How does gum graft surgery affect the need for braces in a 14-year-old?

Hello doctor,

My 14-year-old son recently underwent a gum graft procedure due to a significant gum recession on his lower teeth. Many of these teeth required grafting, and our orthodontist referred him to a periodontist. During the evaluation, it was discovered that his gums were too thin and lacked the necessary strength for braces. The specific grafting technique used, which I believe may have been a free gingival graft, involved removing a substantial amount of tissue from his palate and then stitching it below the lower teeth. His need for braces has been apparent for some time now. Approximately two years ago, our orthodontist postponed placing braces due to the eruption of his twelve-year molars. Seven years ago when his molars had grown in, he was due to receive braces earlier this year. However, the recent gum graft surgery has delayed this process, and he has not yet been cleared for braces.

I want to ask the following questions:

1. Is it possible to determine the success of a gum graft after just six to seven weeks, or does it typically take longer, such as six months or more? If so, what factors contribute to this extended healing period?

2. How long does it generally take to get juvenile periodontitis under control and stabilize it to prevent or minimize gum recession? When can one expect clearance from a periodontist for braces after dealing with this condition for a while?

3. In cases of moderate or advanced gum disease with bone loss, when is a bone graft recommended, and is it typically performed in conjunction with a gum graft?

4. At what age does juvenile periodontitis usually begin, and how long do each of its stages last? How quickly can it progress from a moderate to an advanced stage in male teenagers?

5. What usually occurs at a periodontist appointment following the removal of stitches after a gum graft? Are intense cleanings or scalings common, and what are the potential reasons for a less-than-pleasant experience at this appointment?

Thank you.