Difference Between an FGG and CTG?

Healthy, sturdy gum tissue, by design, protects vulnerable tooth roots and underlying bone from bacteria, plaque, and other irritants while contributing to a symmetrical smile. When gum tissue is damaged or compromised, or if the gum tissue is naturally thin or weak, interventions like gum grafts help supplement and restore the appearance and protective nature of the gums. The two most comprehensive, effective types of grafts are connective tissue grafts and free gingival grafts. Each of these graft procedures has different indications, methods, benefits, and recoveries, and you and your periodontist can determine which is best for your needs and preferences. As you plan, however, it can be helpful to have some information at the ready.

Both connective tissue grafting (CTG) and free gingival grafts (FGG) rely on tissue harvested from the patient’s own palate to restore the gums, and both procedures have high success and satisfaction rates, but the details of each procedure differ in a few varied ways. These include:

  1. Amount of tissue used for grafting
  2. Type of tissue being harvested
  3. Treatment indications and goals
  4. Recovery experience

The CTG surgery uses harvested connective tissue from the patient’s own palate to restore the gums, but only the layer of tissue underlying the external epithelial tissue is used. Because the epithelium remains intact, the extraction site should be expected to heal quickly, shortening recovery time and lessening discomfort. Connective tissue grafts are generally used to reduce sensitivity that arises when the tooth roots are exposed, to cover said exposed tooth roots, and to improve the appearance of the gum line.

The FGG procedure relies on a thicker wedge of palatal tissue that includes both the underlying connective tissue and the epithelium. This tissue is harvested from the palate and transplanted to the grafting site, helping to build up fragile or thin gum tissue and better support and protect the tooth roots and bone. Free gingival grafts are primarily used to supplement thin gums and create long-term stability in the gingival tissue. While CTG surgery is often used to cover tooth root surfaces to improve aesthetics, sensation, and function, FGG surgery is primarily used to improve the stability and support of the gums, improving the height and thickness of the gums, and is less geared toward an aesthetic solution.

Breaking down the benefits and long-term outcomes of each procedure can help with understanding their similarities and differences.

  1. CTG:
  2. Offers optimal aesthetic results
  3. Reduces tooth pain or sensitivity by protecting tooth roots
  4. Minimally invasive harvesting procedure that facilitates faster, more comfortable healing
  5. Can use smaller amounts of donor tissue to restore multiple areas of recession
  6. FGG:
  7. Builds highly durable gingival tissue that is fully keratinized
  8. Stronger tissue than CTG
  9. Predictable height and thickness outcomes
  10. Ideal treatment for thin or fragile tissue

For both types of grafts, commitment to proper aftercare is vital to complete, comfortable healing. Recipients of FGG treatment may notice textural differences between the existing tissue and the graft tissue, though this level out as the surgical sites heal. Post-operative discomfort is milder with CTG surgery, and the donor site heals more quickly than FGG surgery, though healing for both treatments shouldn’t take more than a couple of weeks. With effective care and attention to oral health, both graft types provide long-term stability for gums and effective, beneficial outcomes for patients.

Related Article: The Subepithelial Connective Tissue Graft