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What are the different healing stages of a gum graft?

gum graft healing stages
Gum grafting is a procedure performed by a periodontist. 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 recessions and strengthening your gums.
In other cases, a gum graft prepares a site for an implant or a dental appliance such as a bridge.
The healing process takes a few weeks. However, the first few days are crucial because they are the key to successful treatment. Hence the importance of following your dentist's instructions for optimal healing.

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:

The first 24-48 hours:

The first stage of gum graft healing

The first few days after a gum graft are critical. The blood clot that forms immediately after the procedure is important as it allows for better healing. It is a kind of blood mass that stabilizes the wound and promotes the migration of cells into the surgical site. In addition, it is rich in growth factors that allow tissue regeneration.

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

During the first few days, you may notice swelling and discomfort in the treated area. These are natural reactions and even necessary for the initial healing process.
For your comfort, you should follow your dentist's instructions and prescription.

Day 3:

The second stage of gum graft healing

The cells have already started to proliferate and migrate to the surgical site.
Don't worry if you notice that the gum graft has an unpleasant appearance. This is normal as our body must first remove the outer layer of the graft to form a new, well-fitting one.
The graft's aspect will improve as it adheres to its recipient site.

After one week:

The third stage of gum graft healing

A new layer will form over the gum graft, which will be attached and better fit your gums. At this stage, 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, seen from the outside, looks normal after the first week, the maturation process continues until the end of the first mouth.

At the end of the first month:

The fourth stage of gum graft healing

By the end of the first month, the gingival graft will have completed its maturation.
It will gradually take the pale pink color of the roof of your mouth, where the graft was taken.
Shrinkage of the gum graft up to 20% from the initial size is to be expected. But after that, the results should be stable in the years to come.

What to expect after the healing phase?

The gum grafting procedure has a high success rate. The results depend mainly on the depth of the recession: the wider and deeper it is, the more challenging the treatment.

You can expect full root coverage in cases of narrow, shallow recession (1-3 mm).

If the recession is moderate to 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 deep and the gum between the teeth is affected, 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 treatment failures are rare, knowing the symptoms is important to identify them and act quickly.

If you have any doubts, visit your dentist as soon as possible to assess the situation and choose the right treatment for you.

The most common symptoms are pain, persistent redness, and swelling at the surgical site with pus discharge. Pain that worsens or appears suddenly should also concern you.

In other situations, the graft tissue may not properly adapt to the graft site. You may need to have the procedure performed again if this happens.

Certain harmful habits and medical conditions increase the risk for some people, such as diabetes, blood disorders, and smoking. All of these conditions contribute to the failure of the gum graft.

However, these symptoms should not be confused with the postoperative effects of the procedure, including discomfort, swelling, and minor bleeding. These reactions are normal, temporary, and part of the healing process. They gradually subside and usually disappear by the end of the first week.

Instructions for optimal healing

After the procedure, you must follow exactly your dentist's instructions. He or she will tell you what to do and avoid to ensure a quick and optimal recovery.

For the first 24 hours, you should not brush or floss your teeth. Afterward, you can brush your teeth, being careful not to touch the surgical site, as this can dislodge the gum graft.

Your periodontist will likely recommend that you use an antimicrobial mouthwash for the first few weeks and that you must begin the day after the procedure by rinsing your mouth twice a day. This will help prevent infections, plaque buildup, and any other problems related to the graft.

During the first two weeks, you should eat soft, cold, or warm foods and avoid hot and spicy foods to prevent irritating the gingival graft. Nutritious and safe foods during the healing period include eggs, vegetable soup, juice, and cottage cheese.

You should rest for the first two or three days and talk as little as possible. Physical activity increases blood pressure, which impedes healing. Therefore, a break after the procedure is important to give the graft time to recover.

You should also follow the medication prescribed by your dentist to reduce discomfort. You can apply ice to the swollen areas for the first 24 hours. Place it on your cheek for 10 minutes, then take a 10-minute break before starting again.

The pain should gradually decrease throughout the healing phase. However, if it intensifies or recurs, you should consult your dentist to assess the situation.

Here is what not to do after a gum graft:
  • Brush your teeth vigorously
  • Smoke for the first 3 weeks
  • Spit or rinse your mouth aggressively
  • Suck on the wound and drink through a straw
  • Eating hard, hot, and spicy foods
  • Doing strenuous exercise
  • Not following your dentist's prescription

  1. Miller, P.D., Jr. (1987), Root Coverage with the Free Gingival Graft. Journal of Periodontology, 58: 674-681.
  2. Silva, C.O., Ribeiro, É.D.P., Sallum, A.W. and Tatakis, D.N. (2010), Free Gingival Grafts: Graft Shrinkage and Donor-Site Healing in Smokers and Non-Smokers. Journal of Periodontology, 81: 692-701.
  3. Oliver, R.C., Löe, H. and Karring, T. (1968), Microscopic evaluation of the healing and revascularization of free gingival grafts. Journal of Periodontal Research, 3: 84-95.