Restoring lost gum
Restoring gum where it has been lost
When the gum recedes, the root is exposed: the tooth looks longer, cold hurts and the root wears down. A graft covers it again with your own tissue.
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Why gums recede
Gum recession has no single cause, and identifying the right one is what makes a graft last. In some patients the reason is mechanical: horizontal, overly vigorous brushing, often with a hard brush, wearing the gum margin down year after year. In others it is anatomical: very thin gum tissue, or a root positioned too far outside the bone, with a bony wall so thin it eventually disappears.
There are also inflammatory causes, such as periodontitis, and functional ones, such as a bite that overloads a particular tooth, or a lip frenum that pulls on the gum margin every time the lip moves. And there is iatrogenic damage: poorly fitting crown margins, or orthodontics that has moved a root outside the bony envelope.
That is why the first appointment does not start by measuring the recession but by looking for its origin. Cover the root without correcting the cause and the gum simply recedes again.
When surgery is needed and when it is not
Not every recession needs surgery. A stable recession that is not advancing, does not hurt and does not bother you aesthetically can simply be monitored. The indication appears when there is documented progression, sensitivity that cannot be controlled, root wear, difficulty cleaning, or a clear aesthetic concern.
Prognosis depends heavily on how much tissue remains between the teeth. When the papillae are intact, root coverage is usually complete and predictable. Once interproximal bone has been lost, coverage will be partial however good the technique, and that is worth saying beforehand rather than afterwards.
There is also a legitimate preventive reason: thickening very thin gum tissue before orthodontics or before fitting a crown, to prevent the recession that would otherwise appear.
Techniques and what to expect from healing
The subepithelial connective tissue graft is the reference technique: a piece of tissue is taken from the palate and placed under the gum of the area being treated, combined with a flap that covers it. It adds thickness and your own colour, and gives the most stable long-term results.
When many teeth need treating at once, or when the palatal donor site is best avoided, dermal matrices and enamel matrix derivatives are alternatives. They do not always match the thickness of your own graft, but they save the second wound.
Healing follows a predictable timetable: sutures come out at around ten to fifteen days, the palate closes over in two to three weeks, and the final colour and volume of the treated area do not settle until two or three months. During the first weeks the operated area should not be brushed: it is managed with mouthwash.
When it needs treating
- Exposed roots that hurt with cold
- A tooth that looks clearly longer than the one beside it
- Recession that advances year after year
- Gum tissue too thin, receding with brushing
- Excess gum covering part of the tooth
- A gummy smile: too much gum shows when you laugh
How we do it
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1
Diagnosing the recession
We look at why it receded: brushing technique, bite, tissue thickness or bone loss. Without that, the graft fails again.
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2
Planning the tissue
We decide where the graft comes from, usually the palate, and which technique best covers that root.
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3
Surgery
Under local anaesthetic with fine sutures. Usually one to one and a half hours, depending how many teeth are involved.
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4
Healing checks
Reviews over the first weeks. The final colour and volume settle at around three months.
Frequently asked questions
Does gum grow back on its own?
No. Lost gum does not regenerate spontaneously: covering the root means adding tissue.
Where does the graft come from?
Usually from your own palate. Tissue matrices are an alternative when many teeth need covering.
Is the palate sore afterwards?
For the first few days the palate is more uncomfortable than the graft site. It is managed with pain relief and soft food.
Will the graft be noticeable?
The aim is that it is not. That is why the technique is chosen to match each patient's tissue thickness and colour.
Can several teeth be treated at once?
Yes. In fact, when recessions are adjacent it is usually better to treat them in a single surgery: healing happens together and the aesthetic result is more even.
How long until I see the final result?
Coverage is visible straight away, but the final colour and thickness settle at two to three months. Judging the result before that point leads to the wrong conclusions.
Can I brush the operated area?
Not during the first weeks. Mechanical brushing displaces the graft exactly while it is attaching. The area is kept clean with a chlorhexidine mouthwash until brushing is allowed again.
If I keep brushing the same way, will it happen again?
If the cause was mechanical, yes. That is why the review includes correcting brushing technique and switching to a soft brush. The graft repairs the damage done; it does not protect against what continues to be done.
Shall we talk?
Tell us what is going on and we will say whether this is your case or not. The first visit is about naming it.