Gum Graft Failure Symptoms: Signs You Shouldn't Ignore (pictures)

Gum grafting is a highly successful procedure for covering receding gums and strengthening them. In the days and weeks that follow, you can expect gradual improvement in both appearance and gum health.

However, there are a few symptoms to watch for that may signal graft failure. The first few days after the procedure are especially critical, as this is when the graft survives and starts to take hold.

We will discuss in this article the most common causes of graft failure, the symptoms to watch out for, and how to manage them.

The Most Common Causes of Gum Graft Failure:

The first few days following the gum graft are the most critical. During this time, the graft must attach to its recipient site and form new blood vessels to survive.

Therefore, you must be careful not to injure or touch it with your tongue, finger or other objects for the first week. Otherwise, you risk dislodging the graft, which may not attach properly and fail.

When the blood flow inside the graft is not properly established, the tissue may die. You may also hear about necrosis. This can also affect the donor site (often the roof of your mouth). The most common causes are:

1. Technical mistake:

The technique is a major factor in the success of any gingival graft procedure. An inexperienced professional is more likely to make mistakes that can prevent the graft from integrating properly.

2. The graft did not take hold properly:

Once the graft is placed and sutured, it must not shift or change position, as this can disturb the blood clot—an essential part of the healing process.

During the first few days, the graft depends on the underlying recipient site to receive most of the nutrients and moisture it needs. So be careful not to touch or dislodge the graft, especially during the first three days.

3. Smoking and diabetes:

Both smoking and uncontrolled diabetes (high blood sugar) can disrupt blood flow to the graft, decrease the immune response and increase the risk of complications.

Smoking has also been shown to significantly increase the risk of pain and bleeding after surgery.

So, if you have diabetes, make sure your blood sugar level stays within the normal range, and avoid smoking—especially during the first two weeks.

4. You have injured the surgical site:

If you accidentally injure your graft, you can not only rip the dressing off and cause pain, but you might also dislodge the graft and trigger bleeding. This can stop the graft from getting the nutrients it needs, and it may fail to survive.

Symptoms of Gum Graft Failure

1. Failure by Necrosis

Graft necrosis means the tissue did not survive, and it’s one of the most common complications following gum graft surgery.



Symptoms of graft necrosis often include:

• Persistent pain
• A foul smell and taste
• A whitish area that doesn’t improve
• The graft is sloughing off.
• Healing that takes longer than expected

Not all whitish discoloration means something is wrong. It’s totally normal for the graft to appear white or gray during the first week.

This happens because the outer surface of the graft naturally sheds around the third day. Your body then begins replacing this dead, white layer with new, living tissue. As healing continues, the graft should gradually blend in with the natural color of your gums.

What should concern you is if symptoms last too long, such as persistent redness, swelling, pain, or poor healing that seems to take longer than expected. These may be signs that the graft is failing.

It’s always best to contact your dentist if in doubt.

How Is Gum Graft Necrosis Treated?

If graft necrosis occurs, your dentist will clean the area with an antiseptic solution to remove any dead tissue while saving the healthy parts of the graft. Painkillers and antibiotics may be prescribed as needed.

Once the area has completely healed (typically in about 3 months), you can discuss with your dentist the option of a second graft.

2. Gum Graft Infection

Gum graft infection is rare, but it can happen if bacteria enter the surgical site. If not treated early, it can lead to graft failure.

People with weakened immune systems, such as those with diabetes, are at a higher risk of post-operative infection.

Watch for the following symptoms:

• Persistent pain that doesn't improve
• Swelling and redness around the graft site that get worse
• Clear-yellow fluid (pus) leaking from the surgical site

How Is Infection Managed?

The best way to manage infection is to prevent it from happening in the first place.

• Follow your surgeon's post-op instructions carefully, including all scheduled follow-up visits to monitor healing.
• Make sure stitches are removed on time, as they can trap food and plaque, increasing the risk of infection.
• Rinse your mouth gently with warm salt water starting on the second day to help reduce bacteria and support healing.

If an infection does occur, your dentist will:

• Rinse the area with an antiseptic solution
• Remove any dead or infected tissue
• Prescribe antibiotics, if needed

3. You're Not Happy with the Graft Results

This isn’t a true failure, but if the graft didn't achieve the results you and your dentist were hoping for, it can still feel disappointing.

One of the main reasons for having a gum graft is to cover exposed roots and improve the appearance of your smile. This is especially true for the more visible front teeth.

Aside from root coverage, factors like color, contour, and texture of your gums also play a big role.

So, when a graft doesn't fully meet your aesthetic expectations, it may be considered a "partial failure."

How Is Aesthetic Failure Managed?

If the root coverage is incomplete, your dentist may suggest a second grafting procedure, though this isn’t always possible and depends on your specific case.

In cases where the gum line is uneven or there’s a surface irregularity, your dentist can correct it by reshaping the tissue using specialized instruments or a laser. This technique is called gingival recontouring or gingivoplasty.

Takeaway

While gum grafting is generally a highly successful procedure, recognizing the early signs of failure can save your results.
It's always better to catch issues early, when the graft is only partially failing, than to wait until it's too late.
So if something doesn’t feel right, don’t wait. Contact your dentist as soon as possible.