What This Guide Covers and Who It Is For
This guide explains the two most common types of gum grafts so you can understand what your periodontist is recommending and why.
Gum recession is the process where gum tissue pulls away from the tooth, exposing part of the root. According to the American Academy of Periodontology, gum recession is a common condition that can result from periodontal disease, aggressive brushing, genetics, or other factors. [1] Left untreated, recession can lead to sensitivity, root decay, and further tissue loss.
Gum grafting is a surgical procedure that adds tissue to the area where recession has occurred or where the tissue is dangerously thin. The two main types are the connective tissue graft (CTG) and the free gingival graft (FGG). Each approach uses tissue from the palate (the roof of your mouth) but harvests and places it differently.
This guide is for anyone who has been told they need a gum graft, is researching options before a consultation, or wants to understand the differences between these two procedures. If you are looking for a specialist, visit the periodontics page to find a periodontist near you.
How Each Graft Type Works
CTG and FGG differ in how tissue is harvested, where it is placed, and what problem each one solves best.
Connective Tissue Graft (CTG)
A connective tissue graft is the most frequently performed gum graft for root coverage. It uses tissue harvested from beneath the outer layer of your palate.
During a CTG, the periodontist creates a small flap in the palate, removes a piece of the connective tissue underneath, and then closes the flap with stitches. This inner tissue is then placed over the exposed root and tucked under a flap of your existing gum tissue at the treatment site. Because the graft sits beneath your own gum, it receives blood supply from two directions: the tissue above it and the tissue beneath it. This dual blood supply typically supports reliable healing.
The key advantage of CTG is its aesthetic outcome. Because the graft is covered by your own gum tissue, the color and texture tend to blend naturally with the surrounding area. CTG is commonly recommended when the goal is to cover an exposed root, reduce sensitivity, and restore a natural gum line appearance.
The palate donor site heals as a closed wound because the outer layer of tissue is replaced after harvesting. Many patients report that this approach results in less discomfort at the donor site compared to FGG, though individual experiences vary.
Free Gingival Graft (FGG)
A free gingival graft adds thickness to thin gum tissue to protect against future recession. It uses a thin strip of tissue taken directly from the surface of the palate.
During an FGG, the periodontist removes a small rectangle of tissue from the outer layer of the palate and places it directly onto the prepared gum site. Unlike a CTG, the graft is not tucked under existing tissue. It sits on the surface and attaches over time as blood vessels grow into it.
FGG is primarily chosen when the existing gum tissue is very thin and needs to be thickened. It is effective at creating a wider band of attached gingiva (the firm, immovable gum tissue that protects the roots). A wider band of attached gingiva helps resist the mechanical forces of chewing and brushing that can worsen recession. [1]
One trade-off with FGG is color match. Because the graft tissue sits on the surface rather than blending under existing gum, it may appear slightly lighter or pinker than the surrounding tissue. This difference usually softens over several months but may remain somewhat visible.
Side-by-Side Comparison
Understanding the differences at a glance can help you follow your periodontist's reasoning during your consultation.
- Primary goal: CTG is typically chosen for root coverage. FGG is typically chosen for tissue thickening.
- Tissue placement: CTG tissue goes under the gum flap. FGG tissue goes directly on the surface.
- Harvest method: CTG takes tissue from beneath the palate surface (a "trap door" approach). FGG takes a thin layer from the palate surface itself.
- Aesthetic result: CTG generally blends more naturally. FGG may show a slight color difference.
- Donor site healing: CTG leaves a closed wound on the palate. FGG leaves an open wound that heals by secondary intention (new tissue grows in gradually).
- Best candidates: CTG for patients with moderate recession and adequate surrounding tissue. FGG for patients with very thin tissue and little attached gingiva.
What You Should Know Before a Gum Graft
Preparation is straightforward, and most patients return to normal routines within one to two weeks.
Who Is a Candidate
Gum grafting is appropriate for adults at any age who have recession or thin tissue that puts teeth at risk. There is no upper age limit as long as you are healthy enough for a minor surgical procedure.
Your periodontist will evaluate the depth and width of recession, the thickness of your remaining tissue, and the position of the tooth or teeth involved. These factors determine which graft type is most appropriate. In some cases, a patient may need one type of graft in one area and a different type in another.
Certain conditions may affect candidacy or timing. Uncontrolled periodontal disease needs to be treated first, because placing a graft on inflamed tissue reduces the chance of success. [1] Smoking also significantly affects healing. Your periodontist may ask you to stop smoking before and after surgery.
How to Prepare
Your periodontist will give you specific instructions during your pre-surgical visit. General preparation steps typically include the following.
You may be asked to use a chlorhexidine mouth rinse for a few days before surgery to reduce bacteria. If you take blood-thinning medications, your periodontist will coordinate with your physician about whether to adjust them. Arrange for someone to drive you home if sedation is planned. Stock up on soft foods like yogurt, scrambled eggs, and smoothies, because you will need to avoid chewing near the surgical sites for several days.
When Timing Matters
Gum grafting is rarely an emergency, but putting it off too long can make the procedure more complex. As recession progresses, more root surface becomes exposed, and you may lose the surrounding tissue that a CTG flap needs to cover the graft. Early intervention, when recession is mild to moderate, typically allows for more predictable results.
If you notice a tooth looks longer than it used to, feel a notch near the gum line, or experience sensitivity to cold or touch, these are signs worth discussing with a periodontist. The American Dental Association encourages patients to maintain regular dental visits so that early signs of gum recession and periodontal disease can be caught before they progress. [2]
What to Expect During and After the Procedure
Both CTG and FGG are outpatient procedures that typically take 60 to 90 minutes per treatment area.
During the Procedure
You will receive local anesthesia to numb the treatment site and the palate. Some patients also receive oral sedation or nitrous oxide (laughing gas) for comfort. You will be awake during the procedure.
For a CTG, the periodontist lifts a small flap at the recession site, positions the connective tissue graft over the exposed root, and secures both the graft and the flap with small sutures. For an FGG, the periodontist prepares the recipient site by creating a firm tissue bed, places the strip of palatal tissue directly on the surface, and sutures it in place. In both cases, the palate donor site is treated to promote healing; a CTG site is sutured closed, while an FGG donor site may be covered with a protective dressing or collagen material.
You should feel pressure but not pain during the procedure. If you feel any sharpness, tell the periodontist so additional anesthesia can be given.
Recovery and Healing
Initial healing typically takes 2 to 4 weeks. Full maturation of the graft tissue may take 3 to 6 months.
During the first week, expect mild to moderate soreness at both the graft site and the palate. Over-the-counter pain relievers and prescribed medications usually manage this effectively. Swelling is normal and typically peaks around day two or three. Ice packs applied in 20-minute intervals can help.
Your periodontist will instruct you to avoid brushing or flossing near the graft site for a specific period, usually 2 to 4 weeks. A chlorhexidine rinse is commonly prescribed to keep the area clean during this time. Avoid hard, crunchy, spicy, or very hot foods for at least the first week. Physical activity should be limited for the first few days to reduce bleeding risk.
Follow-up appointments are typically scheduled at one week and again at four to six weeks. At these visits, the periodontist checks that the graft is attaching properly and that the donor site is healing. Results vary by patient. Factors like smoking, oral hygiene habits, and the severity of the original recession all influence healing.
Cost Factors for Gum Grafting
Gum grafting costs depend on the type of graft, the number of teeth treated, and your geographic location.
Per-tooth costs for gum grafting in the United States typically range from $600 to $3,000. CTG procedures may cost slightly more than FGG in some practices because the surgical technique involves more steps. If multiple teeth need treatment, the total cost increases, though some periodontists offer a reduced per-tooth rate when treating several sites in one session. Costs vary by location, provider, and case complexity.
Dental insurance may cover part of the cost if the graft is deemed medically necessary, such as when recession threatens the stability of a tooth. Cosmetic-only grafting may not be covered. Contact your insurance provider before the procedure to understand your benefits and out-of-pocket costs. Many periodontal offices also offer payment plans or work with third-party financing companies.
If your periodontist recommends an alternative tissue source, such as an allograft (donor tissue from a tissue bank) or a xenograft (animal-derived collagen matrix), the material cost may be different from a palatal graft. Ask about all available options and their associated costs during your consultation.
When to See a Periodontist
A periodontist is the right specialist when recession has exposed root surfaces or when gum tissue is too thin to protect your teeth.
Your general dentist may be the first to notice recession during a routine exam. General dentists sometimes perform simple gum grafts, but more complex cases, such as multiple teeth with recession, thin tissue biotypes, or areas near dental restorations, typically benefit from the additional training a periodontist has in soft tissue surgery. [1]
You should see a periodontist if you notice any of the following: teeth that appear longer than before, visible root surfaces, persistent sensitivity along the gum line, a feeling of a notch or ledge where the gum meets the tooth, or bleeding that persists despite good brushing and flossing habits. Your general dentist can provide a referral, or you can search for a periodontist directly on the periodontics page.
Even if recession is mild, a consultation with a periodontist can establish a baseline. The periodontist can measure your tissue thickness, chart the recession, and help you decide whether treatment now or monitoring over time is the better approach for your situation.
Find a Periodontist Near You
If you have been told you need a gum graft or are concerned about receding gums, a periodontist can evaluate your tissue and recommend the right approach. Use the periodontics page on My Specialty Dentist to search for a board-certified periodontist in your area, read about their background, and schedule a consultation.
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