Gingival tissue, commonly known as gums, provides a protective seal around the teeth, shielding the sensitive tooth root and underlying bone. When this soft tissue recedes, the body does not possess the inherent ability to naturally restore the lost structure. While the gingiva heals from minor injury, the complex biological attachment to the tooth cannot be spontaneously reformed once destroyed, making intervention necessary.
The Biological Limits of Gum Regeneration
The inability of gums to grow back is rooted in the specialized structure of the tooth-supporting tissues. Unlike skin or bone, the attachment apparatus is composed of four components: cementum, alveolar bone, gingiva, and the periodontal ligament (PDL). When recession occurs, the primary barrier to natural regeneration is the rapid migration of epithelial cells. These cells, which form the outer layer of the gum, proliferate quickly along the exposed root surface, creating a long junctional epithelium.
This swift epithelial downgrowth effectively seals the area, physically blocking slower-moving cells from the PDL and alveolar bone necessary to rebuild the connective tissue attachment. The result is a repair process involving scar-like tissue rather than true regeneration. Furthermore, the exposed root surface, often contaminated by bacterial toxins, lacks the cellular signals and scaffold needed to encourage the formation of new cementum and PDL fibers. The body is programmed to quickly cover the wound with the fastest-growing tissue, preventing organized regrowth.
Common Factors Leading to Gum Recession
The loss of gingival tissue often results from chronic trauma or inflammatory processes. Mechanical trauma is a common cause, typically originating from overly aggressive or horizontal tooth brushing techniques. Using hard bristles or applying excessive force can physically abrade the delicate gingival margin over time, especially in areas with thin tissue. This action causes the tissue to wear away progressively, exposing the root surface.
Periodontal disease is another cause, involving a bacterial infection that triggers a sustained inflammatory response. Toxins released by plaque and calculus destroy the underlying alveolar bone and the periodontal ligament fibers. As bone support is lost, the gingival tissue follows the bone level apically, resulting in recession and the formation of periodontal pockets. This inflammatory damage creates permanent changes that the body cannot naturally reverse.
Anatomical and genetic factors also predispose certain individuals to gum recession, even with good oral hygiene. A thin gingival biotype, where the tissue is naturally delicate, is more vulnerable to mechanical and inflammatory breakdown. Misaligned teeth or an improper bite can place excessive, uneven force on specific areas, causing stress that contributes to the breakdown of the supporting tissue. Using tobacco products is detrimental, as the chemicals cause vasoconstriction, impairing blood flow and hindering the tissue’s ability to repair itself and resist infection.
Surgical Methods for Tissue Restoration
Since natural regeneration is not possible, clinical procedures are the only way to restore lost gum tissue and cover exposed root surfaces. The Connective Tissue Graft (CTG) is the gold standard for root coverage due to its high predictability and aesthetic outcomes. This procedure involves taking sub-epithelial connective tissue from beneath a flap on the roof of the mouth, which serves as the donor site.
The harvested connective tissue is then placed over the exposed root and secured underneath a flap of existing gum tissue at the recession site. This technique provides two sources of blood supply—from the recipient bed and the overlying flap—promoting excellent tissue integration and a natural color match. The goal of CTG is to achieve root coverage, reduce tooth sensitivity, and increase gingival tissue thickness for long-term stability.
The Free Gingival Graft (FGG) involves removing a full-thickness wedge of tissue, including the surface layer, directly from the palate. This graft is then sutured onto the exposed area to create a wider, more durable band of keratinized tissue, useful for fortifying areas with thin gums. While FGG effectively increases attached tissue, it is less preferred for aesthetic root coverage than CTG because the graft may not blend perfectly with the surrounding gum.
A less invasive alternative is the Pinhole Surgical Technique (PST), performed without an external donor site or traditional stitches. A small pinhole is created in the gum tissue above the recession, and specialized instruments gently loosen the existing gum. The tissue is then slid down to cover the exposed root, and small collagen strips are placed through the pinhole to hold the repositioned tissue in place and support healing. This method offers a shorter recovery time and less discomfort since it avoids creating a second surgical wound on the palate.
Guided Tissue Regeneration (GTR) is employed, particularly when bone loss accompanies the recession defect. GTR utilizes a biocompatible barrier membrane placed over the defect to prevent faster-growing epithelial cells from migrating onto the root surface. By selectively excluding these cells, the membrane creates a secluded space, allowing slower-growing cells from the periodontal ligament and bone to repopulate the area and potentially facilitate the formation of new cementum, ligament, and bone.