- The tissue is usually taken from your own palate
- Used to cover exposed roots and to thicken thin gums
- Done under local anaesthetic; stitches out after about 2 weeks
A connective tissue graft is a thin strip of tissue taken from beneath the surface layer of the palate and placed under the gum where it has receded. The graft is covered by your own gum and is nourished both by the tissues beneath it and by the gum above it. The aim is to cover an exposed root surface, to thicken thin gum so that the recession stops progressing, or, most often, both.
The causes of recession, and when surgery is not needed, are covered on the gum recession treatment page. This page explains what happens once the decision to graft has been made.
Why is the tissue taken from the palate?
The palate alongside the upper premolars is one of the few places in the mouth with connective tissue of sufficient thickness. The tissue can be harvested in two ways: the surface layer is left in place and a thin strip is taken from underneath it, or a thin strip is removed in one piece and its surface layer is separated outside the mouth. Which is chosen depends on the thickness of your palate. A large blood vessel runs through the deeper part of the palate; the tissue is taken at a safe distance from it.
If the palate is very thin, or many teeth need covering at once, a collagen-based matrix can be used instead of your own tissue. The advantage is that there is no wound in the palate; we tell you from the start that the results may not be as predictable as with your own tissue.
Tunnel technique or coronally advanced flap?
There are two main approaches at the site where the graft is placed. Neither is better than the other in every case; the choice depends on the number of teeth, the thickness of the tissue and the depth of the vestibule, the fold between the inside of the lip and the gum.
| Coronally advanced flap | Tunnel technique | |
|---|---|---|
| How it is done | The gum is cut and lifted, the graft is placed, and the gum is drawn towards the crown and stitched over it | Without cutting the triangles of gum between the teeth, a tunnel is made under the gum from its margin and the graft is drawn through it |
| Incisions | More; sometimes vertical incisions | Fewer; no vertical incisions |
| Suited to | One or a few teeth; cases where the tissue has to be moved further | Several recessions side by side; the front of the mouth, where preserving the tissue between the teeth matters |
| Points to note | Incision lines may be noticeable in the first weeks | Technically demanding; part of the graft may remain exposed |
What happens on the day of surgery?
- Preparation. The gums must be free of inflammation; if needed, a scale and polish is done first. The root surface is cleaned, and any notch in the root is smoothed.
- Anaesthetic. Both the graft site and the palate are numbed with local anaesthetic. You usually feel no pain during the procedure; you will feel pressure and pulling.
- Recipient site. A flap or a tunnel is prepared, depending on the chosen technique.
- Harvesting. The graft is taken from the palate and the palate is stitched; if needed, you are given a thin plate to protect it.
- Placement. The graft is seated against the root, and the gum is positioned over it and secured with fine stitches.
For a single area the whole procedure usually takes 1–2 hours.
What is recovery like?
The wound in the palate
Most patients worry more about the palate than about the graft site. Once the anaesthetic wears off, there is burning and tenderness in the palate for a few days; hot, spicy and hard foods make this period harder. The surface usually closes within 1–2 weeks. If there is light oozing, pressing a clean gauze pad on it for ten minutes is usually enough. For bleeding that will not stop, increasing swelling or a fever, contact us without delay, and if you are no longer in İzmir, see a local dentist straight away as well.
The graft site in the first weeks
- Do not brush the graft site for about two weeks; use the mouthwash we recommend. Brush the rest of your mouth as normal.
- Do not pull your lip back to look at the area; this stretches the gum and can shift the graft.
- Do not chew on that side; in the first days, choose soft, lukewarm foods.
- Smoking directly disrupts the graft's blood supply and makes the result markedly worse.
- Stitches are usually removed after 10–14 days. When you start brushing the area again, use a soft brush and the technique we showed you; keeping the graft in the long term depends on it.
In the first weeks the graft site may look swollen and paler than the gum around it; this is normal. Colour and contour settle over a few months, and we assess the result after that.
When is it postponed or not done?
We do not graft until active gum inflammation has been treated. Poorly controlled diabetes and heavy smoking markedly affect healing and the result, so we discuss these first. If you take blood thinners, be sure to tell us at the examination, but do not stop the medication yourself; if necessary, the procedure is planned together with the doctor who prescribed it.
How much coverage should you expect?
When the bone and gum between the teeth are intact, studies show that a connective tissue graft can cover most of the exposed root; full coverage, however, is not achieved on every tooth. If there is loss between the teeth as well, coverage will be partial. With advanced loss, root coverage is not a realistic goal; in that case the graft is done to thicken the tissue and stop the recession. The position of the tooth within the bone, wear on the root and smoking also affect the result. Thicker gum is more resistant to further recession, even without full coverage.
The same logic applies around implants: if the gum over an implant is very thin and the grey of the metal shows through, a connective tissue graft can be used to thicken the tissue.
What does the cost depend on?
The cost depends on the number of teeth to be grafted, whether the tunnel or the flap technique is chosen, whether a matrix is used instead of tissue from the palate, and whether another procedure is done in the same session. You receive a written, itemised quote after the examination at our clinic in İzmir.
Common questions
Is the wound in the palate very painful?
Once the anaesthetic wears off, there is burning and tenderness for a few days; for most patients it is kept under control with the painkillers we recommend. If you were given a palatal plate, it protects the wound while you eat. Most people are back to their normal diet within a week.
What happens if the graft does not take?
Losing the whole graft is uncommon; more often a small part at the edge turns white and sloughs off. Smoking, brushing the area too early and repeatedly pulling the lip back increase this risk. If the result is less than expected, the tissue is reassessed once it has settled for a few months.
Can ready-made tissue be used instead of my own palate?
Yes, collagen-based matrices can be used, and there is then no wound in the palate. They are an option especially when many teeth are involved or the palate is thin. The amount of coverage and thickening can be more variable than with your own tissue; we discuss this before you decide.
Will the grafted area look a different colour?
Because a connective tissue graft is covered by your own gum, the colour match is generally good. In the first weeks the area may look thick and pale; it blends in with its surroundings over a few months. With free gingival grafts, which are taken together with the surface layer, a difference in colour can remain more noticeable.
How many days after surgery can I go back to work?
Most people with desk jobs return the next day or two days later. We recommend a break from heavy physical exertion and sport for the first few days, and avoiding movements that stretch the lip too much during that time.
Can several teeth be treated in the same session?
Neighbouring teeth, yes. The limit is set by how much tissue can safely be taken from the palate. With many teeth the treatment can be split into two sessions, or a matrix can be used.
Not sure if this is right for you?
Send us a photo. We will tell you honestly what you need — and what you do not.