Gum recession around a dental implant is fixable, but the approach depends on how much tissue has been lost and what caused the recession in the first place. The most common fix is a soft tissue graft, where a periodontist adds gum tissue to rebuild coverage around the implant. In milder cases, adjusting the implant crown itself can improve appearance without surgery. The key is addressing the underlying cause first, then restoring the tissue or masking the problem.
Why Gums Recede Around Implants
Gum recession around implants happens for different reasons than recession around natural teeth, and understanding the cause shapes how your dentist will treat it. The most common culprits are thin gum tissue, bacterial infection, and improper implant positioning.
People with naturally thin gum tissue are more prone to recession because there simply isn’t enough tissue bulk to maintain a stable seal around the implant. The thinner the tissue surrounding an implant, the higher the risk of inflammation and pulling away over time. Ideally, you need at least 2 mm of firm, attached gum tissue around an implant to keep things stable and allow for proper cleaning.
Infection is the other major driver. When bacteria invade the tissue around an implant, it triggers inflammation that can destroy both soft tissue and bone. This condition, called peri-implantitis, shows up as swollen or bleeding gums, deepening pockets around the implant, and visible bone loss on X-rays. Unlike gum disease around natural teeth, bone loss around implants can progress quickly once it starts.
Other contributing factors include the implant being placed too far forward or at the wrong angle, shifting of neighboring teeth that changes how forces distribute across the area, and systemic conditions like diabetes that slow healing and make tissue more vulnerable.
Soft Tissue Grafting: The Primary Fix
For moderate to significant recession, soft tissue grafting is the standard treatment. A periodontist takes a small piece of tissue, usually from the roof of your mouth, and places it over or around the exposed implant area to rebuild the gum line. This is the same general concept as gum grafting for natural teeth, but the techniques are adapted for the unique anatomy around implants.
Treatment often happens in stages rather than all at once. A typical sequence starts with a connective tissue graft to thicken the gum and increase the band of firm tissue around the implant. A second procedure may then use another graft to physically move the tissue higher up the implant, covering the exposed portion. In some cases, a third procedure uses a donor tissue substitute to add further coverage or mask any metal that shows through the gums. This staged approach gives each layer of tissue time to establish blood supply and heal before the next step.
During the procedure itself, the periodontist creates a small pocket in the existing gum tissue without fully detaching it, slides the graft material underneath, and repositions the tissue higher on the implant before suturing everything in place. By keeping the surrounding gum largely intact, blood flow stays consistent and healing tends to be faster.
Grafting produces measurable results. Studies show an average gain of about 1.6 mm in gum height and roughly 1.3 mm of added tissue thickness. That may not sound like much, but even a millimeter or two of coverage can make the difference between a visible metal line and a natural-looking result.
Crown and Abutment Adjustments
Not every case of recession needs surgery. When the recession is mild, or as a complement to grafting, your dentist can modify the implant crown to improve how things look and function.
The most common adjustments involve reshaping the crown’s emergence profile, which is the way the crown flares out from the implant to meet the gum line. A poorly contoured crown can trap plaque, push tissue away, or create dark triangles between teeth. Refining the crown shape, adjusting where it contacts neighboring teeth, and polishing rough surfaces can reduce irritation and help grafted tissue stay healthy long term.
In some cases, the crown needs to be completely remade with a slightly longer or differently shaped base that covers the recession zone. Your periodontist and restorative dentist typically coordinate this together, often following a “stabilize, graft, then refine” sequence to get the most predictable outcome.
What Happens if Infection Is Involved
If peri-implantitis is driving the recession, grafting alone won’t solve the problem. The infection needs to be controlled first, or any new tissue will break down the same way the original tissue did.
Treatment starts with a thorough cleaning of the implant surface to remove bacterial buildup. Depending on severity, this may involve opening the gum to access the implant threads directly. If bone has been lost, bone grafting may be done at the same time to rebuild the foundation. Studies show bone grafting techniques can recover an average of 3 to 4 mm of vertical bone height in favorable cases, which creates a better platform for soft tissue to reattach.
Once the infection is resolved and the site is stable, soft tissue grafting can proceed. Rushing to graft over an actively infected site is one of the most common reasons treatment fails.
Minimally Invasive Options
The Pinhole Surgical Technique is a newer, less invasive approach to recession that avoids the traditional incisions and palate donor site. Instead of cutting and suturing a graft, the periodontist makes a tiny hole in the gum, loosens the tissue through it, and slides it into a better position. Because there’s no flap and no second surgical site, patients experience less pain and faster early healing.
There’s an important caveat: this technique was developed and studied for recession around natural teeth, specifically milder cases where the bone between teeth is still intact. Its use around implants is not well established in the research, and the anatomy around an implant differs significantly from a natural tooth root. If a provider suggests this approach for your implant, it’s worth asking about their specific experience using it in implant cases.
Recovery After Gum Grafting
Recovery from a soft tissue graft around an implant follows a fairly predictable timeline, though staged procedures mean you may go through recovery more than once. For the first week, expect swelling, tenderness, and a soft-food diet. The palate donor site, if tissue was taken from there, is often the most uncomfortable part. Pain from grafting procedures is consistently higher than from less invasive alternatives, but it’s manageable with standard pain relief.
You’ll need to avoid brushing or flossing the grafted area for at least two weeks to let the tissue integrate without being disturbed. Your periodontist will typically have you use a gentle rinse instead. By three to four weeks, the surface is usually healed enough for light brushing with a soft-bristled brush. Full maturation of the graft, where the tissue thickens, firms up, and settles into its final position, takes three to six months.
During this period, avoid anything that pulls on the tissue: aggressive chewing near the site, using a straw, or stretching your lip to check on the graft. The tissue needs an uninterrupted blood supply to survive, and mechanical disruption is the leading cause of graft failure.
Factors That Affect Your Outcome
Several things influence how well treatment works. Gum tissue thickness is one of the biggest predictors. People with naturally thick, firm tissue tend to heal better and maintain results longer than those with thin, delicate tissue. If you started with thin tissue, your periodontist may recommend a thickening graft before attempting coverage.
Implant position matters enormously. An implant placed too far toward the outer surface of the jawbone leaves less room for tissue and makes recession harder to correct. In severe cases where the implant is badly positioned, grafting may improve things but not fully resolve them, and implant removal and replacement in a better position is sometimes the most reliable long-term solution.
Your oral hygiene and overall health also play a role. Smoking significantly reduces graft survival. Uncontrolled diabetes slows healing. And poor plaque control around the implant can restart the cycle of inflammation and recession even after successful grafting. Maintaining adequate firm tissue around the implant, keeping the area clean, and attending regular maintenance visits are what protect the investment over time.