Free Gingival Graft: Improving Gum Thickness and Long-Term Stability

Harvesting a graft from the palate

What is a free gingival graft?

A free gum graft (FGG) is a type of periodontal surgery that can help increase the thickness of your gums and prevent or even cover areas of recession. Gum recession is when the gum tissue that covers the roots of your teeth pulls away, exposing more of the tooth.

A free gingival graft is different from other types of gum grafts. In fact, it is called "free" because the graft is not connected to its donor site like the pedicle grafts. Instead, it involves taking a small piece of tissue from the roof of your mouth and attaching it to the area where your gums have receded.

We also use the term "autogenous" to describe this type of procedure. This is because the tissue used is taken from your own body.

When is free gingival graft recommended?

Some of the uses of FGG are:

1. Thickening the gums:

If your gums are thin and fragile, they may be more prone to receding over time. FGG can add more tissue to your gums and make them stronger and more resistant to wear and tear.

Increasing the gums height and thickness by a free gingival graft

2. Covering areas of recession:

If you have lost gum tissue due to gum disease, trauma, or aging, you may have exposed tooth roots that look unsightly and feel uncomfortable. FGG can cover these areas and restore a healthy gum line.

3. To prepare for crown placement or orthodontic treatment:

Prior to undergoing procedures like dental crown placement or orthodontic treatment, it is important to have a stable and healthy gum foundation. Free gingival grafts can be used to enhance the gum tissue around the teeth, providing a solid base for these treatments and preventing recessions later on.

An ill-fitting crown causing gum inflammation and recession

The procedure of free gingival graft:

The procedure of free gingival graft can be divided into three main steps:

1. Preparing the recipient site:

This is the area where your gums have receded and need more tissue. Your dentist or periodontist (a gum specialist) will numb this area with local anesthesia and then clean it thoroughly. They will also make a small incision along the edge of your gum line. Then, they will remove the external gum lining to make room for the graft.

2. Preparing the donor site:

This is the area where the tissue for the graft will be taken from. Usually, this is the roof of your mouth, but sometimes it can be another part of your mouth with healthy gum tissue. Your dentist or periodontist will numb this area with local anesthesia and then cut out a small piece of tissue that matches the size and shape of the recipient site. They will also close the wound with stitches or a dressing.

The palate (donor site) after free gingival graft

3. Attaching the graft:

This is the final step where the graft is placed into the recipient site and secured with stitches.

the recipient site after a free gingival graft

The outcomes of the free gingival graft:

The main purpose of the free gingival graft is to increase the thickness and quality of your gum tissue, which can help prevent or stop further gum recession.

Preventing gum recession from progressing with free gingival graft

But what can you expect after the surgery? How long does it take for the graft to heal? What are the long-term results? Here are some key points to know:

  • Usually, the free gingival graft takes quickly, within a week, after which the sutures can be removed. This means that the graft has successfully attached to the underlying tissue and blood vessels. However, complete healing may take several weeks or months, depending on the size and location of the graft.

  • Following the procedure, it is common for your palate (the donor site) to remain sore and tender longer than the recipient site. The healing process at the donor site may be slower as well. However, by the end of the first week, the inflammation will begin to subside, along with the pain intensity. Over the next few weeks, the roof of your mouth will gradually regain its normal appearance.

  • The tissue taken from the palate helps create a strong and lasting gum thickness. However, this is not always the case for root coverage.
  • The limits and drawbacks of free gingival grafting:

    Despite the many benefits of the free gingival graft, it is not suitable for every situation. Here are some of the limitations and drawbacks of this technique:
  • Free gingival grafting does not provide aesthetic results. The tissue from the roof of your mouth may not match the color and texture of your natural gums, making it look unnatural or patchy. This can be especially noticeable if you have a high smile line or you need grafting on your front teeth.

  • Free gingival grafting requires a second surgical site. This means that you will have two wounds to heal: one on your gums and one on your palate. This can prolong your recovery time and increase your discomfort.

  • The free gingival graft has a higher risk of failure than connective tissue grafting. Connective tissue grafting is another technique that involves taking tissue from under a flap in your palate and placing it inside your tissues. This technique allows the graft to receive a good amount of blood supply, making it more likely to survive and integrate with your existing gums. On the other hand, free gingival grafting is positioned outside the gums, making it more prone to shrinkage, necrosis, or detachment.

  • Free gingival grafting may not be suitable for root coverage. If your goal is to cover your exposed root and restore your gum line, free gingival grafting may not be effective. This technique is mainly used to increase the thickness and width of your gums, but it does not necessarily move them up or down. Connective tissue grafting or pedicle grafting (using tissue from adjacent gums) may be better options for root coverage.