Gum grafting refers to several dental surgical procedures used to repair areas where normal gum tissue is missing due to disease, trauma, tooth movement, or attrition. (loss due to the wear and tear of use as we age)

Skin grafts have been used for many decades to enhance the healing of burns or other skin injuries. The common dental graft is a type of skin graft called an “autogenous” graft. This means the donor material is taken from “self”, ie. from one area of the body to another. Such grafts have been used in the mouth since the 1960’s with success rates of nearly 100%. A “tissue paper thin” donor graft of surface tissue is removed from the palate (roof of the mouth) and meticulously sutured into place in the area where gum tissue is lacking. When this heals, stronger gum tissue results, which stops the progressive loss of gums in the affected area. Dr. Loshin, having done over 1000 gum grafts without a single failure, is very experienced with this procedure. The results last well over time. Dr. Loshin has never found the need to repeat a graft in the same area, even after several years or decades.

The surgery takes about an hour and is completely free of procedural pain or discomfort. Gum tissue gets numb easily. Often this is a less disconcerting operation than a typical filling or crown. There is no drilling! As healing proceeds over the following week, there is some minor discomfort and some food recommendations.

Normal gums	Recession defect with loss of attached gums

How do we determine when a gum graft is necessary?

There are specific criteria (measurements) that we use to determine the appropriateness of gum grafting. Although gums usually change slowly, we know that when these criteria get to a certain serious point, then there is a high risk of further deterioration at a more rapid pace. We want to prevent serious further deterioration that can place the tooth or teeth at risk of loss or infection.

Some definitions will help with our explanation:

“Free Gingiva” – In dentistry, free gingiva does not refer to a dental office giveaway of free gum tissue! Rather, it does denote a very specific part of our mouth anatomy. That part of our gums that can move loosely and freely when our lips, tongue and cheeks move, is called free gingiva. Without this band of loosely attached tissue, even a simple smile would be a strain.

“Attached Gingiva” – The gum tissue that forms the borders of our gums nearest the teeth from the edge against the teeth to approximately ¼ inch below is called attached gingiva. This zone of specialized gum tissue is firmly bound down to the bone underneath with lots of keratin and strong connective tissue. It is within this tissue that the seal forms against our teeth providing a barrier to bacterial invasion and infection.

“Lack of Attached Gingiva” – When the zone of attached gingiva shrinks to a very narrow width or dissolves away entirely, the condition is described as a lack of attached gingiva. Without this zone of firmly attached tissue, the free gingiva pulls at the gum border every time your mouth muscles move. This allows bacteria to invade under the gums, causing inflammation and progressive further recession or disolving away of the protective gum tissue. Untreated, this leads to infection, abscess, and/or loss of the involved teeth.

The gum graft procedure, as described above, is the treatment for lack of attached gingiva. When we see continuing recession (movement away from the tooth) of the attached gingiva over time, and when the amount of attached gingiva reduces to 0mm to 1mm in width, it is imperative to provide a graft that halts any further deterioration.

Gum graft needed Less than 1mm attached tissue	Two weeks after graft placed 8mm attached tissue established

Why does a graft work? – It is actually the genetic information in the cells of the tissue that directs the type of connection to the bone, ie. free or attached. 100% of the palatal donor tissue is genetically the attached type and thus that is how it heals.

Click HERE to print a pdf of surgery instructions for patients.

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