When a deep cleaning hasn’t closed the pockets around your teeth, bacteria keep living below the gumline, and over time the bone and tissue that hold your teeth in place can be lost, sometimes to the point that a tooth has to come out. That’s when a periodontist may recommend gum surgery. “Gum surgery” isn’t one procedure. It’s several, each aimed at a different problem: deep pockets, bone lost to gum disease, receding gums, or a tooth broken too close to the gum to restore. Here’s what each type does, what recovery generally involves, and how the choice gets made.
Table of Contents
When Gum Surgery Is Recommended
Gum surgery is usually recommended after a deep cleaning has been tried and pockets around some teeth are still deep.
Healthy gum and bone fit snugly around each tooth. Gum disease destroys that support and leaves pockets between the gum and the tooth, where plaque and bacteria hide out of reach of a toothbrush and floss. In a healthy mouth these spaces are usually 1 to 3 millimeters deep, and your dentist or periodontist measures them with a small probe.
Treatment starts without surgery. A deep cleaning, called scaling and root planing, is the first step in gum disease treatment: it removes plaque and tartar from below the gumline and smooths the roots so plaque is less likely to stick. The gums are checked again about 6 to 8 weeks later. Pockets that are still 6 millimeters or deeper are likely to benefit from surgery, while shallower ones are usually treated without it. Whether you need surgery also depends on the stage of the disease, your general health, and how well you can keep the area clean afterward.
The Main Types of Gum Surgery
Periodontal surgery falls into four main groups, each aimed at a different problem.
| Procedure | The problem it treats | What’s done |
|---|---|---|
| Pocket reduction (flap) surgery, including osseous surgery | Deep pockets that remain after a deep cleaning | The gum is folded back, the roots are cleaned, damaged bone is smoothed or reshaped if needed, and the gum is stitched back |
| Regenerative procedures | Bone destroyed by gum disease, especially deep bone defects | Bone grafts, membranes, or tissue-stimulating proteins help the body regrow some lost bone and tissue |
| Gum (soft tissue) graft | Gum recession and exposed roots | Tissue, usually from the roof of the mouth or a tissue bank, is placed over the exposed roots |
| Crown lengthening | A tooth broken or decayed below the gumline that needs restoring | Gum and bone are reshaped to expose more of the tooth |
Pocket Reduction Surgery (Flap and Osseous Surgery)
Pocket reduction surgery shrinks deep pockets so plaque and bacteria have fewer places to hide, and it’s used for moderate to severe periodontitis.
It’s also called flap surgery. When the periodontist also reshapes the bone, it’s often called osseous surgery. After numbing the area, the periodontist makes an incision along the gumline, folds the gum back to see the roots, and cleans plaque and bacteria off them. Damaged bone is smoothed or reshaped where needed so the gum can reattach better, and the gum is then put back in place and stitched. Osseous surgery usually takes about 30 to 60 minutes, depending on how many teeth are treated.
The trade-off is that pocket reduction usually leaves some gum recession: teeth can look longer, and exposed roots may be sensitive. On its own, osseous surgery isn’t recommended for deep bone defects. Those are treated with regenerative surgery instead, or the tooth is removed.
Regenerative Procedures: Bone Grafts, Membranes, and Proteins
When gum disease has destroyed the bone that supports a tooth, a regenerative procedure can help the body regrow some of the lost bone and tissue. The periodontist folds back the gum, removes the bacteria, and then uses one or more of these:
- Bone grafts. A bone graft uses your own bone, donated bone, or a synthetic material as a scaffold that holds the space while your body regrows bone.
- Membranes (guided tissue regeneration). Gum tissue heals faster than bone, so a thin membrane keeps gum tissue out of the space and gives bone time to grow. It’s usually combined with a bone graft.
- Tissue-stimulating proteins. Enamel matrix derivative is a gel made from proteins involved in forming a tooth’s attachment as it develops, and it’s applied to the cleaned root surface. Our periodontist uses Emdogain, an FDA-approved product of this kind. A Cochrane review found modestly better results a year after treatment compared with surgery alone, though how much real-world difference that makes is unclear, and membranes had more complications.
Results depend on the shape of the bone defect, smoking, conditions such as diabetes, and the surgeon’s experience, and they’re generally similar whichever material is used.
Gum Grafts for Receding Gums
A gum graft covers roots that gum recession has exposed and helps keep the recession from getting worse. Recession happens when the gum edge moves down past where the enamel ends, leaving the root exposed, which raises the risk of decay and sensitivity. Receding gums don’t grow back on their own, so a graft adds tissue.
The graft tissue usually comes from the roof of your mouth, or a donor material from a tissue bank can be used instead. The periodontist makes a small flap at the recession, cleans the root, and stitches the graft over it. The main types:
- Connective tissue graft: tissue from under the surface of the palate, placed under a flap. In reviews it gives the best root coverage, and it also thickens the gum.
- Free gingival graft: a piece of surface gum tissue from the palate, used to add firm gum tissue.
- Pedicle graft: gum next to the problem area is moved over it, so there’s no second site, but it needs enough healthy gum nearby.
How much root a graft covers depends on the type of recession: often all of it in simpler cases, part of it in others, and little or none in the most advanced.
Everett, WA
Told you may need gum surgery?
We can measure your pockets and explain what treatment would involve.
Crown Lengthening
Crown lengthening exposes more of a tooth so it can be restored, most often when decay or a break extends below the gumline. If a tooth breaks near the gum and there isn’t room for a crown, the periodontist removes a few millimeters of gum and bone around it so the crown can fit. The tooth has to be restorable otherwise. Afterward it looks longer, and it usually wears a temporary crown for at least six weeks before the final one. There’s more on our crown lengthening page.
What Happens on the Day
Gum surgery is generally done with local anesthetic, so the area is numb while the periodontist works. Beforehand, the periodontist reviews your medical and dental history, including your medicines and conditions such as diabetes, measures your pockets, and may take X-rays to see the bone. At Icon Dental Center, nitrous oxide and oral sedation are also available from our periodontist.
Questions about gum surgery? Call our Everett dental office to talk it through.
Recovery and Risks
Most people recover in one to four weeks, depending on the procedure.
| Procedure | Typical recovery |
|---|---|
| Pocket reduction (osseous) surgery | About two to four weeks on average |
| Gum graft | About one to two weeks; most people are back at work or school in a day or two |
| Bone graft | About a week at first, but the graft needs at least three months to heal |
| Crown lengthening | A temporary crown for at least six weeks before the final crown |
Soreness, some bleeding, swelling, and bruising are common and usually ease within a few days. After a gum graft, the roof of the mouth where the tissue was taken is usually sorer than the graft itself. Your periodontist will give you detailed instructions for the days afterward, and it’s important to follow them closely.
Complications are uncommon. The most frequent are tooth sensitivity, more pain than expected, and bleeding, and infections are rare. Pocket reduction usually leaves some gum recession, which can make teeth look longer, leave roots sensitive and more prone to decay, and open small gaps between teeth. A gum graft can occasionally fail. Smoking is linked to poorer results and slower healing, and diabetes to more complications.
Call your periodontist if bleeding doesn’t slow down, pain doesn’t get better with the medicine you were given, you see pus, or you have a fever over 101°F.
Keeping the Results
Periodontitis can be managed but not cured, so the results of surgery depend on care afterward. Some procedures can regrow part of the lost bone and tissue, but none can undo all of the damage. The results have to be kept up with good daily care at home and regular professional cleanings. Many people who’ve had gum disease have maintenance cleanings every three to four months, where the pockets are measured again.
Gum Surgery at Icon Dental Center
Dr. Betsy Mosquera, our in-house periodontist, does all periodontal surgery at our Everett office. Our general dentists, Dr. Aboulhosn, Dr. Valentine, and Dr. Kwok, see patients for routine exams, so if your gums need surgery, it’s done in the same office.
Common Questions About Gum Surgery
Is gum surgery painful?
Gum surgery is generally done with local anesthetic, so the area is numb while it’s done. Afterward, soreness, swelling, and some bleeding are common, and they usually ease within a few days.
Is gum surgery the same as a deep cleaning?
No. A deep cleaning (scaling and root planing) cleans below the gumline without surgery and treats mild to moderate gum disease. Surgery is for problems that remain afterward, such as pockets that are still deep.
Can gum disease come back after surgery?
It can. Periodontitis can be managed but not cured, and the results of surgery have to be kept up with daily care at home and regular cleanings.