Types of gum grafts

So many options...

There are several types of gum grafting that can be done.  For your convenience, I summarise them here:

Free gingival graft

• Procedure: Tissue is taken from the roof of the mouth and grafted onto the gums. The roof of the mouth will be protected with a dressing or specially made plate
• Second surgical site: Yup, tissue is directly removed
• Pros: Mainly for people with very thin tissue, as it toughens up the area
• Cons: The healed site may not match the rest of the surrounding gum tissue.  Limits to the number of teeth that can be taken. Limited or no root coverage (mainly for preventing further recession)
• My take: This was suggested to me by one periodontist, but since it doesn't offer any root coverage I didn't choose it. It is often used for the front lower bottom teeth, where the aesthetics don't matter so much because this area doesn't typically show.

Connective tissue / subepithelial graft

• Procedure: The surgeon creates a flap in the roof of your mouth and takes the connective tissue from underneath. The flap is the stitched closed and the connective tissue is used to form the graft
• Second surgical site: Yup, but stitched closed. A dressing may also be applied on top, or a specially made stent
• Pros: Studies show that the results are very predictable and long-lasting in terms of root coverage
• Cons: Limited number of teeth can be treated due to the limits on the donor tissue that can be taken
• My take: People's experience in recovery seems to depend on how the donor site at the roof of the mouth is treated. Generally, if you get a plastic stent made, I have read that it prevents pain better than other options (such as "putty-like" packing).  It does seem like this is the best option if you have few teeth to treat - the results seem to be the most predictable and long lasting. I would have chosen this for myself if I had fewer teeth to treat. 

AlloDerm / acelluar dermal matrix graft

• Procedure: The surgeon creates a pocket around the tooth to be treated and inserts the AlloDerm material before stitching closed. More details here. 
• Second surgical site: Nope
• Pros: No second surgery site. Loads of teeth can be treated - all of them if you want. Results are similar to connective tissue graft, although studies do seem to suggest that in the longer term the connective tissue performs better in terms of root coverage and tissue thickness (according to one study, 66% root coverage long term for AlloDerm versus 97% for connective tissue - but another study shows the results are the same - my view is that AlloDerm is probably more dependent on surgical skill/technique)
• Cons: The AlloDerm is donated from a cadaver (processed to remove all of the DNA so that only the tissue matrix remains for your own cells to populate). 
• My take: I picked this one both times, mainly because it allows treating of many teeth at once... it took some time to come to terms with the cadaver issue, but in the end I figured that I would get an organ transplant if I ever needed it, so it would be inconsistent to have a problem with using donated tissue in my gums.  

Pinhole surgical technique (Chao technique)

• Procedure: The surgeon creates a small hole and inserts tools through the opening to loosen up the gum tissue so it can be moved down to cover the exposed roots. Collagen strips are inserted in the holes to help keep the tissue in place.
• Second surgical site: Nope
• Pros: No second surgery site. Loads of teeth can be treated - all of them if you want. Apparently it is quick and relatively pain-free
• Cons: Does not toughen up the tissue. Not everyone will be suitable.  It's also quite hard to find in the UK at the moment
• My take: Touted as a new surgery, but has actually been around for some time. I actually asked for this procedure, did not choose it in the end because it doesn't toughen up the tissue (and that was absolutely key for me, with my feeble thin little gums).  

The information above is just my take - please be sure to discuss all of the options with your periodontist to find out what is right for you.  Do you have any thoughts on the different procedures?