Gum Graft Surgery: What you need to know

When most people discover that they may need to have gum grafting surgery, their first reaction can be one of alarm. Gum grafting at first sounds like a serious, painful, invasive procedure that is going to be uncomfortable, to say the least. This can cause significant amounts of anxiety in some people, much of which can be calmed by proper information.

Dr. Choi has extensive experience in performing gum grafting surgeries over many years. During that time, he has amassed a list of some of the most common questions and concerns that are put to him by his patients. For your convenience, we have put together a comprehensive guide to gum grafting on this page. We will explore what the treatment is, why people need it, how it works, and answer some of the most frequently asked questions.

If at any point you are unsure of something you read (or would like to schedule an appointment for a professional opinion), give Dr. Choi a quick call at (214)592-0692 to see how he can help.

Why do people need gum grafting surgery?

Gum recession is the main issue that creates the need for gum grafting surgery. Despite sounding like a reasonably uncommon issue, it is actually fairly widespread. Some estimates state that up to 12% of adults in the US suffer from gum recession in some shape or form.

The main issue with gum recession is that it is a slow and gradual process. Many people do not realize that their gums are receding until it is too late. Regular dental check-ups can help catch gum recession before gum grafting is required.

As you may have guessed from the name, gum recession is essentially a condition where the gum starts to pull away from the teeth. Over time, this process usually continues until small pockets start to form between the teeth and gums. These small pockets heavily promote bacterial build up. Without an excellent oral hygiene routine (or intervention from your dentist), this bacterial build up can cause severe issues over time.

If caught early enough, gum recession can be treated by your dentist without requiring gum grafting surgery. As such gum recession is not something you should delay in treating. It should be addressed as soon you think you might be suffering from it.

However, as we mentioned earlier this is often easier said than done due to the slow, gradual nature of the recession. Some early warning signs to look out for are:

  • Increased tooth sensitivity
  • Teeth looking slightly larger than usual
  • Small indentations where your teeth meet the gums

The first stage of the process is the installation of the titanium implants themselves. Under anesthetic, Dr. Choi will make a small incision into the gum to access the bone socket of the missing tooth. The titanium screw-like device will be attached securely and aligned perfectly. This is important to ensure an excellent fit when the replacement tooth is fitted.

The next part of the process is the healing stage. This is arguably the most important part of the whole procedure and can take anywhere from 6 to 12 weeks. During this time the bodies natural healing processes will enable the jawbone to regrow around the titanium implant. This effectively fuses it in place as part of your body. This is what provides the extreme stability and reliability of dental implants.

Once the healing process has been completed to Dr. Choi’s satisfaction, the next part of the process can begin. During this phase, a connector called an abutment is attached to the implant. The small but essential abutment is the object that helps your new tooth secure itself to the implant.

Once the abutment has been attached, it is time for Dr. Choi to start taking measurements of your mouth to enable your new tooth to be crafted. He will take molds and impressions of your teeth, and he will carefully model your current bite pattern. This accurate tried and tested process allows for the creation of a custom replacement tooth (or teeth), that will literally fit perfectly in your mouth.

Once the replacement tooth has been created, it will then be color-matched to your existing teeth. This is one of the most impressive parts of the process for many people. Color-matching technology and processes are extremely precise. There will not be any obvious difference between your new tooth and any existing ones.

When the tooth is ready, it is then attached to the abutment (which is attached to the implant) and the process is finished. At this point, you have a new tooth in your mouth that seamlessly blends in, and is as strong as (or stronger) than your other existing teeth.

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connective tissue grafting 8b
connective tissue grafting 8a

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Causes of gum recession


The number one cause of gum recession is gum disease. If gum disease is caught and treated while in the gingivitis stage, it is treatable and recession can be prevented. However, without treatment, over time gum recession is inevitable. Especially, when the gum disease reaches a more advanced stage known as periodontitis. At this point, a surgical procedure is required to remove the bacterial infection from underneath your gums.


Without an adequately comprehensive oral hygiene routine​that up to 30% of people​​​, gum recession is just one of the many issues that can be faced. Recession can occur when plaque in your mouth is not removed properly by brushing and flossing. Over time this plaque can turn into tartar, which promotes bacterial build up. This can create gum disease, which can then lead to gum recession.


Many people are seemingly unaware that brushing your teeth too vigorously can have negative consequences for your teeth and gums. One of these consequences is gum recession. Using a toothbrush that is too firm for your brushing style, or applying too much pressure while brushing can cause recession over time.


Grinding your teeth while sleeping (or awake) puts an almost constant and unusual amount of stress and pressure on your gums. Over time, this weakens the gums and can cause several issues, one of which is gum recession.


One of the less commonly known reasons for gum recession is related to female hormones. During puberty, pregnancy, and menopause a female can be much more likely to experience gum recession than normal.


Studies have shown that up to 30% of people have a genetic predisposition towards gum disease. The severity of the issue varies from person to person, but in rare cases, gum disease can be almost inevitable. As we mentioned earlier, gum disease can eventually lead to gum recession.


Tongue, cheek, and lip piercings are reasonably common causes of isolated instances of gum recession. Over time the piercing in the mouth can repeatedly rub against the gum, which slowly but surely wears them away causing gum recession.


When it comes to your health, there is not much that smoking does not harm. Smoking has numerous negative effects on your oral health, one of which is the build up of a sticky plaque on your teeth. This plaque can turn into tartar over time, which then causes gum disease and gum recession. The CDC state on their website that smokers are over 4 times more likely to develop gum disease as a result of their addiction.

If left untreated, gum recession can cause serious oral health issues. The small indentations that are formed in the gap between your teeth and gums continue to grow in size. They also continue to promote bacterial growth, which can increase the risk of gum disease and cause other issues.

Over time tooth loss is a possible outcome resulting from the recession itself, and the associated conditions it promotes.

Additionally, many people are unhappy with the way their mouth and smile looks when they have gum recession. When it has reached the point of it being easily noticeable by other people, this can cause mental health issues. Things like anxiety and self-confidence issues brought about by recession can have a real impact on people’s lives.

What is gum grafting surgery?

There are three main types of gum grafting surgery that are commonly used as treatment options. Connective tissue grafts, free gingival grafts, and pedicle grafts.


 Connective tissue grafts are the most common form of gum grafting surgery by far. The procedure sounds scary, but in reality, it is reasonably simple. A small and thin piece of your palate (the roof of your mouth) is cut to make a small flap. The dental surgeon will then remove a small amount of connective tissue from underneath the flap.

This tissue is then stitched to your gums, covering the exposed root and any gaps that have formed. At the end of the procedure, the flap in the roof of your mouth is stitched shut. The entire operation is conducted under local anesthetic and is painless.



A free gingival graft is very similar to the connective tissue graft that we described above. Again the dentist will take tissue from the roof of the mouth. But the main difference between the two surgeries is that a free gingival graft does not make a small flap (and then get tissue from underneath it). Instead with a free gingival graft, the tissue is taken directly from the roof of the mouth. This allows the dental surgeon to take more tissue in total.

This surgery is mainly performed on people who have thin or small gums, and need additional tissue for the surgery to be acceptable. Once the tissue has been extracted from the roof of the mouth, it is attached to the gums in a very similar manner to a connective tissue graft. Again the whole procedure is conducted under local anesthetic and is pain-free.



A pedicle graft is different to the two surgery types we mentioned above. An incision is made in the patient’s gums as close as possible to the exposed root that needs covering. This incision is made in such a way that it creates a flap of skin that is still partially attached to the gums.

The flap that has been created is then stretched down over the exposed root, and stitched into place to secure it. This keeps the discomfort experienced after the surgery localized. However, pedicle grafts are not always a viable treatment option because they require the patient to have an adequate amount of gum tissue remaining to safely create the flap.

There are also combinations of different techniques that can be used with the surgeries above (which some dentists prefer to utilize). For example, some dentists will suggest using tissue from a tissue bank instead of making an incision in the roof of the mouth. Occasionally, dentists will also use some kind of regenerative protein that encourages your body to naturally regrow bone and tissue around the affected area.

Because a local anesthetic is usually used, you will be able to drive yourself home, and you can leave the surgery as soon as your treatment has been completed.

Dr. Choi will give you specific instructions on how to care for your gums in the days following your treatment. You should always follow his advice, and ask him if you have any questions.

However, you can expect to be told not to floss or brush around the gumline for several days until it has healed properly. Doing so could interrupt the healing process and even cause infection. You will also be given advice on the kinds of food that you should try and eat. Again Dr. Choi will give you a thorough overview of acceptable food types, but generally the softer the food the better. Because of this, many patients like to eat a good meal of their favorite hard food the night before surgery (as it might be several days before they get to enjoy it again).

The pain and discomfort experienced during the healing process varies and depends upon the type of gum grafting surgery you have had. If no tissue was removed from the roof of your mouth, then you can expect the healing process to be nearly painless, and reasonably quick.

However, if your treatment required a tissue extraction from the roof of your mouth, discomfort will be more noticeable. Many people have made the anecdotal remark that it feels like a serious case of eating food that is too hot and burns the roof of your mouth. Discomfort can usually be subdued through the use of over the counter pain medicine, such as Ibubrofen.

After the healing process has been completed, you can then return to a normal, comprehensive oral hygiene routine. Some benefits of the treatment will be immediately noticeable. Any sensitivity to hot and cold temperatures that was brought on by your gum recession will be gone in an instant.

However, the most obvious improvement that many people concern themselves with is the improvement in appearance. Any self-confidence issues or anxiety that was brought about by the patients receding gums seemingly disappears in an instant. Patients are often happy and full of life. They love their beautiful set of happy healthy gums, and they want to show them to the world through a daily dose of smiling.



The Chao pinhole technique has gained quite a bit of media attention recently due to some well paid, and highly skilled marketing managers. On paper, the surgery sounds like it would be a game changer for people with receding gums. However, the Chao pinhole technique has some serious shortcomings that prevent us from recommending it as a treatment option.

The technique works by opening a very small pinhole in the gums close to the exposed root. The dentist then loosens the gum tissue exposed by the hole and slides it over the root to cover it. Patients who have the procedure are exposed to much less pain and have much faster recovery times than traditional techniques.

However, in our opinion, the success rate of the surgery is too low for Dr. Choi and the North Texas Dental Surgery team to offer to patients as a treatment option. Various estimates are bounded around the internet, but as far as we know, only one real world study has been conducted. It has been stated that results were “comparable” to traditional treatment methods in this small scale (less than 50 people) experiment. Anecdotally, we hear of much less promising success rates.

If you feel strongly about the technique, we highly advise you to independently research patient reviews and success rates. If after doing some research you still feel like it is the option for you, why not give Dr. Choi a call at 214-592-1630 to hear his professional medical opinion on the Chao pinhole technique.

Why is choosing the right dental surgeon important?

Dental implants are at the cutting edge of dental technology. They are one of the most advanced and complex procedures that a dentist can perform. Ensuring you choose the right surgeon is as important as brushing your teeth.

This is true for two main reasons. The invasive nature of dental implants means that while the procedure is painless, it can be uncomfortable. A patient will experience a lot of pulling, pushing, pressure, and drilling in and around their mouth. A highly skilled dental surgeon will be able to perform the procedure with speed and efficiency, minimizing your discomfort.

Dr. Choi is a board-certified surgeon. He has extensive experience in placing dental implants quickly, comfortably, and painlessly (in a calm and relaxed atmosphere).

The next reason for choosing your surgeon wisely is reasonably shocking to learn about. A small number of dentists that offer dental implants are driven by greed and financial gain (instead of their patient’s best interests). There are regular anecdotal reports of patients being pressured into having several of their healthy teeth removed and replaced by implants (when in reality it’s totally unnecessary).

This is an abuse of trust since most people believe they can trust their dentist. Most people recognize that their years of training and expertise puts dentists in the best position to make recommendations. Abuses like this for financial gain are disgusting.

This is admittedly a very rare occurrence, and the vast majority of dental surgeons in the USA are honorable, trustworthy people.

Dr. Choi abhors this detestable practice of putting profit before patients. He has never, and will never make a treatment recommendation to a patient that is not entirely based on their best interests.

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Frequently asked questions & additional information







This concludes our comprehensive overview of gum grafting surgery. We hope that after reading our guide you are a little bit more knowledgeable about the procedure than you once were. It’s a procedure that can get people worried, but in reality, pain and discomfort are minimal (despite the scary sounding name).

Dr. Choi has been performing gum grafting procedures at North Texas Dental Surgery for many years now. He has extensive experience in transforming his patient’s lives and smiles through his passion for dental surgery.

If you are experiencing signs of receding gums, or think you may need gum grafting surgery, then why not give Dr. Choi a call at 214-592-1630. His friendly and experienced team look forward to helping you regain the beautiful smile you once had.

Schedule your appointment now 

​and let us help you reclaim your smile.

or call: (214)592-0692