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If you’re considering or have just had a gum graft you may be wondering how your grafted tissue will heal, and how the body systems will work to integrate the grafted tissue and repair the wound.
Your body has a complex but fragile way of repairing and replacing damaged tissue throughout the body including the gums. During a gum graft incisions are made in the gums for the grafted material, damaging them. A regulated sequence of events is set into motion to repair the damage and integrate the grafted tissue.
The expert dentists here at the Gum Disease Guide explain the gum grafting healing stages – we’ll give you an idea of what the wound will look like and what’s going on as heals.
Gum Graft Healing Stages
Your gum graft heals in four main predictable but overlapping stages. The stages are
- Stop the bleeding – blood clotting (hemostasis)
- Defend and clean up the area – Inflammation
- Repair – Tissue growth (cell proliferation)
- Heal – Tissue remodeling (maturation and cell differentiation)
Stage 1 – Stop The Bleeding
Whilst there are several different gum graft procedures, in general, to prepare your gums the periodontist will make an incision into your gums and place the donor material over the exposed root. The grafted tissue is then stitched into place.
Within minutes of this, platelets (small, colorless cell fragments sometimes called thrombocytes) stick to the injured site. They change shape and release chemical signals that promote clotting. Fibrin (a tough protein substance) is activated and forms a mesh. This mesh binds with the platelets like glue to make a clot and plugs the blood vessel. Bleeding is slowed and stopped.
The graft will be a pale white color as it has no blood supply. The side of the graft becomes covered by the fibrin mesh.
Stage 2 – Defend and Clean Up The Area – Inflammation
The day after surgery your gums will be a deep red color indicating inflammation and a build-up of blood in the area. The area might feel a little warm but this is nothing to worry about.
A little layer of fluid separates the grafted tissue from your natural gum tissue for a couple of days [we mention below that the graft can’t survive without a blood supply – if it’s not connected to your gum how’s it getting oxygen etc? It’s being kept alive by plasma – a straw-colored fluid that blood cells float around in – it contains hormones, nutrients, and proteins and helps exchange oxygen and carbon dioxide.]
During this stage – the very top layers of the graft become necrotic – they die and start to flake off (this doesn’t mean that the graft has failed). It may look a yellowish-white or gray color (find our why your gum graft looks gray).
Special cells called phagocytes remove any damaged or dead cells, along with bacteria or cells which might cause infection.
Platelet-derived growth factor (PDGF) is released into the wound which causes the migration and division of cells for the next phase. PDGF plays an important role in the growth of blood vessels which will grow into the grafted material. The fancy word for the growth of blood vessels into the area is angiogenesis which starts around day 3 or 4.
Stage 3 – Repair – Tissue Growth (cell proliferation)
Once the wound has been cleared of debris and bacteria the area is ready to be repaired and rebuilt. The area around the graft will become less inflamed and red.
Oxygen, cells, and hormones will be delivered to the area for angiogenesis and new tissue can be built to repair the area.
At around day 7 days the graft should start to connect with the surrounding tissue. It will be a mixture of red-pink and white opaque areas. Special cells called fibroblasts grip the wound edges, contract, and decrease the size of the wound.
After 14 days the graft will have fused with your original gum tissue.
Stage 4 – The Tissues Mature
After 2 weeks it may look like your graft has fused but the healing process will continue for up to a year or so. The tissue will be remodeled and mature. Sometimes the area might feel a little tight or itchy as this happens.
How Long Does It Take For The Gum Graft to Heal?
After around 3 months most wounds have fully healed and the graft will be completely integrated. The gum will be almost as strong as it was originally. Between 21 days and 3 months, the graft will make a transition from reddish-pink to a white-pink color, indicating that the gum tissue has been completely regenerated.
Poor Gum Graft Healing
Blood supply is one of the most important things in wound healing and the success of your gum graft. The grafted tissue does not have a blood supply when it is placed over your exposed root and it cannot survive unless capillaries (small blood vessels) grow into it.
Blood carries oxygen, nutrients, blood cells, immune cells, and other factors that a wound needs to heal and the grafted tissue needs to survive.
Age, some health conditions, and environmental factors can affect how quickly you heal. How quickly your wound heals can be slowed by
- Diabetes
- Obesity
- High blood pressure (hypertension)
- Vascular disease
- Smoking – nicotine causes blood vessels to constrict and reduces blood flow to the area.
Some health conditions are associated with an adverse outcome so in those cases, you may be excluded from having a gum graft procedure.
Signs of an Infected Gum Graft
If your gum graft becomes infected it may slow the wound healing down. This is because the body is busy trying to get rid of the infection and can’t start repairing and healing the area.
Infections happen when bacteria, fungi, or other germs get into the wound before it has had time to heal.
Signs that your gum graft is infected are
- Severe swelling in the area
- Swollen lymph glands
- Evidence of pus or fluid coming out of the graft site
Treatment
You will be advised not to brush the area and one of the following treatments may be recommended:
- Antibiotics
- Anti-inflammatories
- An antibacterial mouth rinse.
When to see a Dentist
If you think you have an infected wound contact your periodontist or dentist as soon as possible. An infection could delay wound healing and the success of your graft. The good news is that according to the Canadian dental association, only 2% of grafts fail.
To Summarize
Your gum graft goes through many stages as it heals.
In the beginning, the area around the wound might look red, inflamed, and watery. After a few days, the inflammation will subside and return to its normal color.
The grafted tissue will initially look white as it has no blood supply. It will then turn a yellowish-cream color and will gradually transition to a reddish-pink color and then a white-pink color.
References
- Healing Progression of the Free Gingival Graft. M. McClain Woolsey, DDS, Donna L. Sneddon, Keerthana Satheesh, DDS, MS, Simon R. MacNeill, BDS, DDS and Charles M. Cobb, DDS, MS, PhD On Oct 6, 2020. Accessed 7/11/22. Available here: https://decisionsindentistry.com/article/healing-progression-of-the-free-gingival-graft/
- Managing Patients with Gingival Graft Failure or Loss. J Can Dent Assoc 2014;80:e17. Available here: https://jcda.ca/article/e17. Accessed 7/11/22
- The Four Stages of Wound Healing. Available here: https://www.woundsource.com/blog/four-stages-wound-healing. Accessed 7/11/22
