The different healing stages of a gum graft (Day by Day Pictures)

gum graft healing stages
Gum grafting is a procedure with a very high success rate. It involves attaching a piece of soft tissue, often taken from the roof of your mouth to the recessed areas around your teeth. It aims to treat periodontal disease by stopping or covering areas of recession and strengthening your gums.

The gum graft usually takes hold quickly and without complications. On the other hand, the roof of the mouth may take longer to heal and cause you some discomfort during the process.

However, keep in mind that the first few days are the most crucial as they are the key to the success of the treatment.

What are the healing stages of a gum graft?

After a gum graft, it is normal to experience some temporary symptoms such as discomfort, swelling, and bleeding. They are part of the natural healing process and should gradually decrease over time.
Before your gums return to their normal appearance, the healing process goes through several stages:

1. The first 24-48 hours: Blood Clotting and Inflammation

The first stage of gum graft healing: Immediately after the procedure

Day 1 (1)

The first few days after a gum graft are the most important. The blood clot that forms around the graft immediately after the procedure is crucial for optimal healing.

It's a kind of blood mass that helps stabilize the graft, stop bleeding, and promote the migration of cells into the surgical site. In addition, it is rich in growth factors, essential for tissue regeneration.

Therefore, you should not destabilize the blood clot or damage it during the first 24 hours by sucking, rinsing, spitting vigorously, or mobilizing the graft with your tongue.

Inflammation is also expected, which peaks on the first day and gradually subsides by the third. You may notice signs like swelling, pain, and redness around the treated area.

What to do:

  • Take the medication as prescribed by your dentist.
  • Take a good rest.
  • Follow a liquid diet.
  • Be gentle with your mouth, especially around the surgical site.
  • For the first 24 hours, apply ice to your cheeks near the surgical area, every hour for 10 minutes, then repeat.
  • In case of bleeding, apply a cotton ball to the surgical site for 20 minutes with light pressure.

What not to do:

  • Don't rinse your mouth or spit vigorously.
  • Don't brush your teeth. You can use a cotton swab to clean your teeth, without touching the graft.
  • Don't drink through a straw.
  • Don't drink or eat hard, hot, or spicy foods.
  • Don't smoke or do strenuous exercise.

2. Day 3: Granulation and New Blood Vessels

The second stage of gum graft healing: From day to to day 3

Day 3 (1)

The cells have already started to proliferate and migrate to the surgical site. Also, the blood clot will gradually turn into granulation tissue. This will be the foundation for new blood vessels, providing the nutrients and growth factors needed for healing.

Don't worry if you notice that the gum graft has a white or unpleasant appearance. This is normal, as your body must first remove the outer layer of the graft to form a new, well-fitting one. The appearance of the graft will gradually improve as it attaches to its recipient site.

What to do:

  • Switch to warm compresses instead of cold ones.
  • Use antiseptic mouthwash as prescribed by your dentist.
  • Use a saltwater rinse (1/2 teaspoon for 1 cup).

What not to do:

  • Do not touch the graft with your toothbrush or tongue yet.
  • Avoid hard and sticky foods, and keep foods liquid.

3. After one week: Graft Attachment

The third stage of gum graft healing: After 8 days

Day 8 (1)

A new layer has formed on the gum graft, which is well attached and adapted to the gum. At this point, the sutures can be safely removed.

Signs of inflammation, including swelling, redness, and pain, should have decreased or disappeared.

You will also be allowed to resume your oral hygiene routine at the surgical site, gently at first, with a soft toothbrush.

If the graft, when viewed from the outside, looks normal after the first week, the maturation process will continue until the end of the first mouth.

What to do:

  • Resume your normal oral hygiene routine, but be gentle at first.
  • You can gradually introduce hot, solid foods.

What not to do:

  • Do not apply too much tension on the graft. Maturation is still in progress.

4. After 4-6 weeks: Maturation

The fourth stage of gum graft healing: After 2 months

Two month later (1)

By the end of the first month, the gum graft will have almost completed its maturation. It will gradually take on the pale pink color of the roof of the mouth, where the graft was harvested.
You can expect the gum graft to shrink up to 20% from its original size. But after that, the results should be stable in the years to come.

The different healing stages of the donor site (roof of the mouth):

While the recipient site heals smoothly and takes hold rapidly within the initial week, that's not the case for the donor site (palate or roof of the mouth). Your palate may be sore and tender and may take longer to recover.

Wound healing on the roof of the mouth depends on many factors, especially the technique used.

For instance, the connective tissue grafting technique, which involves taking only the inner tissue from the palate while keeping the outer skin, is known to heal more quickly and cause less discomfort. This is because the wound edges are brought together with sutures, allowing them to fuse smoothly. We call this healing by primary intention.

Roof of the mouth after connective tissue graft technique

On the other hand, the free gingival grafting technique is a bit more intense because it involves removing the entire skin thickness from your palate (not just the inner tissue). As a result, it can cause discomfort for a few weeks and take longer to recover from. With this method, the wound edges won't be brought together. We call this healing with second intention.

roof of the mouth after free gingival graft technique

Here's what to expect in the healing process of the roof of the mouth:

  • The first week after the procedure will be the toughest. In the initial hours following the procedure, your palate may be sore, red, and swollen, and you may feel pain or a burning sensation as the numbing effect wears off.

  • After that first week, most of the pain and swelling will start to go down. You might still feel some tenderness in the surgical site, but it won't be as intense as before.

  • As you move into the second week, you'll begin to see a new outer skin forming. However, the complete healing process and maturation can take up to 4-6 weeks, depending on the size of the wound and how well your body heals.

How to ensure optimal and smooth recovery of the roof of the mouth?

After the procedure, your dentist or periodontist may have taken a few steps to help with your healing.

They might have stitched up the wound on your palate or covered it with gauze. You might have also been given a plastic "guard" or appliance to wear for the first few days. You'll need to remove it only to brush or rinse your mouth. This guard will help protect the wound, prevent bleeding, and promote a faster and more successful recovery.

Plastic guard after gum graft surgery to protect the palate

Other tips for a smoother recovery of the donor site:

First 1-2 days:

  • Take the pain medications as prescribed by your dentist
  • Apply cold compresses for the first 24 hours to reduce swelling in the following days
  • Take a good rest and avoid strenuous exercises
  • Do not rinse your mouth or drink through a straw for the first 24 hours
  • Stick to a soft diet and avoid solid, hot, or spicy foods
  • Do not smoke, especially during the first week
  • Do not touch the wound with your tongue or fingers

After 2 days:

  • Rinse your mouth with salt water (½ teaspoon of salt in a cup of warm water). Do this after meals and after removing your appliance.
  • Avoid mouthwashes that contain alcohol
  • Continue to take your pain medication as directed

The following days until recovery:

  • Healing will gradually improve. After the second week, the discomfort will subside, and you can resume your oral hygiene and eating habits. However, call your dentist if you notice the following signs:
    • Increasing pain that gets worse and worse
    • Persistent swelling
    • Bleeding is excessive and uncontrollable.
    • Pus leaking from the wound

What to expect after the healing phase?

The gum grafting procedure has a high success rate. There's a good chance you'll be happy with the results.

One of the main reasons for the procedure is to cover areas where the gums have receded. Here, results depend largely on the severity of the recession; the wider and deeper it is, the more challenging it is to completely cover exposed roots.

You can expect full root coverage when the recession is small, narrow, and shallow (between 1 and 3 mm).

If the recession is mild but not too severe (3.5 to 5 mm) without the gum between the teeth being affected, the chances of healing and successful treatment are still high.

But if the recession is too deep and extends to the gum between the teeth, the root coverage after surgery can only be partial, and the chances of stable results in the years to come are lower.

Possible complications of a gingival graft:

Although complications after a gingival graft are rare, it is important to follow the postoperative advice of your dentist to avoid them and reduce postoperative discomfort.

If you experience any of these complications, talk to your dentist to address them quickly. They may include:
  • Excessive bleeding: This can occur at either the donor or recipient site and may require additional intervention to control.

  • Graft failure: The graft may not successfully integrate with the surrounding tissue, which may require additional procedures. The most common cause is a lack of blood supply. Signs that the graft has not survived are a white or gray discoloration and a tendency for the graft to come out of the recipient site.

  • Infection: This can also occur at the donor or recipient site and can be serious if not treated. Symptoms include severe pain, pus leakage, bad breath, and persistent swelling and redness.

  • Persistent pain: Some discomfort and pain are expected during the healing process. But long-lasting or intense pain may indicate an issue such as infection or graft failure.

  • Poor aesthetics: If the gum appearance does not meet your expectations, you may need additional procedures to achieve the desired result.

Patients with certain medical conditions like diabetes, blood disorders, or who smoke run a higher risk of treatment failure.

But remember that the above complications are different from the normal postoperative effects. These are mild and temporary and are part of the healing process. They gradually decrease within the first week after the procedure.

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