When the donor tissue comes from a tissue bank, healing takes place over 2-4 days and discomfort is mild to moderate.

  3. Dolores Pavela June 5, 2011 at 11:30 am #

    What is the standard cost for a connective tissue gum graft using donor tissue?

  4. Jack Wasserstein, DDS June 6, 2011 at 3:42 pm #

    Hi Dolores,

    Unfortunately, I cant say. I think there are standard fees for certain geographic areas. For example the fees in Beverly Hills are much higher than you would pay for the same service in a neighboring city. Insurance contracting could also be a factor. What I would recommend is that you get a second or even third opinion about condition and the fees involved for treatment. Most healthcare professionals will not quote fees over the phone as its important to have a proper diagnosis first. Sorry I couldn’t be more helpful about this.

  5. Gretchen July 19, 2011 at 8:04 pm #

    I had this surgery 6 weeks ago and my mouth still doesn’t feel right. I have a tingling sensation in my lower lip and cheek closest to the area where the gum was grafted.

    The graft is lumpy and my gums are numb where graft was attached.

    Will the numbness and tingling go away? I asked the periodontist that did the surgery and he said to come back in two months!

  6. Jack Wasserstein, DDS July 20, 2011 at 8:09 pm #

    At what tooth sites was the graft performed? Have you followed up with your doctor about this condition? Tingling following any surgery may be a sign of nerve trauma, however it usually resolves with time. Is the tingling getting better or staying the same? If it is getting better then I would expect it to completely resolve. It may be difficult to gauge this on a day to day basis, but compared to the date of surgery to where you are now how is the progress?

  7. Karla July 24, 2011 at 4:00 pm #

    I had this done about a week and a half ago. I was supposed to have the stitches removed after two weeks, but they fell out last night and it looks like the skin that was stitched over is now falling lower and lower. Is it possible to go in and have the skin stitched up higher again to prevent from redoing the entire procedure?

  8. Jack Wasserstein, DDS July 25, 2011 at 11:14 am #

    Hi Karla,

    I would go see your Periodontist and ask them about that. Its hard to answer your question without seeing it. I would typically give it a chance to heal. Sometimes minor touch ups are necessary with these types of procedures.

  9. azhar jawed February 1, 2012 at 10:27 am #

    I want to get gum recession surgery of my five teeth.pleaselet me know about the expenses.please e-mail me

  10. Jack Wasserstein, DDS February 1, 2012 at 10:32 am #

    Dear Azhar,

    Thank you for your post. The standard procedure is for you to have an exam and diagnosis first. There are many treatment options, and ultimately which option you choose will dictate the expenses involved.

  11. Katt March 6, 2012 at 8:12 am #

    i have to have this done, probably the end of this month. However, I have braces on, which i’ve now had for about two and a half years. When i get another tightening on my wire, will that cause any pain to the area they’re grafting? I was super curious and haven’t seen my orthodontist about it yet. Thanks!

  12. Jack Wasserstein, DDS March 15, 2012 at 4:01 pm #

    No you should be fine.

  13. M December 27, 2012 at 12:57 am #

    How often do allografts from donor patients get rejected? Is one better than the other?

  14. Sue Brandt February 23, 2014 at 4:37 am #

    HI, I come from Australia & have c r e s t. I recently felt pain in my right back gum & discovered bone coming out of the inside of my gums. It progressively got worse & very very painful. I have been on strong doses of antibiotics x 2 prescriptions now & have gone to a dental specialist who without any warning just got a pair of snips & sniped of the bone. It was horrific for me & my husband nearly fainted. That was 4 days ago & I am still in a lot of pain & the bone is still growing & going further along my gums & really swollen. I have no teeth there but one is coming up soon if it keeps going. The dental surgeon said it is left over tooth particles but to me it feels like my jaw is growing. My tongue is sore as is my ear as well. I have 3 big hard lumps also in my inside part of my gums lower. Any suggestions would be appreciated as here in Australia not a lot is know about Scleroderma, Cheers Sue

  15. Jack Wasserstein, DDS March 30, 2014 at 10:35 pm #

    It sounds like you had a perforation of your gum tissue, specifically the mucosa – cheek tissue, over a buldge of bone called a tori or exostosis. This is a complication I see from time to time following routine gum surgery. It will heal uneventfully but usually takes 6-8 weeks. During that time it can be painful. The bone forms a scab and new tissue forms underneath. Your Dentist did the right thing if the bony piece was loose. These can heal quicker with surgical intervention where the bone is smoothed down and the tissue is re-sutured closed. In your case I would probably go that route because it sounds like you are having a lot of pain. You might seek a second opinion with a Periodontist or Oral Surgeon.

  16. lulu June 16, 2015 at 10:28 pm #

    4 weeks ago i had gums grafted. Alloderm was used. I have no feeling where the grafts are so i cant tell if i am brushing my teeth or my gums. Is this normal? How long will it take to regain feeling. Is there something I can do or take?

  17. Lisa November 26, 2015 at 9:04 am #

    I had this procedure about 8 weeks ago. The palatel donor site is still slightly numb. It feels funny to eat, and food is not as satisfying. Will I have complete feeling once the area has filled back in? It is healed externally, I just can’t find any info about internal healing of donor areas.

  18. Melody January 30, 2016 at 4:57 pm #

    I had a gum graft done 5 days ago. Yesterday, the plaster protecting the stitches in the roof of my mouth came off and some stitches came off with it. Today, other stitches are loosening and feel like they might come off too. Is that normal or should I contact my doctor? It’s not bleeding.

  19. Jack Wasserstein, DDS June 10, 2016 at 8:04 pm #

    That is normal and nothing to worry about but contact your doctor if you have any concerns.

  20. Jack Wasserstein, DDS June 10, 2016 at 10:29 pm #

    Typically there is no numbness on the roof of the mouth but if there is then the condition will almost always resolve with time.

  21. Jack Wasserstein, DDS June 10, 2016 at 10:33 pm #

    Numbness is not typical following periodontal surgery, though it can happen. Typically when it does it resolves in weeks to months. I would recommend that you and your doctor continue to monitor this situation and if you dont have ongoing improvement then your doctor should make a referral to have your condition evaluated.


  1. Dental Tips for Scleroderma & Why I Love Working W/ Students - November 21, 2012

    […] for a few reasons, but one is I recently had some dental surgery.  Last monday, I underwent a Connective Tissue/Gum Graft.  This is my third.  Yes, you read that correctly.  So for those of you doing dental searches on […]

Leave a Reply