Soft tissue grafting procedures address gum recession — one of the most common periodontal problems affecting adult patients. As a dental assistant in a periodontal or general practice that performs these procedures, understanding the different graft types, their indications, and your specific role at the chair makes you a more valuable and prepared clinical partner.
Why grafting matters: Gum recession exposes tooth roots, causing sensitivity, aesthetic concerns, and vulnerability to decay and further recession. Soft tissue grafts cover exposed roots, increase the zone of attached gingiva, and protect the tooth long-term.
Types of soft tissue grafts
Connective Tissue Graft (CTG) — the most common
The connective tissue graft is the gold standard for root coverage. Donor tissue is harvested from the palate through a partial-thickness incision — the surface epithelium of the palate is not removed, leaving a covered donor site that heals more comfortably. The harvested connective tissue is placed beneath a flap at the recipient site, covering the exposed root. Excellent root coverage outcomes and a well-healing donor site make this the most commonly performed graft.
Free Gingival Graft (FGG)
A free gingival graft takes a strip of tissue including both the surface epithelium and connective tissue from the palate. It is placed at the recipient site on top of the periosteum rather than beneath a flap. The FGG is particularly used to increase the width of attached gingiva — the firm, bound-down tissue adjacent to teeth — rather than for root coverage specifically. The palatal donor site heals as an open wound, making it more uncomfortable than the CTG donor site.
Pedicle Graft (Rotational or Lateral)
A pedicle graft uses tissue adjacent to the recession site rather than harvested tissue from the palate. A flap of nearby gingiva is rotated or advanced laterally to cover the exposed root, maintaining its blood supply at one edge. It is limited to situations where there is adequate adjacent tissue — not all recession sites qualify.
Allografts and Xenografts
When palatal donor tissue is insufficient or the patient prefers to avoid a second surgical site, processed donor tissue from a tissue bank (allograft) or animal-derived materials (xenograft) can be used. Results are generally good but outcomes vary compared to autogenous (patient's own) tissue.
When grafting is recommended
- Root surface exposure causing pain or sensitivity that affects quality of life
- Progressive recession that is continuing to worsen
- Minimal or absent attached gingiva that puts teeth at risk for further recession
- Planned orthodontic treatment that would move teeth through areas of thin tissue
- Planned implant placement requiring adequate attached tissue around the future implant
- Patient aesthetic concerns about the appearance of "long teeth"
The dental assistant's role
Tray setup for a connective tissue graft
- Surgical kit: tissue scissors, periosteal elevator, surgical curettes, suture scissors
- Micro blade or surgical blade (typically 15c) for donor site incision
- Suture material — commonly 4-0 or 5-0 chromic gut or vicryl; confirm with your dentist
- Saline for irrigation
- Gauze packs — both standard and collagen for donor site hemostasis
- Local anesthetic: infiltration at recipient site and palatal block for donor site
- Tissue forceps and needle drivers
During the procedure
- Provide continuous irrigation and suction — the surgical field must stay clean and visible
- Handle harvested tissue carefully — keep it moist in saline-dampened gauze while the recipient site is prepared
- Pass suture material and instruments efficiently — grafting procedures require precise sequencing
- Monitor patient comfort and communicate with the dentist if the patient shows distress
Post-operative instructions you help deliver
- Avoid brushing the surgical site for 2 to 4 weeks
- Soft diet for the first week minimum
- No smoking — significantly impairs healing and graft success
- Prescription medications as directed — typically an antibiotic and analgesic
- Return for suture removal at 1 to 2 weeks
The bottom line
Tissue grafting is a technically demanding procedure that requires a well-prepared, attentive assistant. Knowing the graft types and their rationale helps you understand what you're setting up and why. Efficient instrument passing, continuous irrigation, and careful handling of harvested tissue are the highest-impact things an assistant contributes to a successful graft procedure.