by Rana Baroudi
Dr. Baroudi is a Board Certified Periodontist. She has successfully passed the American Board of Periodontology oral and written examinations covering all phases of periodontal disease, its treatment and dental implants. She is also an Associate Clinical Professor of Periodontology at UCSF where she enjoys teaching and lecturing on a bi-monthly basis.
Learn MoreWhen addressing exposed tooth roots, receding gums, or insufficient gum tissue, two of the most effective interventions are a connective tissue grafting and a free gingival grafting. Both procedures fall under the umbrella of gum grafting but have distinct uses, benefits, and recovery experiences. This guide will help you understand which option is best suited to your oral health goals.
Soft tissue grafting serves to enhance the gum line in different ways. While both techniques draw from your own palate to restore gums, the specifics differ:
A connective tissue graft involves harvesting sub-epithelial tissue from underneath the top layer of the palate. Because only the underlying layer is needed, the overlying surface heals quicker, often reducing discomfort and speeding up recovery. This graft is typically used to cover exposed roots, improve aesthetics, and reduce sensitivity.
A free gingival graft involves removing a full-thickness wedge of tissue—epithelium included—directly from the palate and transplanting it to the recipient site. This method is especially useful when building up thin gum tissue to create a wider band of keratinized tissue.
Connective tissue grafts excel at covering root surfaces and improving both function and aesthetics. They’re the go-to for gum recession paired with sensitivity or aesthetic concerns. Free gingival grafts, on the other hand, are optimal for patients with very thin gums who need to build a more robust, firm gum band—this contributes to long-term gum stability.
Harvesting: Connective tissue graft: Only deep tissue is removed, preserving the palate’s outer lining. Free gingival graft: A wedge-shaped piece including surface gum is taken. Placement: Both grafts are carefully sutured at the recipient site. Techniques like tunneling may be used to minimize trauma and maximize integration. Healing: Connective tissue graft: Faster healing, typically less discomfort. Free gingival graft: May feel grittier until the new epithelium settles.
Connective Tissue Grafting: Aesthetic improvements thanks to excellent color match. Reduced sensitivity by covering exposed roots. Faster post-op comfort due to minimally invasive donor site. Versatility: Can address multiple recession sites with less donor tissue. Free Gingival Grafting: Stronger tissue resistance; builds durable, keratinized gum. Predictable increase in gum height and thickness. Ideal for thin tissue without relying on donor tissue beneath epithelium.
Connective tissue patients often resume soft foods within a few days. Post-op discomfort is mild, with pain diminishing quickly. Free gingival recipients may experience temporary textural mismatch but it levels out in weeks. The donor site takes 1–2 weeks to fully heal. Your ability to follow aftercare instructions—like avoiding brushing near graft sites and using prescribed rinses—greatly influences outcomes. Commitment to recovery is key.
Both graft types show excellent long-term stability and patient satisfaction. Maintaining gum health post-surgery involves consistent oral hygiene (brushing, flossing), regular cleaning visits, and addressing risk factors like aggressive brushing, gum disease, vaping, or teeth grinding. Regular check-ups ensure your gum tissue remains healthy and intact.
Choosing between a connective tissue graft and a free gingival graft depends on your individual goals:
Health matters: both procedures require good oral health. Underlying gum disease should be controlled first. Gum thickness and site: CT grafts adapt well around front teeth; free grafts are more useful for back areas with thin tissue.
During your consultation, you can expect a comprehensive review: dental and medical history, oral exam with precise measurements, and a customized treatment plan outlining graft type, cost, recovery, and benefits. This personalized evaluation ensures the approach aligns with your goals—addressing both functional and aesthetic priorities.
Many patients note immediate improvements in comfort after a connective tissue graft, with minimal swelling and root coverage that reduces sensitivity. Others undergoing free gingival grafting appreciate the long-term stability of a wider, firmer gum band, even if the texture takes time to normalize.
Connective tissue grafts may require multiple sites but often use less tissue, which can moderate costs. Free gingival grafts may involve more tissue harvesting, potentially increasing the cost slightly. Overall pricing depends on the number of sites, extent of recession, and whether additional procedures (like crowns or orthodontics) are needed. Typically, both procedures are comparable, with cost differences mainly driven by complexity.
Is pain worse with one graft vs. the other? Both involve numbing during surgery. Post-op, CT grafts often cause less discomfort because only deeper tissue is harvested, leaving the outer palate intact.
Can both techniques be used together? Yes, in complex cases, a combined approach might be ideal: a CT graft for coverage and a free gingival graft to build tissue strength.
How long do grafts last? When paired with good oral care, grafts can remain healthy for decades, providing lasting root protection and gum aesthetics.
What happens if a graft doesn’t take? Fortunately, failures are rare. If issues arise, your specialist may suggest a touch-up or alternative procedure, based on thorough evaluation.
Connective tissue grafts are best for root coverage, natural gum aesthetics, and quick recovery. Free gingival grafts are optimal for reinforcing thin gum tissue and achieving stable keratinized gum bands. Consult with a specialist to determine which gum grafting method aligns with your oral health needs and cosmetic goals. This investment in your gum health is an investment in long-term dental wellness.
