When Is It Too Late For Gum Grafting?

Did you think you had gum recession some time ago but ignored the signs? Perhaps you visited the dentist a while back and they recommended a gum grafting but you disregarded their advice? Has your gum recession got worse? Are you now worried that it’s too late for a gum graft?   

The good news is that it’s never too late to get treatment for gum recession

However, several factors influence how successful a gum graft is and the size of the initial recession does affect the outcome. Unfortunately, when the cause of gum recession is not addressed, gum recession worsens, bone loss occurs and gum grafting becomes more unpredictable. 

This post takes a closer look at gum recession and when it becomes too late for treatment. 

Too Late For Gum Grafting

Gum Recession and its Causes

Gum recession is when the edge, or to use its technical name, the margin shrinks back or pulls away from the teeth (1). 

When the gum recedes, the tooth roots become exposed. In its initial stages, you might just feel a small ridge. This is the junction between the crown (the bit of tooth above the gum) and the tooth root.  When left untreated root exposure increases and black triangles can form between the roots.

Gum recession can be caused by mechanical forces such as aggressive tooth brushing or oral piercings rubbing against the gums.  Gum recession can also be caused by loss of the bone and soft tissue that support and give structure to the gums. When bone is lost the gum tissue recedes. Bone loss is frequently caused by periodontal disease.

When Should You Get a Gum Graft?

You should enquire about a gum graft as soon as possible when you have gum recession. Your dentist may suggest a gum graft or treatments to prevent the gum tissue from receding further. 

The goal of a Gum Graft

A gum graft aims to increase the amount of gum tissue around the tooth and cover any root surfaces exposed by gum recession. This has several benefits which include: 

  • Protecting roots from decay
  • Reduces tooth sensitivity
  • Improves aesthetics of your smile
  • Improves gum health
  • Enables proper oral hygiene
  • Prevents further gum recession
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Can You Wait Too Long To Have A Gum Graft?

Sadly, yes you can wait too long to have a gum graft. 

Studies have shown that grafting procedures are more predictable and have a better outcome when the procedure is performed on mild gum recession when the recession is less than 4mm. Untreated gum recession progresses and bone loss around the teeth occurs along with further gum recession and it becomes harder to treat with a gum graft (2). 

Why It Might Be Too Late for a Gum Graft

It can be too late for grafting if your gum recession is severe. Gum recession is too severe in the following situations. 

  • There is a loss of alveolar bone that surrounds the tooth
  • Gum tissue has receded past the mucogingival junction – an area where two different types of gum tissue meet. 
  • When the papilla, the gum tissue that sits between the teeth recedes and flattens

The success of a gum graft is dependent on the grafted material having a blood supply. Blood brings essential oxygen and nutrients, without which the new tissue will be starved of oxygen and die. It will fall off. 

Adequate bone and papilla are required for an adequate supply of blood to the area. When these structures have been lost through severe gum recession and/or periodontal disease blood cannot be delivered to the grafted material. 

How Do Dentists Know It’s Too Late?

Periodontists use a classification system to assess the degree of gum recession along with other factors to predict the possible outcome of a gum graft. 

Classification of Gum Recession

In 1985, Professor PD Miller, a Clinical Professor at the Medical University of South Carolina classified gum recession into 4 groups based on how far the gums had receded along the tooth roots and whether there had been any bone loss (3).

This is a simple overview of the system. 

  • Class I – mild gum recession and no loss of bone or ligaments that hold the teeth in place. 
  • Class II –  no loss of bone but gums have receded to or past an area called the mucogingival
  • Junction. The gums are made up of two types of tissue and where these tissues meet is called the mucogingival junction.
  • Class III – the tissue has receded and there is a loss of bone and ligaments that secure the teeth to the bone. 
  • Class IV – there is severe bone loss and severe gum recession. There are large gaps between the tooth roots. This is often seen in those with advanced gum disease. 

If your gum recession is mild (class I or II) you could expect full coverage of your exposed roots with a gum graft.  

Those with class III gum recession could expect partial coverage of the exposed roots. However, whether you would be a suitable candidate may depend on whether you have lost the papilla and the extent of bone loss. 

Class IV recession is often seen in those with chronic periodontal disease. Unfortunately, a gum graft in these situations would not be successful and a gum graft wouldn’t be advised. 

Why You Should Still Seek Treatment

In some instances, you might not be suitable for the gum grafting procedure for a variety of factors or your gum recession might be too advanced. However, don’t put off seeking advice from a dental expert, as alternative treatments for gum recession are available and in many instances, the dentist will be able to help prevent the gum recession from worsening. 

Also, techniques and procedures are advancing all the time. Some gum recession defects that couldn’t be treated successfully 10 years ago with a gum graft can now be treated. Always contact your dentist and get their expert opinion of your unique situation. They will be able to advise you on the best treatment available for you. 

What A Dentist Might Suggest

If it’s too late for a gum graft or you’re not a suitable candidate, a dentist may suggest several alternatives depending on the cause of your gum recession. Alternatives include the following. 

  • Monitoring and prevention – if periodontal disease is causing gum recession, professional gum health treatments may be recommended along with a wait-and-see approach. First-class oral hygiene may prevent your gum recession from progressing to a stage which needs treatment.
  • Use of desensitizing agents – varnishes and dentine bonding agents can be applied to the roots to prevent sensitivity in instances where aesthetics is not a concern. 
  • Composite restorationcomposite resins can be applied to the tooth roots to cover and improve aesthetics. 
  • Removable gingival veneers – a removable gingival mask made from thermoactivated acrylic resin in a color similar to the gum tissue can be placed over the gums to hide the recession.
  • Orthodontics – clear aligners and braces can be used to realign teeth to improve aesthetics and prevent gum recession from worsening.
  • New surgical procedures – pinhole surgery and future techniques are being developed which may be able to address more advanced gum recession 

Final Thoughts

Whilst it can be too late for a gum graft, it’s never too late to seek advice and treatment for your gum recession. 

The sooner you seek dental advice the better. Gum grafts are more predictable and successful when they are performed during a mild gum recession. The longer you wait for treatment the more advanced your gum recession becomes and the harder it becomes to treat. 

Developing first-class oral hygiene that gently but effectively disrupts plaque bacteria without damaging the gentle gum tissue is the best way to prevent gum recession from developing or progressing further. We recommend a Gum Pocket Brush to reach those harmful periodontitis-causing bacteria in gum pockets that cannot be reached with a normal toothbrush.

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  1. Patel, M., Nixon, P. & Chan, MY. Gingival recession: part 1. Aetiology and non-surgical management. Br Dent J 211, 251–254 (2011). https://doi.org/10.1038/sj.bdj.2011.764
  2. Gingival recession – p1404. Vol. 138     http://jada.ada.org    October 2007
  3. Miller PD. Miller Classification of Marginal Tissue Recession Revisited After 35 Years. Compend Contin Educ Dent. 2018 Sep;39(8):514-520. PMID: 30188152. Available here: http://text2fa.ir/wp-content/uploads/Text2fa.ir-Miller-Classification-of-Marginal-Tissue-1.pdf
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Written by Gareth Edwards

Co-Founder & GDG Dentist

Dr. Gareth Edwards BDS (Hons) MFDS (RCPS Glasgow) is GDG Co-Founder and Gum Disease Expert.

He is a practicing dentist based in Bournemouth, UK and has treated thousands of patients with gum-related diseases.

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