What Is a Gum Graft?
A gum graft is a periodontal procedure that adds gum tissue to areas where the gums have receded, exposing the tooth root. The grafted tissue covers the exposed root, reducing sensitivity, protecting against root decay, and improving the appearance of the gum line.
Gum recession can happen gradually due to periodontal disease, aggressive brushing, grinding, or naturally thin gum tissue. Once the gum tissue is lost, it does not grow back on its own. A gum graft is the primary treatment to restore that tissue.
Types of Gum Grafts
There are three main types of gum grafts, and your periodontist will recommend the one best suited to your situation.
- Connective tissue graft: The most common type. A small piece of tissue is taken from under the skin on the roof of your mouth and stitched over the exposed root. This technique provides good root coverage and a natural appearance.
- Free gingival graft: Tissue is taken directly from the surface of the palate and placed at the recession site. This type is often used when the goal is to thicken thin gum tissue rather than cover a root.
- Pedicle graft: Gum tissue from an area adjacent to the recession is partially cut, rotated, and stitched over the exposed root. This works only when there is enough healthy tissue next to the recession site.
When a Gum Graft Is Recommended
- Exposed tooth roots causing sensitivity to hot, cold, or touch
- Root surfaces at risk for decay because they lack the protective enamel that covers the crown of the tooth
- Progressive recession that is getting worse over time
- Cosmetic concern: uneven gum line or teeth that appear too long
- Before orthodontic treatment in patients with thin gum tissue that may recede further during tooth movement
What Is Crown Lengthening?
Crown lengthening is a periodontal procedure that removes or reshapes gum tissue, and sometimes bone, to expose more of the tooth structure above the gum line. Despite the name, the procedure does not make the tooth longer. It repositions the gum line to reveal tooth structure that was previously hidden beneath the gums.
Crown lengthening is performed for two main reasons: to provide enough tooth structure for a dental crown or other restoration, and to correct a "gummy smile" where excess gum tissue makes the teeth appear short.
Functional Crown Lengthening
When a tooth is broken, decayed, or worn down near or below the gum line, there may not be enough tooth structure above the gums for a dentist to place a crown. In this situation, crown lengthening exposes more of the tooth so the crown has a solid foundation to grip.
Without adequate tooth structure, a crown will not stay in place reliably. Your dentist or prosthodontist may refer you to a periodontist for crown lengthening before the crown can be fabricated. After the gum tissue heals (typically 4 to 6 weeks), your restorative dentist can proceed with the crown.
Cosmetic Crown Lengthening (Gummy Smile Correction)
Some people have gum tissue that covers too much of their teeth, making the teeth look short or the smile look "gummy." This is called excessive gingival display. In many cases, the teeth underneath are a normal size, but they are hidden by extra tissue.
Cosmetic crown lengthening removes the excess gum tissue (and sometimes reshapes the underlying bone) to reveal more of the natural tooth. The result is a more balanced proportion between teeth and gums. This procedure can be done on one tooth, several teeth, or the entire upper gum line.
Key Differences Between Gum Graft and Crown Lengthening
Although both procedures involve the gum tissue and are performed by periodontists, they address opposite problems. Understanding the core difference helps clarify which one applies to your situation.
Tissue Addition vs. Tissue Removal
A gum graft adds tissue. It takes tissue from one site (usually the palate) and places it where tissue has been lost due to recession. Crown lengthening removes tissue. It trims away gum tissue (and occasionally bone) to expose tooth structure that is covered by excess tissue. In simple terms: if your teeth look too long because the gums have pulled back, you may need a gum graft. If your teeth look too short because the gums cover too much of the tooth, you may need crown lengthening.
Functional vs. Cosmetic Indications
Both procedures can be done for functional or cosmetic reasons, but the balance is different. Gum grafts are most commonly performed for functional reasons: protecting exposed roots from decay and sensitivity. The cosmetic improvement is a secondary benefit. Crown lengthening is performed roughly equally for functional reasons (making restorative dental work possible) and cosmetic reasons (gummy smile correction).
Cost Comparison: Gum Graft vs Crown Lengthening
Costs vary by location, provider, and the number of teeth involved. The ranges below represent typical fees in the United States.
A gum graft typically costs $600 to $1,200 per tooth. If multiple teeth in the same area are treated during one procedure, the per-tooth cost may be lower. The total for grafting across several teeth can range from $1,500 to $4,000.
Crown lengthening typically costs $800 to $3,000, depending on how many teeth are involved and whether bone reshaping is needed in addition to soft tissue removal. Cosmetic crown lengthening across the full upper arch can cost $3,000 to $6,000.
Insurance coverage differs for these procedures. Functional gum grafts and functional crown lengthening (needed before a crown can be placed) are more likely to be covered by dental insurance than purely cosmetic procedures. Most insurance plans do not cover cosmetic gummy smile correction. Check with your provider and insurance plan for specific coverage details.
Recovery Comparison
Both procedures are performed under local anesthesia in a periodontist's office. Neither requires general anesthesia or hospitalization. Recovery timelines are similar, though the type of discomfort differs.
Gum Graft Recovery
After a gum graft, you will have two healing sites: the graft site on your tooth and the donor site on your palate (if a connective tissue or free gingival graft was used). The palate donor site is often the more uncomfortable area during the first week.
Expect mild to moderate discomfort for 5 to 7 days. A soft food diet is recommended for the first 1 to 2 weeks. Avoid brushing or flossing directly on the graft site until your periodontist gives clearance, typically at the 1 to 2 week follow-up visit. Full tissue maturation takes 3 to 6 months, though the graft is stable enough for normal daily activities within 2 to 3 weeks.
Crown Lengthening Recovery
After crown lengthening, you may have a periodontal dressing (a putty-like bandage) over the surgical site for 7 to 14 days. Discomfort is typically mild to moderate and manageable with over-the-counter pain relievers.
A soft food diet is recommended for the first 1 to 2 weeks. The surgical site heals enough for normal daily activities within 2 weeks. However, if the procedure was done to prepare for a dental crown, you will need to wait 4 to 6 weeks for full gum healing before the restorative work begins. Complete bone and tissue remodeling may take 3 to 6 months.
Can You Need Both Procedures?
Yes, though it is uncommon to need both on the same tooth. A patient might need a gum graft on teeth with recession (often lower front teeth or upper canines) and crown lengthening on a different tooth where a crown needs to be placed or where excess tissue creates an uneven gum line.
When both procedures are needed, they are typically performed at separate appointments to allow each site to heal independently. Your periodontist will evaluate your full mouth and create a treatment plan that addresses all areas. You can learn more about how periodontists treat gum conditions on our [periodontics specialty page](/specialties/periodontics).
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