What Is a Gum Graft? Types, Candidates and What to Expect

A gum graft is a small piece of tissue moved onto a part of the gum line that has pulled away from the tooth. The immediate effect is mechanical: the exposed root gets a layer of tissue over it again. The longer-term point is protective. Once the root is covered, it is less sensitive to cold, less vulnerable to decay at the cementoenamel junction, and less likely to keep receding.

It is one of the most common procedures in periodontics. The American Academy of Periodontology describes gum graft surgery as taking tissue from the palate or another donor source to cover an exposed root, on one tooth or several. The technique varies, but the goal does not.

Why gums recede in the first place

Gum recession is not one disease. It is a final common path for several different problems:

• Periodontal disease. Plaque-driven inflammation destroys the attachment between gum and tooth. The gum line drops as the supporting tissue is lost.
• Aggressive brushing. A hard brush and a scrubbing motion, especially with a stiff bristle, can wear a notch at the gum line over years.
• Thin gum tissue. Some people are born with a thin biotype and little attached gum. The same brushing that leaves another person unaffected can strip their roots.
• Orthodontic movement. Teeth moved outside the bone envelope can end up with less gum coverage.
• Grinding and clenching. Heavy occlusal forces can contribute to recession and to gum grafts failing later.
• Smoking and uncontrolled diabetes. Both impair healing and increase the risk of periodontal disease.

That list matters because a graft is a repair, not a cure. If the cause is still active — untreated periodontitis, a hard brush, a nighttime clench — the new tissue is exposed to the same forces that removed the old tissue.

The three main graft techniques

Periodontists choose a technique based on how much attached gum remains, how deep the root is exposed, how many teeth are involved, and whether the patient can spare palate tissue.

Connective tissue graft (CTG)

This is the workhorse. The surgeon opens a small flap on the palate, removes a strip of tissue from underneath the surface, and stitches it over the root. The surface of the palate stays intact, which makes the donor site more comfortable than a free gingival graft. CTG is usually the first choice for a single exposed root with a good blood supply.

Free gingival graft (FGG)

Here the surgeon takes a piece of the palate’s surface, including the epithelium, and places it directly on the recipient site. FGG is useful when the goal is to increase the band of attached, keratinized gum — often on lower front teeth or around an implant — rather than to cover a deep root. The trade-off is a second wound surface and a patch that looks paler than the surrounding gum for a while.

Pedicle or laterally positioned flap

Instead of taking tissue from the palate, the surgeon releases a flap of gum next to the recession and moves it sideways or upward over the root. There is no donor site, which is appealing, but the technique needs enough healthy neighbouring tissue. It is best for a single narrow defect beside a healthy tooth.

A fourth option is acellular dermal matrix, a processed donor-tissue sheet used instead of palate tissue. It avoids a palate harvest and can cover a large area, but it adds a material fee and is not right for every case.

Who is a candidate

A periodontist is likely to recommend a graft when:

• A root is exposed and causing sensitivity or a visible aesthetic problem.
• The exposed root surface is at risk of caries or has already developed a cavity.
• There is not enough attached gum to keep the margin stable, especially before orthodontics or an implant.
• Recession is progressing despite hygiene changes and periodontal treatment.

A graft is less urgent when recession is shallow, stable, and not causing symptoms, particularly in an older patient with a thin biotype. In that situation, monitoring and removing the cause may be the better plan. This is a judgement a periodontist makes after probing, measuring the width of attached gum and looking at radiographs.

What the surgery involves

Most grafts are done in the office under local anaesthesia. The visit typically runs 45 to 90 minutes for one tooth. The surgeon measures the defect, numbs the area, harvests or prepares the graft, prepares the root surface, positions the tissue and sutures it. A protective dressing or stent may be placed over the palate.

You should expect to arrange a ride if sedation is used, avoid smoking for at least two weeks around surgery, and plan a soft-diet week. The full sequence is covered in gum graft surgery.

How success is measured

Success is not just “the graft stayed on.” Periodontists look at three things:

1. Graft survival — the tissue stays vital and integrates.
2. Root coverage — how much of the exposed root is covered, often reported as a percentage of the defect.
3. Stability — the result holds at one year and beyond, with no new recession.

Cleveland Clinic notes that gum grafting has a good success rate, over 90%, while also making clear that results depend on the case. A graft can partially contract as it heals, so the final gum line is usually judged at eight to twelve weeks, not on the day of surgery.

What a graft does not fix

It does not replace lost bone. If periodontal disease has destroyed the bone around a tooth, a soft tissue graft covers the root but does not rebuild the foundation. That is a separate procedure — see gum graft vs bone graft.

It does not cure gum disease. Active periodontitis needs treatment first, usually scaling and root planing, and then maintenance. Placing a graft on an inflamed site is a recipe for failure.

And it does not guarantee a perfect gum line. Coverage may be partial, the grafted tissue may be a slightly different shade, and a second procedure is sometimes needed for a large defect.

Gum graft, gum grafting or gum reconstruction?

The names overlap, and offices use them differently:

• Gum graft usually means the piece of tissue or the operation itself.
• Gum grafting means the process — the same procedure described as an activity.
• Gingival graft is the clinical adjective form; “gingiva” is the gum.
• Gum reconstruction surgery is a broader phrase that can include a graft, a flap, crown lengthening or several periodontal procedures planned together.

If a quote says “gum reconstruction,” ask which procedures are included. It may be a graft plus a bone graft, or a graft plus soft tissue contouring — and that changes the fee. The cost guide breaks the components apart.

The cost question

A single gum graft generally falls between $550 and $1,600 in the US, with connective tissue grafts at the upper end. The range is wide because the procedure is not one product. The gum graft cost guide breaks down what each technique costs and what the fee includes. If you are ready to find a surgeon, the periodontist directory lists practices by state and city.

The takeaway

A gum graft is a targeted repair for a root that has lost its covering. It works best when the cause of the recession is under control, the technique matches the defect, and the patient understands that the result is measured in months, not days. It is not cosmetic dentistry with a medical label, and it is not a substitute for treating gum disease.