Receding Gum Recession - Gum Grafts

Gum Grafts

There are many ways of doing gum grafts. Dr. Madison has developed the most advanced procedures for performing gum grafts predictably, and pain free. Dr. Madison's gum grafts look and feel natural. Dr. Madison teaches other dentists and periodontists how to perform gingival grafting.

In health, there are two types of gum tissues (gingiva) that surround the tooth. The part that is around the neck of the tooth is firmly attached to the tooth and underlying bone, and is called attached gingiva. The attached gingiva is immovable and tough, and is resistant to normal trauma form eating, tooth brushing etc. Right below the attached gingiva a looser gum tissue called alveolar mucosa. This tissue is loose to allow the movement of the lip and the cheeks, but is not tough enough to withstand the normal trauma form eating and tooth brushing.

gum grafts

Adequate attached (hard) gum to prevent
spontaneous receding gum recession. No gingival grafting needed.

Genetically each one of us has different width and thickness of attached gingiva. Some people are born with thin or insufficient attached gingiva. In these cases the gum slowly continues to recede over time, even though the patient may be very conscientious with their oral health. This is not an infection, as is seen with periodontal disease, but rather simply an anatomic condition. Unfortunately, bone recession is occurring at the same time the gum is receding. This is because the bone, which is just under the gum, will not allow itself to become exposed to the oral cavity and moves down with the gum.

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Insufficient attached gum results in recession starting	Insufficient attached gum without treament results in continued loss of gum and bone



Lack of attached gum with resulting recession		Note gum pulling away when cheek muscle retracted. The bone that previously covered the root has also receded.

A lack of attached gingiva is sometimes associated with a high frenum attachment, which exaggerates the pull on the gum margin. A frenum is a naturally occurring muscle attachment, normally seen between the front teeth (either upper or lower). It is normal to have a frenum, but it should not pull on the gum margin or recession will occur. If pulling is seen, the frenum is surgically released from the gum with a frenectomy. Often a new band of hard gum is also added to re-establish an adequate amount of attached gingiva (see below).


Child with naturally occuring high frenum attachment
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High frenum with lack of attached gum causing muscle pull and tooth separation	After frenum removal, and addition of adequate attached gingiva

With the wear and tear of time, even normal attached gum can be worn away, generally from vigorous brushing. This often happens in people with naturally thin tissues, or when the tissues have been stretched during orthodontics. If there is still adequate attached gum to act as a barrier to the muscle, the treatment for gum recession is to ensure further damage isn't done when brushing. However, if the attached gum is worn to the point where it cannot resist the constant pull of the mucosa, gum recession will continue unless a new hard band of gum is placed. Unchecked, the gum recession can cause tooth loss as the bone recedes with the tissue and tooth support weakens.


Recession associated with a lack of attached gingiva.	After placement of a gum graft, adequate attached gingiva to prevent further bone/tissue loss.
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Recession with no attached gum. Without treatment, the recession will continue. The root is difficult to clean, leading to plaque formation and inflammation.	After placement of new attached gum.

Gingival Grafting

The replacement of missing attached gum is called gingival grafting. The muscle that is pulling down on the edge of the gum is first surgically resected and repositioned away from the gum margin. Then a small piece of attached gingiva is taken from the roof of the mouth, just adjacent to the back teeth, and transplanted to the site in question. The new tissue reattaches and reforms a new layer of attached gum, which should last a lifetime with proper care. The roof of the mouth heals quickly, just like a skinned knee might. With this procedure the root is not covered, and the tissue stays at the same level as before, except with attached gingiva at the margin. Gingival grafting procedures are very easy on the patient, and rarely require more than over-the-counter pain pills post-operatively (ibuprofen).

Routine gum grafts ("free gingival grafts") do not cover up the exposed root surface - if this is desired, a different technique is used (Click here to See Root Coverage procedures).

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