Lost gum tissue, known as gingiva, cannot naturally regenerate to its original form or height; the body’s natural healing process for gum recession is limited to simple repair. Once tissue is lost due to trauma or disease, the structure does not grow back. Modern periodontics offers predictable surgical solutions, such as grafting and guided regeneration techniques, to restore lost tissue and underlying supporting structures. These procedures overcome the biological limitations of the body’s natural healing response.
The Limits of Natural Gum Tissue Healing
The primary limitation to natural gum tissue regrowth is a biological competition for space during healing. When supporting tissues are damaged, the body attempts repair, not true regeneration. True regeneration requires the complete restoration of original structures, including new alveolar bone, cementum, and a functional periodontal ligament.
Four cell types compete to repopulate the exposed root surface: epithelial cells, gingival connective tissue cells, bone cells, and periodontal ligament (PDL) cells. Epithelial cells, which form the gingiva, are the fastest-growing and quickly migrate down the root surface. This rapid migration forms a “long junctional epithelium,” creating a soft tissue seal but failing to re-establish structural attachment to the bone. Slower-growing PDL cells, which are necessary for forming new cementum and a functional ligament, are physically blocked from the root surface, preventing healthy attachment reformation.
Surgical Approaches to Tissue Restoration
Since the body cannot regenerate lost tissue structures, surgical intervention is used to physically replace gum tissue or guide the growth of new supporting tissue. Soft tissue grafts are the most common restorative procedures, effective for covering exposed root surfaces and thickening thin gum tissue.
Soft Tissue Grafts
The connective tissue graft (CTG) involves harvesting the subepithelial connective tissue layer, typically from the palate, and transplanting it to the recession area. This establishes a robust layer of gum over the exposed root surface, improving density and appearance.
The free gingival graft removes a small amount of the top layer of tissue directly from the palate and attaches it to the recipient site. This technique is employed primarily to increase the width and thickness of the attached gingiva.
The pedicle graft involves sliding adjacent gum tissue over the exposed root while keeping one edge attached to maintain its blood supply. This local flap technique is only feasible when sufficient healthy gum tissue is immediately next to the recession defect.
Guided Tissue Regeneration (GTR)
For defects involving the loss of underlying bone structure, GTR is employed. This technique addresses the biological failure of natural healing by placing a biocompatible barrier membrane over the bony defect and exposed root surface. The membrane acts as a physical shield, excluding fast-migrating epithelial cells and gingival connective tissue. This strategic exclusion creates a protected space, allowing time for slower-growing PDL cells and bone cells to migrate and successfully regenerate the lost cementum, periodontal ligament, and alveolar bone.
Maintaining Gum Health to Prevent Future Loss
Once gum tissue has been restored through surgery, long-term care is necessary to prevent the recurrence of recession or periodontal disease. Proper oral hygiene includes using a soft-bristled toothbrush to prevent physical abrasion to the gum margin. Brushing should be performed with gentle, circular, or vertical motions, avoiding aggressive horizontal scrubbing that can traumatize the tissue.
Daily flossing removes plaque and food particles from between the teeth and along the gumline, preventing the inflammation that drives tissue loss. Plaque that is not removed hardens into tartar, which requires professional cleaning. Regular dental check-ups and professional scaling are necessary for monitoring gum health and removing hardened deposits that contribute to periodontal disease.
Lifestyle factors also influence gum health. Tobacco use compromises the gums’ ability to heal and increases disease risk, making cessation a high priority. A balanced diet rich in nutrients like Vitamin C supports the health and resilience of the gum tissues. Managing conditions such as teeth grinding (bruxism), often with a night guard, prevents excessive mechanical pressure on the supporting structures.