What happens before a soft tissue graft procedure?

There are three types of gum grafts:

• free gingival graft

• connective tissue graft

• pedicle (lateral) graft

A periodontist will discuss these options with you and make their recommendation based on your individual needs.

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Once you’ve decided to have the procedure done, you don’t have to fast or change your diet on the day before or the day of the procedure. All you have to do is show up. 

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However, if sedation is being done you should stop eating or drinking at least 6-8 hours before the procedure and you do need to arrange a ride to and from your appointment. You’ll be given medications for pain and discomfort that may make it unsafe for you to drive, so you’ll need to ride home with a friend or use a car service.

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Please discuss your chronic medications and vitamins (especially omega 3 & 6) taken with your periodontist to make sure that you do not have any excessive bleeding risk. 

Soft tissue graft procedure

Now, we'll go over what you can expect in surgery so that you're fully prepared and confident as you go into your gum graft procedure. Here's a general sequence of events that take place during surgery after the area is numbed:

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1. Prepare the site. Once you’re comfortable, your periodontist makes an incision (cut) and creates a small flap in your gums. They’ll also thoroughly clean your teeth roots.

2. Harvest the gum graft. Next, your surgeon creates another incision on the roof of your mouth and removes a small wedge of inner tissue. The outer layer remains intact. They’ll close the site using sutures or periodontal dressing. (If your surgeon decides to use a manufactured membrane, they’ll skip this step.)

3. Place the gum graft. Next, your surgeon places the gum graft over your exposed teeth roots (the area of recession).

4. Place sutures. Finally, your surgeon repositions your gum tissue and stitches it into place. Your periodontist might use stitches that fall out on their own. Or you might need to have them removed at your follow-up visit.

5. The flap is then placed back on its original position and secured with sutures.

6. The healing process starts soon after.

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The duration of the procedure depends on how many teeth have gum recession. If you only need one gum graft, it usually takes about an hour. If you need multiple grafts in different areas of your mouth, it could take longer.

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What to expect after surgery?

Does gum graft surgery hurt?

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You’ll be numb during your gum graft surgery, so you won’t feel anything during the procedure. You’ll probably have mild soreness after your procedure (like scalding your palate with a hot drink), but your periodontist will give you medications and post-surgical instructions to help minimize your discomfort.

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What’s the gum graft recovery timeline?

Your surgeon will probably want to check on your gum graft one week later. Then, you’ll have routine follow-ups until your periodontist releases you back to your general dentist for continuing care.

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During this time, they’ll provide you with specific instructions. In general, here’s what you can expect:

The first day

Following your procedure, you’ll experience some bleeding, swelling and discomfort. To manage these side effects, take all medications exactly as prescribed by your surgeon. Get lots of rest and avoid strenuous activities.

Eat soft, cool foods, such as yogurt, pudding or smoothies.

Keep the surgical area clean using an antibacterial mouthwash. Don’t brush or floss directly on the gum graft, as this can damage it and lead to failure. (You can brush and floss your other teeth as your comfort level allows.)

The first week

Bleeding should subside within the first 24 hours to 48 hours. Swelling will continue for three to four days. You may also develop bruising during this time. These side effects are normal and should subside within the week. Continue taking all medications as prescribed.

You can incorporate more soft foods into your diet as you’re able, including things like eggs, pasta, fish and cooked vegetables.

Gently brush your teeth near the surgical site, but don’t brush directly on your gums. Don’t brush or floss around the gum graft until your surgeon says it’s safe.

The second week

Swelling and bruising should begin to fade, and your comfort level should continue to improve. Ask your surgeon when it’s safe to begin decreasing your medication dosage.

As your comfort level improves, you can incorporate more solid foods. However, you should still avoid hard, crunchy or spicy foods until your surgeon clears you.

Once your surgeon says it’s safe to do so, you can resume normal brushing and flossing.

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How long does it take to recover from a gum graft?

Every person heals differently. But on average, gum graft recovery takes one week to two weeks. If you had multiple areas treated at once, recovery might take a little longer. Your periodontist can tell you what to expect.

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When can I resume normal routines?

You should avoid exercise, heavy lifting and other strenuous exertions for at least the first week. These activities increase your heart rate and can lead to more discomfort, bleeding and swelling. Be sure to clear it with your surgeon before you resume these activities.

Most people can return to work or school in one day to two days.

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Bleeding

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• It is normal to expect some minor bleeding, even though it will be sufficiently controlled during the procedure.

• Any provided gauze should be kept in your mouth for about 1-2 hours, but you can replace it as needed.

• If bleeding continues, you can manually apply pressure or gently bite down on the gauze over the site; a wet teabag can also be used if you run out of gauze.

• It is also important to avoid intense rinsing and spitting for at least the first 24 hours in order to aid blood clot stabilization.

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Swelling

• You can expect to swell to some degree, this is normal and is nothing to worry about.

• The swelling usually reaches a peak in about 3-4 days so do not worry if it continues to swell.

• Use of ice packs for the first 48 hours and application of moist heat after 48 hours can minimize the swelling. Please post-operative instructions section for more detail.​

• If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. 

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Pain

• The amount of pain that you feel varies from patient to patient.

• Some level of discomfort is to be expected from any oral surgical procedure.

• To stay ahead of the discomfort, you should take the first dose of pain medication before the local anesthesia wears off.

• If you do have a lot of pain it may indicate an infection and should be checked.

Bruising

• Bruising over the face, eye, and neck can occur and is nothing to worry about.

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Sutures

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• Stitches are used to close the gums back together.

• Doctors may use either dissolvable or non-dissolvable stitches, depending on your particular case.

• The dissolvable variety will begin to disintegrate in 10 - 14 days, while the doctor will remove the non-dissolvable type at the first or second post-operative visit.

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Diet and chewing

• After your surgery, you will have to maintain a SOFT diet for at least 2 weeks.

• A diet of soft foods will serve to minimize trauma to the surgical sites, and this can have a positive effect on healing.

• Sometimes an even longer period of time is necessary, and the doctor will inform you if the period needs to be longer or if a liquid diet is required.

• Try to chew on sides not affected by surgery when possible.

Post-opertative instructions

Rinsing

• Mouthwash should be used regularly to lower the chances of infection,

• Do not dilute the mouthwash, it is to be used twice a day 30 minutes after you brush your teeth to prevent inactivation of the mouth rinse active ingredients by the toothpaste. Rinse your mouth for one minute then spit out.

• Do not rinse, brush, or eat for at least an hour after using mouth wash.

Medication

• If antibiotics are prescribed, please use it as per prescription instructions.

• Anti-inflammatory painkillers are important to reduce the level of discomfort as well as to reduce the swelling. These must be taken even if you do not feel any discomfort. Take 2 tablets/capsules immediately after surgery and then two tablets 4 – 6 hourly thereafter.

Other instructions

• You must eat soft foods like soups and yogurts etc. for at least one week.

• Use of ice packs for the first 48 hours can minimize the swelling.

  • The ice packs provided by our office (or bags of frozen peas) should be applied to the sides of the face continuously while awake where surgery was performed.

  • After 48 hours, ice has no beneficial effect, then moist heat can be applied to the respective area.

• No exercise for at least 3 days.

Tooth brushing & flossing/interdental brushes

• Avoid the surgical area with a toothbrush for 10 - 14 days.

• Start brushing gently as soon as you can.

• Brush all other areas that have not been treated and try to dislodge any food that may be sitting in the area of the surgical site.

• No flossing or interdental cleaning with brushes for 12 weeks.

Dentures & Prostheses

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• Partial dentures, flippers, or full dentures should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise.

• When it is placed it should not touch the gums in the area of the surgery. If it does, this can cause ulceration of the wound edges and breakdown of the suture margins. 

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* This list serves merely as a guideline should you encounter any of these complications. Please call us if anything worries you. We will easily
be able to put your mind at rest.

Possible Complications

What are the risks or complications of gum graft surgery?

Complications following gum graft surgery are uncommon, but they can happen. Possible complications include:

• Infection.

• Excessive bleeding.

• Rejection of the gum graft (failure).

If you notice heavy bleeding, pus or anything else that doesn’t look right, contact your surgeon right away.

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What are gum graft failure symptoms?

If your gum graft failed, you’ll probably notice a large patch of white tissue that has come off of your tooth. Its lack of color means that the gum graft lost blood supply and is dying. If you notice this or have other concerns, such as pus at the surgical site or a fever over 38.33 degrees Celsius, call your surgeon immediately.

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