— PERIODONTAL SURGERY - TORONTO
Gum Grafting
in Toronto
Gum recession exposes root surfaces, causes sensitivity, and — if left untreated — progresses to tooth loss. At Innova Dental, gum grafting restores lost tissue around teeth and dental implants using free gingival and connective tissue grafting techniques.
IV
Sedation available for all gum grafting proceduresFGG
Free gingival graft — keratinized tissue augmentationCTG
Connective tissue graft — root coverage and implant dentistry — UNDERSTANDING GUM RECESSION
Why Gum Recession
Needs to Be Addressed
Gum recession occurs when the gingival margin migrates apically — exposing the root surface of the tooth below the level it should naturally sit. It can affect a single tooth or multiple teeth, and once recession has occurred, the gum tissue does not regenerate on its own.
Exposed root surfaces are more susceptible to decay, as the cementum covering the root is softer and less resistant than enamel. Sensitivity to temperature and touch is common. Without adequate keratinized tissue — the firm, resilient gum tissue that protects the root and forms a stable seal against bacteria — the site is at ongoing risk of further recession, attachment loss, and ultimately tooth loss.
Around dental implants, the same principles apply. A band of keratinized peri-implant tissue is associated with better long-term implant stability and resistance to infection. Insufficient keratinized tissue around an implant is a recognised risk factor for peri-implantitis.
WHEN GUM GRAFTING IS INDICATED
Recession exposing root surface with associated sensitivity
Thin gingival biotype at risk of further recession
Insufficient keratinized tissue around teeth or implants
Root surface decay associated with recession
Recession affecting aesthetics in the visible smile zone
Pre-implant site preparation requiring tissue augmentation
Peri-implant tissue augmentation for long-term implant stability
Recession does not reverse itself. Unlike inflammation — which can resolve with improved home care — gum tissue that has receded will not regenerate without surgical intervention. Addressing recession early produces better outcomes and typically requires less grafting than waiting until the defect is more advanced.
— GRAFT TECHNIQUES
Graft Techniques
Matched to the Clinical Goal
The appropriate technique depends on the clinical goal — whether the primary aim is tissue augmentation, root coverage, or both. Both procedures harvest from the palate.
01Free Gingival Graft
FGG — palate surface harvest
A free gingival graft harvests a thin strip of tissue directly from the surface of the palate. Because the tissue is taken from the outer keratinized layer, the graft itself is already keratinized — making it highly effective at creating a stable, resilient band of attached gingiva. The palate heals predictably; the surface will appear white initially as the epithelium regenerates, resolving over several weeks.
Best suited for
Implant sites requiring keratinized tissue augmentation
Areas of severe recession with very thin or absent keratinized tissue
Cases where tissue stability is the primary goal over aesthetics
Sites where tissue width matters more than root coverage
Biomaterials
Allogain / AlloDerm / Mucoderm — no palate donor site required
Biomaterial substitutes eliminate the need for a palate donor site entirely. Acellular dermal matrices (Allogain, AlloDerm) and collagen matrices (Mucoderm) serve as graft scaffolds, supporting tissue integration at the recipient site without a second surgical site.
These are particularly valuable when the patient is not a candidate for palate harvest.
Long-term outcomes may differ from autogenous grafts depending on the clinical context — this is discussed at the treatment planning stage.
Best suited for
Multi-site grafting where palate volume is the limiting factor
Patients preferring to avoid a palate donor site
Cases where donor site availability is limited
02Connective Tissue Graft
CTG — palate harvest placed beneath a tissue flap for root coverage
A connective tissue graft is placed beneath a flap of the patient's existing gum tissue at the recipient site, which is advanced to cover the graft — allowing the overlying native tissue to provide blood supply, colour, and texture blending. The harvest technique varies by clinical preference.
Deepithelialized FGG (DFGG) — Dr. Cavus's preferred approach — harvests a full-thickness strip from the palate surface and removes the epithelial layer, leaving the connective tissue. The DFGG maintains excellent volume due to lower adipose tissue content, making it a reliable and dimensionally stable graft for both root coverage and soft tissue augmentation.
Subepithelial CTG harvests connective tissue from beneath the palate epithelium through a smaller incision, leaving the palate surface intact — a well-established technique where palate surface preservation is a priority.
Best suited for
Recession with aesthetic concerns in the visible smile zone
Root coverage where adequate existing tissue allows flap advancement
Cases requiring both tissue volume and recession coverage
Peri-implant augmentation where aesthetics are a priority
— TREATMENT CONTEXT
Grafting Around
Teeth and Implants
Gum grafting is performed both around natural teeth and around dental implants. The biological goals are similar — adequate keratinized tissue, stable soft tissue attachment, and protection of the underlying structure — but the anatomical context differs.
Around Natural Teeth
Gum grafting around natural teeth most commonly addresses recession on the buccal (cheek-facing) surfaces — particularly lower anterior teeth and canines, though any tooth can be affected. The goals are to arrest recession, restore root coverage, increase the band of keratinized tissue, and reduce sensitivity.
Both FGG and CTG are used depending on whether the primary goal is tissue augmentation or root coverage with aesthetic integration. The extent of recession, tissue thickness, and available tissue for flap advancement all influence which technique is appropriate.
Around Dental Implants
Implants lack a periodontal ligament — the attachment mechanism differs fundamentally from natural teeth. A minimum band of keratinized tissue around the implant collar is associated with better long-term bone stability, easier plaque control, and reduced risk of peri-implantitis.
Gum grafting around implants — most commonly FGG — is often planned as part of the implant treatment sequence: before implant placement, at placement, or after osseointegration is confirmed. The timing is determined by the existing tissue volume and the planned implant position.
Planning implants with a history of recession? Patients with a history of gum recession or thin gingival biotype around natural teeth have an elevated risk of insufficient peri-implant tissue. Soft tissue assessment before implant placement allows grafting to be planned proactively — producing better long-term outcomes than addressing deficiency after the implant is in place.
— RECOVERY GUIDE
What to Expect
After Gum Grafting
Recovery involves two sites: the recipient site where the graft was placed, and the donor site at the palate. Each has its own healing trajectory. Written post-operative instructions are provided at every appointment.
Most patients find the palate donor site the more uncomfortable of the two. A palatal stent or protective dressing is provided to reduce discomfort and protect the palate during healing.
Recipient Site — First Week
Avoid brushing directly over the graft site
Soft diet only — nothing hard, crunchy, or requiring pressure over the graft
Prescribed chlorhexidine rinse to maintain hygiene without mechanical disruption
Swelling and bruising normal for 3–5 days
Some bleeding or oozing in the first 24 hours is normal
Palate Donor Site
Palatal stent or dressing provided to protect the donor site
Tenderness and sensitivity to hot or spicy food for 1–2 weeks
Palate heals by re-epithelialisation — complete within 2–4 weeks
CTG donor sites heal faster than FGG — surface epithelium is preserved
Avoid hard or sharp foods near the palate during healing
Recipient Site — Weeks 2–4
Graft will appear white or pale initially — this is normal epithelialisation
Colour and texture gradually blend with surrounding tissue over 4–6 weeks
Sutures dissolve or are removed at follow-up (typically 7–14 days)
Gentle brushing may resume around the graft site as directed
Full maturation continues over 3–6 months
What Is Normal
Mild to moderate discomfort at both sites — managed with analgesics
Initial pale or white appearance of the graft
Minor swelling and bruising around the treated area
Slight tightness or pulling sensation as healing progresses
Some sensitivity at the recipient site during healing
Contact the Clinic If You Experience
Bleeding that does not slow with sustained gentle pressure
Fever, increasing swelling, or signs of infection after 48 hours
The graft appears to be detaching or lifting from the recipient site
Severe pain not managed with prescribed analgesics
Numbness or altered sensation persisting beyond the anaesthetic window
— SEDATION OPTIONS
Comfortable from
Start to Finish
Gum grafting involves two surgical sites — the recipient site and the palate donor site — and typically takes 60 to 90 minutes. IV sedation is available at Innova Dental for all gum grafting procedures and makes a significant difference for patients with dental anxiety or sensitivity to palate procedures.
IV sedation produces a deeply relaxed, amnesic state. Most patients have little or no recollection of the procedure. A responsible adult must accompany you to and from the appointment.
LOCAL ANAESTHETIC ONLY
Both the recipient site and palate donor site are anaesthetised. You are awake and aware throughout but should feel no pain — only pressure and movement. Appropriate for patients comfortable with oral surgery under local anaesthetic.
IV SEDATION + LOCAL ANAESTHETIC
Intravenous sedation administered and monitored by Dr. Cavus, who holds RCDSO certification as a moderate IV sedation provider. Produces deep, amnesic relaxation. Recommended for anxious patients and longer grafting procedures. Escort required.
— WHAT TO EXPECT
From Consultation
to Healed Graft
Gum grafting at Innova Dental follows a structured clinical sequence. Any underlying gum disease must be treated and stable before grafting is performed. The procedure is always preceded by a thorough soft tissue assessment.
Final outcome assessment — recession coverage achieved and keratinized tissue width gained — is carried out at 3 to 6 months.
01 Consultation & Soft Tissue Assessment
A full soft tissue assessment records recession measurements, tissue thickness and biotype, keratinized tissue width, and pocket depths. Any active gum disease must be treated and stable before grafting proceeds. The appropriate graft type and technique are discussed, along with expected outcomes for your specific anatomy.
02 Treatment Planning
The treatment plan documents the sites to be grafted, the graft type, and whether a staged or single-appointment approach is appropriate. If multiple teeth require grafting, appointments may be divided depending on the extent of tissue needed from the palate. Sedation preference is recorded and palatal stent fabrication arranged if required.
03 Surgical Appointment
Local anaesthetic is administered to both the donor site (palate) and the recipient site. The graft is harvested, prepared, and placed at the recipient site, then sutured into position. The palate donor site is sutured or dressed. Most appointments take 60 to 90 minutes. Written post-operative instructions and prescriptions are provided before discharge.
04 Follow-Up & Suture Removal
A follow-up appointment at 7–14 days checks graft integration, removes any non-dissolving sutures, and assesses the palate donor site. Early assessment allows any concerns to be identified and addressed before they affect the outcome.
05 Healing & Outcome Assessment
Initial graft integration takes 4–6 weeks; complete tissue maturation and colour blending continues over 3–6 months. A clinical assessment at 3–6 months measures recession coverage achieved and keratinized tissue width gained — the two primary outcome measures for gum grafting.
ABOUT GUM GRAFTING
Gum grafting — clinically referred to as periodontal plastic surgery or mucogingival surgery — is a surgical procedure that restores or augments gum tissue lost through recession, inadequate keratinized tissue, or gingival deficiency around teeth and dental implants. Two primary graft categories are used: the free gingival graft (FGG), which harvests keratinized tissue from the palate surface to create a stable band of attached gingiva; and connective tissue grafts (CTG), which are placed beneath a flap of existing gum tissue to achieve root coverage with better aesthetic integration. CTG harvest techniques include deepithelialized FGG (DFGG — palate surface harvest with epithelium removed, preferred for superior volume and lower adipose tissue content) and subepithelial CTG (connective tissue harvested from beneath the palate epithelium). Biomaterials including acellular dermal matrix (Allogain, AlloDerm) and collagen matrices (Mucoderm) are used as graft substitutes when palate harvest is not preferred or tissue volume requirements exceed what a single harvest can provide. Gum grafting around implants establishes or augments peri-implant keratinized tissue, which is associated with reduced peri-implantitis risk. Gum grafting is performed by periodontists and dentists with a surgical scope of practice.— FAQ
Gum Grafting
Questions
Questions about your specific situation are best answered at a consultation, where your recession measurements and tissue biotype can be assessed directly.
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The procedure is performed under local anaesthesia — you should feel pressure but not pain at either site during the appointment. Most patients find the palate donor site more uncomfortable than the recipient site during recovery. Discomfort is managed with prescribed analgesics and typically resolves within 5 to 7 days. IV sedation makes the procedure itself a non-event for most patients.
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This depends significantly on the technique used. Connective tissue grafts (CTG, DFGG placed beneath a flap) tend to achieve good aesthetic integration because the patient's own overlying tissue provides the surface colour and texture — results typically blend well with the adjacent gum at maturity. Free gingival grafts (FGG), where the harvested tissue is exposed at the surface, may remain visibly different from the surrounding tissue even after full maturation — the palate-derived keratinized tissue can appear paler or have a different texture than the adjacent alveolar mucosa. This is expected and accepted, because FGG is used primarily where tissue stability and keratinization are the clinical priority rather than aesthetics. The appropriate technique for your situation — and the expected aesthetic outcome — is discussed at your consultation before any procedure is planned.
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If the underlying cause of recession is not addressed, recurrence is possible. Common causes include aggressive tooth brushing technique, ongoing gum disease, orthodontic tooth movement outside the alveolar bone, and thin gingival biotype. Your clinician will advise on contributing factors and home care modifications to protect the graft long-term.
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Multiple sites can often be addressed in a single appointment, depending on the extent of grafting required and the volume of tissue available from the palate donor site. In some cases, two separate appointments are needed — either because the number of sites exceeds what one palate harvest can provide, or because the patient prefers a staged approach. This is discussed at your treatment planning consultation.
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Not always — but it is often worth considering. If you have insufficient keratinized tissue at the planned implant site, a gum graft before or at the time of placement establishes the soft tissue environment needed for long-term implant health. Your clinician will assess the tissue at your implant consultation and advise whether augmentation is indicated.
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Gum grafting is typically classified under the periodontal surgery or oral surgery benefit of dental insurance plans. Coverage varies significantly by plan and by the number of teeth being treated. Our treatment coordinator can prepare a predetermination letter to submit to your insurer before treatment begins.
— BOOK A CONSULTATION
Protecting Your Gums —
and Your Investment in Your Teeth
If you have noticed your gum line receding, or if sensitivity or aesthetics have become a concern, a consultation will clarify whether grafting is indicated and what results are achievable. Addressing recession early produces better outcomes.