Recession Management

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Recession Treatments

Periodontal disease particularly, can greatly disfigure the natural appearance of the gums and teeth and give the smile an unaesthetic appearance.

New “cosmetic surgery” procedures are now available in periodontics, which effectively correct cosmetic problems and restore natural beauty to the smile.


Here are some of the most common gum and jawbone corrective treatments:
Before and after on the right side:

The three different types of common soft tissue grafts include:

Palatal Grafts

This is still the gold standard for covering exposed roots, but it does require tissue to be borrowed from the roof of the mouth. Although our periodontists prefer to avoid the palate if possible, there are some clinical situations which require this type of gingival grafting. To help aid in post-operative comfort, we provide clear, firm, thin acrylic stents that cover the palate area during initial healing. The stent provides protection, acts as a band-aid, and assist in wound healing.

  • Free gingival graft – A strip of tissue is removed from the roof of the mouth and stitched to the grafting site in order to promote natural growth. This type of graft is most commonly used for thickening existing tissue.
  • Connective tissue graft – For larger areas or root exposure, subepithelial tissue is needed to remedy the problem. This subepithelial connective tissue is removed from a small flap in the mouth and sutured to the grafting site. This is the most common treatment for root exposure
  • Pedicle graft – This type of graft involves the “sharing” of soft tissue between the affected site and adjacent gum. A flap of tissue is partially cut away and moved sideways to cover the root. The results of this type of graft are excellent because the tissue that is moved to the adjacent area includes blood vessels that are left in place.


This is a minimally-invasive technique that creates a space in between the exposed roots and the gums without the use of any scalpels. A donor graft is used to aid in the patient’s gum tissues and cells to adhere strongly to the root surface. Long term studies show tunneling with a donor tissue graft is equally effective as using palatal tissue in covering recessed roots and to thicken and fortify the gum tissue. The natural donor graft comes from a stringent screening and sterilization process. No cells remain, and so your body’s cells do reject the tissue but rather incorporates it into the gum tissue.

Pinhole Surgical Technique

The Pinhole Surgical Technique (PST) is a newer, minimally-invasive technique that avoids the use of scalpels and sutures (stitches) by utilizing tiny access points in the gums to loosen the gum tissue. Once the gums are pulled over the recessed roots, collagen is placed into the site to thicken the gum tissue. The benefit of the PST is not having to use sutures that may become bothersome later in the healing, and there is much less discomfort, if any at all, than using palatal grafts.

Soft tissue grafting is often necessary to combat gum recession. Periodontal disease, trauma, aging, over brushing, and poor tooth positioning are the leading causes of gum recession which can lead to tooth-root exposure in severe cases.

When the roots of the teeth become exposed, eating hot and cold foods can be uncomfortable, decay is more prevalent and the aesthetic appearance of the smile is altered. The main goal of soft tissue grafting is to either cover the exposed root or to thicken the existing gum tissue in order to halt further tissue loss.

Reasons for soft tissue grafting

Soft tissue grafting is an extremely versatile procedure that has many uses. Recent developments in dental technology have made soft tissue grafting more predictable and less intrusive. Here are some of the main benefits associated with soft tissue grafting treatment:

  • Increased comfort – Root exposure can cause substantial pain and discomfort. Eating hot, cold or even warm foods can cause severe discomfort. Soft tissue grafts cover the exposed root, decreases sensitivity and restore good health to the gum area.
  • Improved aesthetics – Gum recession due to periodontal disease can cause the smile to look “toothy” or the teeth to appear uneven in size. Soft tissue grafting can be used as a cosmetic procedure to re-augment the gums, and make the smile appear more symmetrical.
  • Improved gum health – Periodontal disease is a progressive condition that can destroy soft tissue very rapidly. When used in combination with deep cleaning procedures, soft tissue grafting can halt tissue and bone loss, and protect exposed roots from further complications.

What does soft tissue grafting treatment involve?

Initially, deep cleaning will be performed both above and below the gum line to clear the teeth and roots of calculus (tartar). The grafting procedure itself will generally be performed under local anesthetic, but this will depend on the size of the areas receiving grafts. A small incision will be made at the recipient site in order to create a small pocket. A split thickness incision is made in this pocket and the donor tissue is placed between the two sections of this area. The donor tissue strip is generally larger than the incision, so some excess will be apparent.

Platelet rich growth factors which stimulate natural tissue growth and promote good healing may be applied to the site before suturing. In addition, tissue-stimulating proteins may be added to encourage quicker tissue growth. Finally, the wound site will be sutured to prevent shifting, and surgical material will be placed to protect the sensitive area. Gum uniformity and substantial healing will take place in the first six weeks after the procedure.

If you have any questions about soft tissue grafting, please ask your dentist.