Connective Tissue Grafting

Oral Surgeon Dr. Tsvetov — Temecula, Murrieta, Perris CA

Whenever dental implants are placed, there are two very important factors to consider—how much bone is available to support the implant and how much gingival or “gum” tissue is present to support the implant and the crown. The “gum tissue” is of two types—pink, around teeth, and reddish, further down toward the lip. When it comes to providing support for implant and crown, the pink, or “keratinized” gum tissue is extremely important. It is very strong, resilient, immovable (attached gingiva) and provides an excellent tissue barrier to prevent bacteria from getting to the implant surface and causing problems.

Some people naturally have very thin pink gingiva. This may cause a problem with implant therapy because if the pink gingiva is not thick enough, it will not seal the implant properly and will predispose it to failure in the long term. Similarly people who have been missing a tooth for a long time can also have a pink gingival deficit since bone and gingival tissue resorb or melt away when the tooth has been missing for a long time.

In these types of situations a Connective Tissue Graft is extremely useful. The graft (a small sliver of tissue) is taken from the roof of the mouth and is used to bulk up the pink tissue at the site of implant placement. This provides the best chance of implant success. It is a very predictable procedure and here at Temecula Facial Oral Surgery we are happy to offer it to our patients.


In patients with multiple missing teeth or those who are missing all of the teeth in upper or lower jaw, the problem with “pink tissue” deficit can be large. When a large number of teeth are missing, the pink tissue often atrophies and becomes a very thin, long band of tissue that is not able to support the implants properly. Another problem that can occur is that the red tissue creeps up toward the top of the jawbone, complicating the situation even further, especially for patients who want to have a “snap-in” denture supported by implants. Not only is there not enough pink tissue to support the implants, there is also not enough room for the denture because the red, movable tissue is in the way and would constantly get pinched by the denture, causing a lot of discomfort.

In this type of situation, a Vestibuloplasty procedure can be extremely useful to recreate more “pink gingiva” and to make more physical space for the denture by lowering down the red gum tissue. It’s a procedure that is also very predictable and will provide positive results for the patients.