Gum Grafting and Recession Treatment in Ukraine

Recession is when the gum margin recedes and exposes part of the tooth root. The reference point is the cemento-enamel junction: normally the gum covers it, but with recession 1–5 mm or more of root shows above the gum. The root is covered not by enamel but by cementum, so it looks darker, wears faster and is more sensitive to cold.

There are usually several causes at once: a thin gum phenotype and a narrow band of keratinised gum, missing bone over the outer surface of the root, hard brushing with horizontal strokes and a hard brush, a high frenulum or muscle attachments, a tooth moved outside the bone during orthodontic treatment, chronic gum inflammation, or a lip or tongue piercing. The cause determines not only the technique but also whether the result will last.

The surgery is not only about appearance. An exposed root is sensitive to cold, sweet things and touch, is prone to decay at the gum line and is harder to clean, and an area without firm gum is easily injured by the toothbrush and becomes inflamed. Another reason is preparation for orthodontic treatment or crowns: with thin tissue, moving a tooth or placing a crown margin often makes a recession worse, so the gum is thickened in advance rather than after a problem appears.

The doctor decides on treatment after taking measurements, and not every recession needs surgery. A shallow defect that is not sensitive or getting worse is monitored: it is photographed and measured every six months and, above all, brushing technique is corrected. Surgery is not done with active inflammation and poor hygiene, uncontrolled periodontitis, or when the bone and papilla between the teeth have already been lost: in that case the root cannot be covered, and this needs to be discussed before surgery, not after.

MediUkraine is a treatment search and coordination service, not a clinic. We choose the clinic and a doctor with the right specialism, arrange the visit dates and support you throughout, including if you are travelling from abroad. The diagnosis, indications and treatment plan are decided by the doctor after an in-person examination.

How much of the root can be covered depends not on the technique but on the tissue between the teeth, so everything starts with classification. The Miller classification has four classes: I, the recession does not reach the mucogingival junction, and the bone and papilla between the teeth are preserved; II, the recession reaches or extends beyond the junction, but there is no loss between the teeth; III, there is already loss of bone or soft tissue between the teeth, or the tooth is out of position; IV, marked tissue loss all around the tooth. In Classes I and II full root coverage is predictable, in Class III partial coverage is usually the realistic goal, and in Class IV the root cannot be covered.

The later Cairo classification (RT1, RT2, RT3) does the same thing more simply, based on the attachment level between the teeth, which the doctor measures with a probe rather than judging by eye. RT1 means no attachment loss between the teeth, RT2 means loss between the teeth no greater than on the outer surface, and RT3 means greater loss between the teeth. The practical point is the same: the height of the papilla between the teeth is the ceiling, and the gum margin will not rise above it after surgery.

The coronally advanced flap is the basic operation for covering recession. The gum over the defect is lifted, released and moved up above the cemento-enamel junction, where it is secured with microsutures. The method works where a band of firm keratinised gum remains below the recession; on its own it adds almost no thickness, so it is used without a graft only with a thick phenotype and shallow defects.

The tunnel technique needs no vertical incisions: special instruments are passed through the gum crevice to create a tunnel under the papillae, and the flap stays in one piece. The blood supply suffers less and there are no incision scars, which is why it is often chosen in the smile zone and for several neighbouring recessions. The tunnel is almost always combined with a graft, which is slid into the space and drawn up with sutures together with the gum margin.

A connective tissue graft from the palate remains the gold standard against which other materials are judged. A piece about 1–1.5 mm thick is taken from between the canine and the first molar, a few millimetres from the gum margin; the palatine artery runs deeper, so the soft-tissue thickness is assessed in advance. The donor wound is closed with sutures, a collagen sponge and a protective plate, and the surface heals over in about 2–3 weeks. The graft thickens the gum and widens the band of keratinised tissue, and this is what determines whether the gum margin will hold a year later.

A free gingival graft solves a different problem: not covering the root but creating a band of firm gum where there is none. It is taken from the palate with its surface layer and stitched onto a prepared site. The method is predictable, but the grafted area usually differs in colour and texture from the surrounding gum, so it is used sparingly in visible areas and more often in the lower jaw, around implants and before crowns or bridges.

Substitutes for your own tissue avoid a second wound. A xenogeneic collagen matrix or an acellular dermal matrix causes less discomfort and is not limited by the size of the palate; studies show they come close to a graft for root coverage but fall short of it for gain in tissue thickness. Enamel matrix proteins applied to the cleaned root surface are also used as an adjunct. The choice of material depends on the area of the recessions, the thickness of the palate and how much of a gain in gum volume is needed.

Sometimes working on the gum alone is not enough. A laterally positioned flap is used for a single defect when the neighbouring area has enough tissue to donate; vestibuloplasty deepens the vestibule if soft-tissue tension keeps pulling the gum margin down; a high or thick frenulum needs separate surgery, which has its own page in our catalogue. With a wedge-shaped defect or wear at the neck of the tooth, surgery is combined with a filling: the part of the defect nearer the crown is restored with composite, and the part nearer the root tip is covered with your own tissue.

Gummy smile correction is a related branch of the same surgery. Excessive gum display is generally defined as roughly 3–4 mm or more in a broad smile, and the causes vary: incomplete eruption, where the gum covers part of the crown, excessive vertical growth of the upper jaw, or a short or overactive upper lip. For incomplete eruption, gingivoplasty with clinical crown lengthening is performed; the attachment zone above the bone crest, about 3 mm, must always be respected, otherwise the gum margin will grow back or chronic inflammation will develop.

When the cause is not in the gums, gum surgery will not help. For an overactive lip, lip repositioning surgery or temporary muscle relaxation with botulinum toxin may be considered; the effect lasts about 4–6 months and needs repeating. The skeletal form, excessive vertical growth of the upper jaw, is treated with orthognathic surgery together with a maxillofacial surgeon, while over-erupted front teeth are corrected orthodontically. So the first step with a gummy smile is finding the cause, not booking a gingivoplasty.

For the first two or three days expect swelling, possibly bruising on the cheek and an ache that ordinary painkillers relieve. On the first day apply cold to the cheek, and sleep with your head raised on a high pillow. The donor site on the palate is usually more uncomfortable than the grafted area itself, especially when eating.

Do not brush the treated area for 2–4 weeks: pressure can shift the flap and graft, which in the first days are held only by stitches and a thin layer of fibrin. Instead, use 0.12% chlorhexidine rinses or applications twice a day. Brush the rest of your teeth as usual, and go back to a normal toothbrush on the treated area only when the doctor says so, and without pressure.

For a week, stick to soft, cool food (nothing hot, spicy or hard) and avoid sport, saunas and straining or bending over. Do not pull your lip back to look at the surgical site: this is the most common way the flap gets displaced. Stitches come out on day 10–14, sometimes in two stages: first from the palate, then from the grafted area.

There is no point judging how the gum looks as soon as the stitches come out. Swelling and redness subside over 1–2 months, colour and texture even out more slowly, and the final contour forms after 3–6 months. That is when follow-up photos are taken from the same angles and compared with the pre-surgery ones.

The result is measured in millimetres, not judged by eye: the doctor re-measures the recession depth and the width of keratinised gum. In Miller Classes I and II full root coverage is predictable; in Class III partial coverage is agreed as the goal before surgery. In some patients the gum margin creeps a little further over the root over the following months, adding 0.5–1 mm.

Sensitivity usually decreases once the root is covered, although in the first weeks it can even get worse because of the procedure itself. After that, the result depends on two things: careful daily hygiene and removing the cause of the recession. Check-ups with professional cleaning are scheduled every 3–6 months, and only a doctor can predict the result in your case, after an examination.