The Tooth That Looked Twice as Long as the One Beside It

Quick answer: Not all recession needs surgery. A graft is worth considering when the recession is getting worse year on year, when there is too little firm gum left to hold the line, or when a visible tooth looks wrong to the person who owns it.

The call

"Can you put it back?"

It is the first question almost everyone asks, and for years the answer was mostly no. It is now often yes.

Tamar, 38, from Mishkafayim, had watched the gum around her upper right canine climb steadily for about six years. She had photographs on her phone, taken a year or two apart, and they made the case better than any measurement.

What we found

Six millimetres of recession on the canine, with the root surface exposed, slightly notched and sensitive to cold. Below the recession, only about one millimetre of firm, attached gum remained — the tough, pale band that resists movement. Beneath that was loose lining tissue that shifted every time she pulled her lip.

The neighbouring premolar had 3mm of recession. Everything else was normal, with no pockets and no bleeding. This was not gum disease.

Three findings decided the plan.

It was progressing. Her photographs showed roughly a millimetre a year. Stable recession can be watched; progressing recession will not stop itself.

There was almost no attached gum left. That band is what holds the margin steady against the pull of the lip. Once it is gone, recession tends to accelerate.

She minded how it looked. The canine sits in the smile line, and she had started covering her mouth. That is a legitimate clinical indication, not vanity, and dismissing it would have been the wrong call.

We also identified the cause, because grafting without correcting it is rebuilding on sand: a hard-bristled brush used with real force, plus a thin gum type she was born with. Some people simply have delicate tissue over a prominent root, and it takes very little to lose it.

What we did

Six weeks of technique change first. Soft brush, electric with a pressure sensor, no scrubbing. Grafting into a mouth where the causative habit is still running is a waste of everyone's effort.

A connective tissue graft. A thin layer of tissue was taken from beneath the surface of the palate, tunnelled under the gum at the recession site, and the existing gum was advanced coronally over it and sutured. The palate donor site was closed and covered with a protective plate.

The graft does two things: it thickens the tissue so it resists future recession, and it brings living tissue with its own blood supply to cover the root.

About ninety minutes, under local anaesthetic.

Recovery, described honestly beforehand. The graft site is comfortable. The palate is not — it feels like a bad burn for about a week. Soft, cool food for ten days, no brushing at the site for two weeks (a prescribed rinse instead), and no lip-pulling to inspect it, which is the instruction people find hardest.

The outcome

Full root coverage on the canine and near-complete coverage on the premolar. The colour blended within about three months; it looks patchy before that, which is worth knowing in advance.

At two years the margin has held, and the tissue is visibly thicker than the matching tooth on the other side. Sensitivity resolved.

What to do if this happens to you

1. Photograph your gum line every six months. It is the only way to know whether recession is progressing.
2. Ask how much attached gum is left, not just how much recession there is.
3. Fix the cause first. Brushing technique, clenching, or an appliance rubbing.
4. Ask whether it is stable. Stable, non-visible recession often needs monitoring, not surgery.
5. Ask about the donor site and plan a soft-food week around it.
6. Do not judge the appearance before three months. Colour blending takes that long.

Gum line creeping upwards? Ramat Beit Shemesh Urgent Dental Care will tell you whether it needs treating or watching. 055-985-8845 · WhatsApp https://wa.me/972559858845 · Harav Kook 28/1, Beit Shemesh

This is a composite clinical story. It reflects a presentation we see regularly in Beit Shemesh and Ramat Beit Shemesh; the name and details are illustrative and are not those of a real patient.