How Each Gum Graft Works
Both connective tissue grafts and free gingival grafts use soft tissue harvested from the roof of your mouth (the palate) and transplant it to the area of gum recession. The key difference is which layer of tissue is used and how it is positioned at the recipient site.
Connective Tissue Graft (CTG)
In a connective tissue graft, the periodontist makes a small flap in the roof of your mouth and removes a piece of connective tissue from beneath the surface layer. The surface layer is then sutured closed, which tends to heal more comfortably because the wound is partially covered from the start.
At the recipient site, the periodontist creates a small flap in the existing gum tissue, tucks the connective tissue graft underneath, and positions it over the exposed root surface. The graft is then covered by the flap and sutured in place. Because the graft sits under the existing gum tissue, it takes on the color and texture of the surrounding gums as it heals, producing a natural appearance.
Free Gingival Graft (FGG)
In a free gingival graft, the periodontist removes a thin strip of tissue directly from the surface of the palate. This leaves an open wound on the roof of the mouth that heals on its own over 2-4 weeks (similar to a skin abrasion).
The harvested tissue is then placed directly onto the gum surface at the area that needs thickening. It is sutured into position on top of the existing tissue rather than tucked underneath it. The graft stays visible on the surface, which is why it may not match the surrounding gum color as closely as a connective tissue graft. Over time, the color difference usually softens but may remain noticeable.
When Each Graft Type Is Used
Your periodontist selects the graft type based on the clinical goal, the amount of recession present, the thickness of your existing tissue, and the location in your mouth.
When a Connective Tissue Graft Is Used
Connective tissue grafts are the most commonly performed gum graft procedure. They are the preferred technique when the primary goal is root coverage, meaning covering exposed tooth roots caused by gum recession.
- Visible gum recession on front teeth or premolars where aesthetics matter
- Root sensitivity from exposed surfaces that has not responded to desensitizing treatments
- Recession around dental restorations (crowns or veneers) where the root is becoming exposed
- Cases where the patient has enough existing tissue thickness to create a flap over the graft
- Recession classified as Miller Class I or II, where the bone between teeth is intact and full root coverage is achievable
When a Free Gingival Graft Is Used
Free gingival grafts are used when the primary goal is increasing the width and thickness of attached gum tissue rather than covering an exposed root.
- Thin, fragile gum tissue that is at risk of future recession, even if minimal recession has occurred so far
- Areas with little or no attached gingiva (the firm, immovable gum tissue that protects the tooth)
- Around dental implants that lack adequate tissue thickness
- Lower front teeth, which commonly have very thin tissue and are prone to recession
- Cases where the priority is preventing further tissue loss rather than achieving cosmetic root coverage
Procedure and Healing Comparison
Both procedures are performed under local anesthesia in the periodontist's office. Most patients are comfortable during the procedure and report that the recovery is manageable with over-the-counter pain medication.
What Happens During the Procedure
Both gum graft procedures typically take 60-90 minutes per treatment area. The periodontist numbs both the palate (donor site) and the area receiving the graft. Some patients opt for sedation if they feel anxious about the procedure.
The surgical technique at the recipient site differs between the two grafts, as described above. The palate harvesting technique also differs: CTG involves a trap-door flap that is sutured closed, while FGG involves a surface harvest that heals as an open wound. Both are well-established techniques with predictable outcomes.
Healing Timeline
Initial healing for both graft types takes approximately 2-4 weeks. During the first week, the grafted area is protected by the sutures and should not be brushed or disturbed. Soft foods are recommended for 7-14 days. Most patients return to normal eating within 2-3 weeks.
The palate donor site is often the area patients notice most during recovery. With a connective tissue graft, the palate wound is partially closed by the flap, which can make it more comfortable. With a free gingival graft, the open palate wound may take slightly longer to feel normal, though it heals well with the protective stent or dressing the periodontist provides.
Full tissue maturation, where the graft is fully integrated and has reached its final color and texture, takes 3-6 months. During this time, the grafted tissue gradually blends with the surrounding gums.
Aesthetics: Which Graft Looks Better
If appearance is a concern, the connective tissue graft generally produces superior cosmetic results. Because the graft is placed under the existing gum tissue, it takes on the color and texture of the surrounding gums as it heals. Most patients and observers cannot tell where the graft was placed once healing is complete.
A free gingival graft sits on the surface and may remain slightly lighter or pinker than the adjacent tissue. The color difference typically softens over several months but may not disappear entirely. For back teeth where aesthetics are less visible, this is rarely a concern. For front teeth in the smile zone, a connective tissue graft is usually the preferred choice when root coverage is the goal.
It is worth noting that the primary purpose of a free gingival graft is tissue thickening, not cosmetic improvement. In cases where a FGG is indicated, the functional benefit of thicker, more resilient tissue outweighs the minor aesthetic trade-off.
Cost Comparison
The cost of both gum graft types falls in a similar range. A connective tissue graft typically costs $600 to $1,200 per tooth or treatment site. A free gingival graft ranges from $500 to $1,000 per site. When multiple teeth need grafting in the same area, many periodontists treat them together in a single procedure, which can reduce the per-tooth cost.
Dental insurance often covers gum grafting when it is deemed medically necessary to protect the tooth, not purely cosmetic. Coverage varies by plan, but many plans classify gum grafts as a major periodontal procedure and cover 50-80% after deductible. Check with your plan for specifics. Costs vary by location, provider, and case complexity.
How Your Periodontist Decides Which Graft to Use
The choice between a connective tissue graft and a free gingival graft is a clinical decision based on several factors that your periodontist evaluates during your examination.
Key Clinical Factors
- Amount of recession: If root coverage is the goal, CTG is typically preferred because it achieves better coverage outcomes.
- Tissue thickness: If the existing gum tissue is very thin (less than 1mm), FGG may be chosen to add bulk first, with a possible CTG later for root coverage.
- Location in the mouth: Front teeth visible in the smile favor CTG for aesthetics. Back teeth or lower front teeth with thin tissue may favor FGG.
- Bone level between teeth: The height of the bone between adjacent teeth (interdental papilla) affects how much root coverage is achievable with a CTG.
- Patient goals: Some patients prioritize aesthetics (favoring CTG), while others prioritize long-term tissue stability (which may favor FGG in certain situations).
- Palate tissue availability: The amount and thickness of tissue available in the palate can influence which harvesting technique is feasible.
Find a Periodontist Near You
Every periodontist on My Specialty Dentist has verified specialty credentials. Search by location to find a periodontist in your area who can evaluate your gum recession, recommend the appropriate graft type, and walk you through what to expect.
Search Periodontists in Your Area