by Neff DM
(Guided Tissue Regeneration)


Periodontal disease often refers to bacterial plaque and infections around the gum and tooth root. It can happen around one or several teeth. In some cases, the gum tissue is damaged or shrinks. In its more advanced stages, surgery to create new gum tissue (and even bone growth) can be done. There are several techniques used to encourage new gum growth using donor tissue, man-made material, or tissue from the roof of your mouth.

Periodontal Disease
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Reasons for Procedure

This surgery is needed to:

  • Cover tooth roots that are exposed, which can lead to bone loss and decay
  • Reduce tooth sensitivity
  • Even out gum tissue due to reduce further recession

Not all grafts are successful over time. The level of disease and your personal care routines will affect success.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your periodontist will review potential problems, like:

  • Changes in gum appearance such as an uneven gum line
  • Graft may move out of place, which can result in needing another procedure
  • Bleeding, which can lead to a hematoma
  • Infection
  • Swelling
  • Reaction to the sedation

Before your procedure, talk to your periodontist about ways to manage factors that may increase your risk of complications such as:

What to Expect

Prior to Procedure

  • Tell your periodontist of any recent changes to your health, medications, allergies, or supplements.
  • Take your prescription medications, unless your periodontist says otherwise.
  • Talk to your periodontist or pharmacist if you are taking more than one drug. Some drugs can be dangerous when mixed. This includes over-the-counter medications and herb or dietary supplements.
  • You may be asked to take an antibiotic before surgery.
  • Arrange for a ride if you are having sedation.

Sometimes, sedative medications are used to make you more relaxed during surgery. If you are undergoing conscious sedation, you will be asked to not eat for at least 6 hours before surgery. Otherwise, you can follow a normal diet.


A local anesthetic will be used near the affected gum area.

Your periodontist may recommend conscious sedation. You will be awake, but will have no anxiety during the surgery.

Description of Procedure

This surgery is usually done in an outpatient setting. You do not need to stay overnight. If you are undergoing sedation, the periodontist or nurse will place an IV in your arm to deliver medication. Your heart rate, blood pressure, and breathing will be monitored during and after the surgery.

The periodontist will numb the affected area with a local anesthetic delivered through a needle. The periodontist will make a small cut in the roof of your mouth and remove surface and/or connective (under the surface) tissue. This is the donor tissue that will be used for the graft. This area will then be stitched closed.

The new tissue flap will be repositioned on the damaged gum line and stitched into place. A dressing will be applied. A piece of mesh is sometimes placed between the gum and tooth to encourage growth.

If there is not enough donor tissue available on you, tissue from another person or man-made materials may be used.

How Long Will It Take?

The time it takes to complete the surgery depends on the level of damage and how much of the gum areas are affected.

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Post-procedure Care

At the Periodontist Office

During your stay, the staff will take steps to reduce your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chance of infection, such as:

  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home

Healing will take place over the next 4-8 weeks. During this time, pain and swelling can be managed with ice packs, medication, and changes to your diet. Changes may include eating soft or bland foods. You may have to restrict activity for a few days. Be sure to follow your periodontist's instructions.

Call Your Periodontist

It is important for you to monitor your recovery. Alert your periodontist to any problems right away. If any of the following occur, call your periodontist:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, a lot of bleeding, or any unusual discharge from the surgical site(s)
  • Pain and swelling that is not controlled with the medications given
  • The dressing or stitches become loose or are uncomfortable
  • Loose tissue
  • Continued swelling after 48 hours
  • Persistent nausea and vomiting
  • New or unexpected symptoms

If you think you have an emergency, call for emergency medical services right away.


American Academy of Periodontology 

National Institute of Dental and Craniofacial Research 


Canadian Dental Association 

Dental Hygiene Canada 


Gingivectomy. Encyclopedia of Surgery website. Available at: Accessed September 13, 2017.

Gum graft surgery. American Academy of Periodontology website. Available at: Accessed September 13, 2017.

Gum graft surgery: Indications, successe rate and possible complications. Net Wellness website. Available at: Accessed September 13, 2017.

Periodontal (gum) disease: Causes, symptoms, and treatments. National Institute of Dental and Craniofacial Research website. Available at: Updated September 2013. Accessed September 13, 2017.

Periodontal pocket reduction procedures. American Academy of Periodontology website. Available at: Accessed September 13, 2017.

6/2/2011 DynaMed Plus Systematic Literature Surveillance  : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.

Revision Information

  • Reviewer: EBSCO Medical Review Board Michael Woods, MD
  • Review Date: 09/2018
  • Update Date: 09/13/2017