Thin Receding Gums And Dental Implants – What’s Important? Video by Ramsey Amin, DDS

Thin gums area major cause of gum recession and can cause problems with dental implants too.  You are genetically given the thickness of your gums.  When it comes to dental implants…the thicker the gums the better.  This is also true for natural teeth.  This video explains some of the important issues.


When someone has receding or thin gums, I can surgically correct this by a gum graft. So if the gum is too thin, it can be thickened.  Here is a photo of a gum graft I did to cover the root of this long tooth.

Before Gum Graft 

There are a couple of main issues associated with thin, fragile gums and dental implants.

  1. The implant shows through the gums as a grey or grayish tint. This does not look good.
  2. The gums can recede causing the bone to recede too.  If this happens, the threads of the implant can show. This becomes a long term issue.

This picture says it all:
Implant_failure Solutions I use: (much more detail in the video)

  1. Gum and/or bone grafting before or during the implant procedure to thicken the gums
  2. Use of a custom abutment made of zirconia or titanium
  3. Proper implant design
  4. Proper crown design
  5. Precise placement of the implant to begin
  6. At the time that I place implants, if possible, I move some of your existing gum from the palate side to the outside of your implant.
  7. Platform switching design

As you can see, there is A LOT to dental implant success.  It is not just a screw put in the jaw!  Many dentists don’t bother with the gums and just put the implant in.  That is fine for the short term, but in time, you will probably develop problems.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow of the American Academy of Implant Dentistry
Burbank, California
http://www.burbankdentalimplants.com


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32 thoughts on “Thin Receding Gums And Dental Implants – What’s Important? Video by Ramsey Amin, DDS

  1. Marion Nugent

    I had all on four dental implants fitted two years ago. I am 70 years old. Now however my gums have receded on three of them . The metal is visible on all of them, one shows the complete abutement. Will the implants fall out or are they fused with the bone that is left.
    ?. Your advice would be appreciated

    Reply
    1. Ramsey Amin DDS

      Hello Marion,

      As you may know, I am not a big fan or advocate of the all on 4 procedure. It is truly under engineered to support a complete set of teeth all the way to the molar region. It can be done for a smaller segment of teeth when the molar teeth are not included (molars are very important.) What you are experiencing is in fact very common because of the under engineered design. Is it on your upper jaw or lower jaw? That will help me answer your question and a little bit more detail. The upper jaw is the weaker of the 2 jawbones.

      The fact that metal is exposed when it wasn’t before, generally means there is some sort of an active process occurring either in the bone and or the gum tissue which may result in permanent bone loss.

      It may stabilize and stay as it is. Of course I would need to personally see you.

      All On Four Dental Implant Procedure Review: Is It The Best? –Ramsey Amin DDS

      All-on-Four Dental Implant Procedure -Ramsey Amin DDS Explains Pros and Cons

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  2. Cari

    Hi, I chipped my top right incisor as a child, the tooth was only partially grown in. At 16 I developed a fistula, so I had a root canal. At 24 I had the tooth removed (there was still infection), and then I had a bone graft. After the graft healed, I had an implant placed. My oral surgeon said it was healing well and I retained a lot of tissue. It has been about 6 months since the implant, but my gum just healed from an infection due to cement getting underneath it. That infection has cleared, but about a week ago I had very sharp pain followed by irritation in my gum. I told my dentist that I thought something was in my gum, she looked at the implant and said nothing was in my gum and that I must have just bit down wrong on my temporary crown. Last Thursday, I got a small piece of bone out of my gum, right wear I felt it was, and now it feels normal but my gum started receding rapidly over the weekend and I am so worried and frustrated with all of problems. I have also had chronic sinusitis since that start less than a year after my root canal. In the last 2 years, I have felt as if air is blowing through my upper jaw when I blow my nose during a boutique of sinusitis. I am going to see my ENT soon, but I am just hoping for an impartial opinion. Could I have a hole in my jaw due to having that infected tooth for almost 20 years? Could it have leaked into my sinus cavity? I am feeling pressure in my right sinus, but not full blown sinusitis, could that be causing bone loss and my gum recession? I just want to know what to ask my dentist and surgeon.
    I’m sorry if this post has been a bit jumpy, I am quite upset. My main question is this, is this implant even worth all of the hassle an am I going to lose more tissue if it is removed?

    Reply
    1. Cari

      I had root trauma which caused My root to not develop* I have also been dealing with an ear infection on that side ever since the gum got infected, I have taken 3 zpacks. I am at a loss at this point.

      Reply
      1. Cari

        I apologize for all of the typos, I was a bit frazzled and typing on my phone. Over zealous auto-correct + emotions = a lack of coherence

        Reply
    2. Ramsey Amin DDS

      Hello Cari,

      Happy Easter. The incisor teeth are not physically connected to the sinuses by anatomy. They are connected to the nasal cavity but not to the sinuses. Whatever sinus conditions you may have are likely unrelated altogether and coincidental. The ear infections are also unrelated to your dental implant but may be related to your sinuses. I would definitely suggest in your ear ,nose and throat doctor and be evaluated with a CT scan of your sinuses and upper jaw. It is not likely that you have a hole in your jaw for 20 years. You would’ve been very aware of this.

      Generally speaking, having a central incisor front tooth dental implant can be complex, but is definitely still the best option long-term. It does require a very skilled team of dentists or an excellent single total solution provider to get a good result. If the gum has receded, it may be best to remove the temporary crown and remove the abutment and allow the implant to be buried again. This may allow the tissue to rebuild itself without having to do a gum graft. The implant can then be reexposed and a temporary be placed again to groom and contour the gum back to normal. I would suggest you stay in the temporary crown for 2-4 months to make sure the gum is stable and healthy before converting to a final crown.

      Most patients that have well done dental implants for front teeth keep them for 20+ years. I am assuming you had a 3-D scan prior to implantation and possible guided surgery.

      How to Choose an Implant Dentist

      Computer Guided Dental Implant Surgery, Things You Need To Know

      sample cases
      examples of other patients

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  3. patricia pasquarello

    good afternoon Dr Amin,
    I had one dental implant put in 14 months ago. I was involved in accident and the
    dental surgeon had to do bone grafting first, after area healed (3 months), he then put the implant in.
    My regular dentist put the crown in. However, the “root” of the crown is
    showing at the gum line (doesn’t look right). Can a tissue graft be done? Does the
    crown have to come out?
    Thank you…….

    Reply
    1. Ramsey Amin DDS

      Hello Patricia,

      As long as there is bone on the outside of the implant, the gum line can likely be corrected. This is a difficult procedure and should be done by somebody who has a lot of experience and repositioning the gumline around an existing front and center dental implant.

      Sometimes the procedure can be done with the crown in place and sometimes it has to be removed and a temporary placed. It depends on your unique situation. Also the procedure can involve taking some gum from the roof of your mouth and transplanting it to the area in need, using tissue from a cadaver, or just sliding your existing gum tissue down over the exposed root.

      Probably the most important thing is going to depend on the position of the implant and whether bone is present on the outer wall. You may need a 3-D scan to evaluate this before doing any treatment.

      3-D scan basics

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  4. Ann

    I had 3 teeth extracted on my upper right and had bone grafting and implants and the 3 teeth were done with one crown (I guess it’s 3 that are connected). The dentist said that would be stronger. The problem is, my gums have receded and when the mold was made rather than correct the gum problem the dentist just had really long crowns made and then put them in my mouth. When I looked in he mirror after he had cemented it in I questioned why the crowns were so long (almost twice what they should be) and he said that was how it’s done… he never even mentioned he option of gum grafting. It feels weird and even though it doesn’t show that much some people have asked about it when I smile. The crown does not butt the gum but goes on top of it… is all this going to cause problems and if so what should I do about it? Thanks.

    Reply
    1. Ramsey Amin DDS

      Hi Ann,

      It sounds like you never had enough bone for a cosmetic result to mimic your natural teeth. Even if you have 90% bone volume in the upper front area it is that final 10% that makes all the difference aesthetically. With 90% bone volume you can have dental implants that are strong and healthy but are not likely to appear like your regular teeth. If the implants are already placed, it is unlikely that gum grafting will make those teeth look like your others.

      My guess is your lacking vertical bone. These aren’t things that I like to work out in advance using 3-D planning and extensive photography prior to ever doing any work at all. This allows me in my patient to understand the limitations in advance of doing anything at all.

      3-D planning sample

      Because you likely have 80-90% bone, the implants are likely deeper than your other teeth and pushed more towards your tongue than your other teeth. If you have a very low smile line you may not show this area but it would be very problematic if when you smile, the gum line shows.

      Sorry for the bad news.

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  5. Leslie

    My 11 year-old daughter has been recommended to get this gum graft as her 4 front bottom teeth are exposed through the gums at the base. My concern is whether to wait a few years to see if the gums will get thicker on their own. They are her adult teeth and they have deteriorated in the past 4 years when it was first noticed. Also, they recommend cutting the tiny muscle that joins between the lip and bum on the bottom of our jaws. This is attached up high in her gumline and he feels it would be hindering the growth of the gums by pulling it down. It is noticably higher than other family members. Thanks for your input!

    Reply
    1. Ramsey Amin DDS

      Hello Leslie,

      This does not sound to be a dental implant related problem but here are some basics: the daughter your discussing likely needs a procedure called a frenectomy…. My own daughter needs this too.

      The muscle pull causes the gums to recede and spaces to develop between teeth. I would also see an orthodontist and get their thoughts as she likely needs braces too

      http://www.burbankdentalimplants.com/smile-gallery/

      Good luck!!!!!!!!!! 😉

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  6. Katie S

    Hi Dr. Ramsey, I’m glad I stumbled upon your site. I have 8 dental implants, I’ve had them for 10 years, and one of them(not sure what the tooth # is but it’s in my lower right jaw) has had some bone loss and gum receding,from an xray four years ago to now the bone has gone down about three threads in the implant. The other ones haven’t changed very much. I am wondering what is causing this. Is there anything i can be doing to prevent the bone from receding more? I have had two children in the past three years and I wonder if that is a factor at all. I am really enjoying your blog. Thank you for such insightful information!

    Reply
    1. Ramsey Amin DDS

      hi Katie,

      That is awesome that you are 10 years out at this point. I just saw one of my patients who I did 12 dental implants on almost 14 years ago and has zero problems. he does have some minor recession at his age of 90 years old now around 1 dental implant.

      Having your children did not cause this problem…but they sure do cause a lot of trouble, don’t they? LOL

      Without seen you in person, it is impossible to tell why your losing bone on just one implant. The good news is your only losing bone on just one implant. It is likely that this area had thinner bone at the very top of the implant. Some threads are bigger than others so he micro-threaded implant with 3 threads exposed is different than a macro threaded implant with 3 threads exposed. There are options to de-thread the implant or possibly attempt bone regeneration depending on the shape and size of the defect. Other reasons could be difficult hygiene of the area, plaque and tartar on the implant, bacteria getting into the gap between the abutments and the implant itself, and loose implants abutment that is causing micro-movement, genetically thin gum, thin bone, bone grafted site, implant is positioned too far to the outer wall, implant size too big and a host of other reasons.

      If you’re local to Burbank California, I would love to see you.

      I hope this is helpful

      Ramsey Amin DDS

      Reply
  7. jean gray

    I had an implant done a long time ago on tooth #7.. However, the gum has gradually receded and it now looks almost exactly like the example in the photo you show above. Is it possibly to get a gum graft to cover that ‘exposed’ area and build up the gum there? I see more people online posting about gum grafts that didn’t work (vs. success stories). What is the prognosis for applying a skin graft to an area that has an implant? Does it have a 75% chance of being successful? 50%?

    Reply
    1. Ramsey Amin DDS

      Hi Jean,

      I see this problem a lot. Many patients come to my office in Burbank with problems from dental implants.

      The gum is receding because you likely have bone missing in the outer wall of the implant and/or between the teeth.

      Recovery of this with a gum graft is difficult and not very predictable. A very skilled implant dentist may be able to do this but will likely and bone too. Combining your own blood products such as PRP PRF and PDGF can help.

      I know this doesn’t help you, but for the many thousands of people that read my blog, the key is to try to avoid this.

      A dentist whose focus and credentials are exclusively in implant dentistry will plan your surgery so that you don’t have or reduce the chance of problems in the future. The experience of someone who has done thousands of implants versus a dentist that has done a few is significant.

      I say this to help many people who seek out the cheapest way to go.

      Very respectfully,

      Dr. Ramsey Amin

      Reply
  8. latino

    Hi there! I could have sworn I’ve been to your blog before but after looking at some of the posts I realized it’s new to me.
    Anyhow, I’m certainly happy I discovered it and I’ll
    be bookmarking it and checking back often!

    Reply
  9. Dawn steityeh

    I recently did three implants , two of which were fine but the third one looks like it hasn’t been angled properly and will show at the top of the tooth when the new crown is fitted ,what can I do about this , please help.

    Reply
  10. Rod G.

    Very informative article and video! It’s nice to see that you take the possible aesthetic issues into account when performing a dental implant.

    Reply
  11. Linda Thomas

    Thank you for posting this information. I had a gum graft at two of my bottom front teeth. I’m very nervous because my periodontist cannot guarantee that this will work. I am 46 with Type ! diabetes and the recession is actually exposing bone. This is due to two different abscesses in my early twenties when my diabetes was not well controlled and flossing was a thing of the future. Fortunately my teeth are not loose but if this doesn’t work they will be some day. I found you as I was looking into whether I could get implants if I did lose those teeth in the future. Also, I’m sorry I didn’t know about you before, I work in Burbank…
    Thanks, Linda

    Reply
    1. Ramsey Amin DDS

      Hi Linda,

      Yes, implants can be done in that area. Let me know how I can help.
      Gum grafts usually heal very well. Have faith!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  12. Waseem

    Thanks. This is useful. My new periodontist has recommended subepithelial tissue grafts on 20/21, 28/29 so I was googling around to find info about this and ran into your site.

    Any thoughts on if platelet growth factor if required or not for this procedure? Its an optional procedure not covered by insurance so trying to figure out if I should go for it. Articles imply that it does seem to help but not sure if it is worth it?

    thanks

    Reply
    1. Ramsey Amin DDS

      Hi Wassem,

      Grafting those particular teeth is very common. Growth factors are helpful and can improve results. The worse the recession is, the more inclined I would be to use growth factors and/or PRP. If the recession is mild and you are very healthy, it may not be needed.

      Does this help you?

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      818-846-3203

      Reply
  13. Ramsey Amin DDS

    Hi Sarah,
    Complications can and do occur, but that doesnt mean it is the fault of your dentist or you. He will probably “re-graft” the area and place the implant in a few months.
    Be patient and it will more than likely work out.
    Ramsey A. Amin, D.D.S.
    Diplomate of the American Board of Oral Implantology /Implant Dentistry
    Fellow of the American Academy of Implant Dentistry
    Burbank, California
    http://www.burbankdentalimplants.com

    Reply
  14. Sarah Martin

    I am 29 years old and I had a bone graft done in early April on my #7 tooth that I have never had (I have had a marilyn bride in that place for 17 years. My Dentist used mineross as the grafting material. When he opened my gums for the implant a few days ago he was shocked to see that the graft did not work. He said instead of bone it looked like gristle. He said he hasn’t seen anything like this in 24 years of doing grafts and implants. Have you ever encountered a situation like this? I don’t know where we go from here.
    Thanks,
    Sarah, Tulsa OK

    Reply
  15. Azhar Keenoo

    I would really like to know the approximate pricing gum grafting in the frontal area of my upper jaw…slight gum loss has started…please help regarding

    Reply