Free Gingival Graft for Thin Tissue on the Lower Front Teeth
The lower front teeth with thin tissue and no band of attached gum below them. When thickness and durability matter more than covering a root that shows, a free gingival graft is the predictable choice. Before and after healing.
What the Patient Noticed
Recession creeping down the lower front teeth. The tissue below them was thin and red, with no firm band of attached gum, so every movement of the lip pulled on the gumline. Thin tissue with no attached band below it is the pattern most likely to keep receding.
Why a Free Gingival Graft
There are two grafts to choose from, and they solve different problems. Connective tissue grafts placed under the gum are the better documented option for covering an exposed root: the systematic review Chambrone and Tatakis prepared for the AAP Regeneration Workshop found that connective tissue graft procedures gave the best outcomes for clinical practice, with superior mean and complete root coverage and a significant increase in keratinized tissue. They also blend in, which matters in the smile. A free gingival graft placed on the surface builds a wide, thick, durable band of attached gum, which is what these lower front teeth needed. Behind the lower lip, durability outranks a perfect color match. Connective tissue graft or free gingival graft goes through the reasoning.
What Was Done
A piece of the surface tissue of the palate was placed across the site below the lower front teeth and sutured in. The palate donor site is the sore part of the recovery for about two weeks. Gum grafting covers the procedure and the recovery.
The Result
A broad, thick band of firm, pale tissue below the teeth, with the gumline stable and the tissue no longer moving with the lip at the time of the photograph. Free gingival grafts stay slightly paler than the surrounding gum, which was the trade-off accepted here for a thicker, more durable band.