Short answer: A connective tissue graft is a periodontal surgical procedure in which connective tissue, usually taken from the palate, is placed in the area of recession to cover a root surface exposed by gum recession and to thicken thin gums. It is performed under local anesthesia; stitches are usually removed within 10–14 days, and the tissue matures over a few months. The result depends on the type of recession, smoking and oral care.
A connective tissue graft is a periodontal plastic surgery procedure in which a small piece of connective tissue, usually taken from the patient's own palate, is placed in the area of recession to cover root surfaces exposed by gum recession or to thicken thin gums. Among gum grafting procedures, it is one of the most commonly used methods for root coverage. In this article, we explain what a connective tissue graft is, who it is suitable for, how the procedure is performed, the recovery process and how the results can be maintained in the long term.
What is a connective tissue graft?
A connective tissue graft is a method in which connective tissue taken from beneath the surface tissue of the palate is placed under the gum of the tooth with recession to cover the root surface and thicken the gum. In the medical literature, it is referred to as a "subepithelial connective tissue graft." Because the tissue taken is the patient's own, it is highly compatible with the body.
Gum recession is the pulling back of the gum margin toward the root surface of the tooth. When the root surface is exposed, the teeth look longer, sensitivity to hot and cold may increase, and the risk of cavities and wear on the root surface rises. A connective tissue graft helps address these problems and makes the gums more resilient.
There are other methods used to treat gum recession: flap techniques in which only the gum's own tissue is shifted, the free gingival graft in which the surface tissue of the palate is taken, and in some cases biomaterials that substitute for tissue. Which method is chosen is determined by a periodontal evaluation based on the type of recession and the patient's tissue structure.
Who is it for?
A connective tissue graft can be used for people whose root surface is exposed due to gum recession, who experience sensitivity or aesthetic concerns in this area, or who have a thin gum type with progressing recession. Proper patient selection is decisive for the predictability of the result.
Common situations
- Recession on front teeth visible when smiling that causes aesthetic concern
- Sensitivity to hot and cold due to an exposed root surface
- Progressing recession due to a thin and delicate gum type
- The need to strengthen the gums in areas where they are thin, before or during orthodontic treatment
- Situations where gum thickness around an implant needs to be increased
- Areas at risk of wear or cavities on the root surface
Causes of recession
Before planning the graft, the cause of the recession needs to be identified and, if possible, eliminated. Otherwise, the problem can recur. Common causes are:
- A hard toothbrush or an incorrect, forceful brushing habit
- Untreated gum disease
- Naturally thin gums and thin bone
- Teeth clenching and grinding
- Teeth positioned outside the bone boundaries
- Lip or cheek attachments pulling on the gums
- Smoking
Because healing can be negatively affected in people with active gum inflammation and in smokers, gum treatment is completed before the procedure and quitting smoking is recommended.
How is the procedure performed?
A connective tissue graft is performed under local anesthesia, working on two areas at the same time: the donor site on the palate, where the tissue is taken, and the recipient site, where the gum recession is.
- Preparation: Before the procedure, gum inflammation should have been treated and oral hygiene should be at a good level. The root surface is cleaned and appropriately prepared.
- Preparing the recipient site: A pocket or tunnel where the graft will sit is created in the gum around the tooth with recession. The technique used is chosen according to the width of the recession and the position of the teeth.
- Harvesting the graft: Connective tissue is taken from beneath the surface tissue in the back-side area of the palate. The area created on the palate is closed with stitches.
- Placing the graft: The harvested tissue is placed under the gum so as to cover the exposed root surface and is secured with fine stitches. The gum over it is positioned to cover the graft as much as possible.
The duration of the procedure varies according to the number of teeth treated. For a single area, it can usually be completed in one to two hours. It is possible to treat more than one tooth in the same session; the scope is also limited by the amount of tissue that can be taken from the palate.
Recovery process
After a connective tissue graft, tenderness and mild swelling are expected both on the palate and at the graft site for the first few days; stitches are usually removed within 10–14 days, and full maturation of the tissue takes a few months.
The first two weeks
- On the palate, where the tissue was taken, tenderness is often felt more noticeably than at the graft site. In some cases, a plate that protects the palate may be recommended.
- Using the pain relievers and mouthwashes recommended by the doctor as directed increases comfort.
- The graft site should not be touched, and you should not pull your lip to check it. These movements can cause the graft to shift.
- The treated area is not brushed until the doctor gives permission; the other areas of the mouth are cleaned as usual.
- Soft, lukewarm and non-spicy foods should be preferred, and chewing should be done on the other side.
- Not smoking is important for the graft's blood supply and attachment.
The following weeks and months
After the stitches are removed, cleaning of the area begins with a soft brush recommended by the doctor and a gentle technique. The color of the graft may look different from the surrounding tissue in the first weeks; it blends in over time. Tissue maturation and the final appearance usually take a few months to become clear. Attending check-up appointments regularly during this period is important.
Success and longevity
A connective tissue graft is considered a method that gives predictable results in covering the root surface and thickening the gums in suitable cases; however, the degree of the result and its long-term maintenance depend on the individual and the type of recession.
Factors affecting the result
- Bone and gum level between the teeth: In recession with little tissue loss between the teeth, covering most or all of the root surface is more likely. If the loss in this area is greater, coverage may remain partial.
- Gum thickness and depth of recession
- Smoking: Negatively affects healing and the graft's blood supply.
- Oral hygiene and brushing technique
- Elimination of the cause of the recession
Gums thickened with a connective tissue graft gain a structure that is more resistant to future recession. However, this does not mean the result will stay the same for life under all conditions. Using a soft brush, brushing without pressing, using a night guard if you clench your teeth, and regular check-ups help maintain the result. For your questions about gum treatment, you can also take a look at our frequently asked questions page.
Evaluation for gum recession in Ankara
If you have noticed that your teeth look longer, or you have sensitivity at root level or thinning of the gums, an examination is the first step to learn the cause of the recession and the treatment options. At our polyclinic next to Panora Mall in Çankaya, a gum evaluation is carried out and you are told whether a connective tissue graft or other methods are suitable for you; the treatment fee is provided in writing after planning. You can use our contact page to make an appointment.
Frequently asked questions
How long does the palate take to heal after a connective tissue graft?
Tenderness on the palate is usually most noticeable in the first few days and decreases markedly within one to two weeks. Stitches are usually removed within 10–14 days. In some cases, a plate that protects the palate may be recommended.
Does a connective tissue graft completely cover receded gums?
In recession where the bone and gum level between the teeth is preserved, most or all of the root surface can be covered. In cases with greater tissue loss between the teeth, coverage may remain partial; the doctor explains what to expect after the examination.
When can I brush my teeth after a graft?
The other areas of the mouth can be brushed normally the day after the procedure. The graft site, however, is not brushed until the doctor gives permission; gentle cleaning with a soft brush usually begins after the stitches are removed.
Can a connective tissue graft be done for smokers?
Smoking negatively affects the graft's blood supply and healing and reduces the predictability of the results. For this reason, quitting smoking before the procedure and during the recovery period is recommended.
