Periodontal Surgery

Periodontal surgery is a set of surgical procedures designed to treat advanced gum disease and repair damage to the gums and supporting bone. It is typically recommended when non-surgical treatments—such as scaling and root planing, improved home care, and periodontal maintenance—are insufficient to control infection or reduce deep periodontal pockets. The goal of surgery is to remove bacteria and diseased tissue, reduce pocket depth, and restore a healthier environment for the teeth and gums.

Surgical options are considered when pocket depths are consistently 5 mm or greater or when there is progressive bone loss that threatens tooth stability. Your dentist or periodontist will evaluate clinical findings, radiographs, and your response to prior therapy before recommending surgery. Treatment plans are individualized to address your specific anatomy, disease severity, and long-term oral health goals.

Non-surgical periodontal treatment focuses on removing plaque and calculus from root surfaces and improving oral hygiene to control infection. These approaches include scaling and root planing and regular periodontal maintenance visits, and they are often effective in early to moderate disease. When pockets remain deep or bone loss persists despite these measures, surgical intervention allows direct access for deeper cleaning and for reshaping or regenerating tissue.

Surgery enables the clinician to examine root surfaces and bone directly, treat defects, and place grafting materials or membranes when needed. It can also reposition gum tissue to reduce pocket depth and improve access for future home care. The decision to proceed surgically depends on clinical measurements, radiographic findings, and the patient’s overall response to conservative therapy.

Common periodontal surgeries include flap surgery (also called pocket reduction surgery), bone grafting, soft tissue grafting, and sinus lift procedures for upper jaw implant sites. Flap surgery provides access to deep root surfaces and bone defects so that infected tissue can be removed and the area can be smoothed to reduce pocket depth. Bone grafting restores lost bone volume to support teeth or future implants, while soft tissue grafts address gum recession and root exposure.

Sinus lift procedures raise the sinus membrane and add bone in the posterior maxilla to create sufficient height for implant placement. Additional options may include guided tissue regeneration and the use of biologic materials to encourage new bone and attachment growth. Your clinician will explain which procedure or combination of procedures best suits your specific condition and treatment goals.

Before your procedure you will have a thorough evaluation that includes medical and dental history, clinical measurements, and imaging as needed to plan treatment. The team will review your medications, allergies, and any medical conditions that could affect healing, and they will provide instructions about fasting or adjustments to medications when necessary. Good oral hygiene and any prescribed preoperative measures, such as antimicrobial rinses, help reduce bacterial load prior to surgery.

It is helpful to arrange transportation if you expect sedation or if you prefer not to drive after the procedure. Plan for a couple of days of lighter activity and follow the preoperative guidelines provided by the practice to optimize outcomes. If you have questions about the logistics or clinical preparations, call the office to discuss them with the team before your appointment.

Initial recovery after periodontal surgery often includes some swelling, minor bleeding, and discomfort that is managed with prescribed or over-the-counter medications and ice packs. You will receive specific postoperative instructions about oral hygiene, diet, and activity restrictions to protect the surgical site and promote healing. Follow-up appointments are scheduled to monitor healing, remove sutures if necessary, and reinforce home care techniques.

Soft foods and careful cleaning around treated areas are commonly recommended for the first week or two, and patients usually return to normal activity within several days depending on the extent of surgery. Maintaining regular periodontal maintenance visits and consistent home care is essential to preserve treatment results and reduce the risk of disease recurrence. Contact your clinician promptly if you experience unusual pain, persistent bleeding, or signs of infection.

Bone grafts and sinus lifts are often necessary when there is insufficient bone volume to support a dental implant securely. Tooth loss, periodontal disease, and long-standing edentulous areas can result in bone resorption that compromises implant placement. Bone grafting rebuilds the ridge by providing a scaffold for new bone growth, while a sinus lift raises the sinus floor and adds bone in the posterior maxilla to achieve the height required for implants.

The need for grafting is determined through clinical evaluation and three-dimensional imaging such as CBCT scans, which measure available bone and inform surgical planning. When grafting is indicated, it can be performed at the time of extraction, prior to implant placement, or concurrently with implant surgery depending on the situation. A staged approach may provide more predictable results in certain complex cases.

Soft tissue grafts, often called gum grafts or gingival grafts, are procedures that replace or augment thin or receded gum tissue to cover exposed tooth roots and restore a healthy gum margin. They are commonly used to treat root sensitivity, reduce the risk of root decay, improve aesthetics, and enhance the periodontal support around teeth. Grafts can be taken from the patient’s own tissue or provided as donor or synthetic materials depending on the clinician’s assessment and patient preference.

The decision to perform a soft tissue graft is based on factors such as the amount of recession, root exposure, tissue thickness, and the patient’s oral hygiene ability. Proper healing and graft integration depend on meticulous surgical technique and adherence to postoperative instructions. Long-term success also relies on ongoing periodontal maintenance and monitoring for any signs of recurrence.

Treating advanced periodontal disease with appropriate surgical measures reduces chronic oral infection and inflammation that can otherwise impact systemic health. Research has shown associations between untreated gum disease and systemic conditions such as cardiovascular disease, diabetes complications, and adverse pregnancy outcomes, so controlling periodontal infection is an important aspect of overall health management. By reducing bacterial reservoirs and stabilizing supporting structures, surgery helps restore oral health and may reduce inflammatory burden.

Effective periodontal therapy also preserves teeth and the ability to chew and maintain nutrition, which supports general well-being. Coordination of care with your primary medical provider is advisable when systemic conditions are present, and your dental team can communicate recommendations to help manage oral-systemic connections. Regular periodontal maintenance after surgery is critical to sustaining these broader health benefits.

Yes, some periodontal procedures can be performed using dental lasers, which may offer advantages such as more precise soft tissue management, reduced bleeding, and potentially quicker soft tissue healing for selected cases. Laser-assisted approaches can be used for pocket reduction, removing diseased tissue, and in some cases to complement traditional flap surgery. The choice of laser therapy depends on the nature of the periodontal defect, clinician training, and the evidence supporting its use for a specific indication.

While lasers can be beneficial, they are not a universal replacement for conventional surgical techniques, especially when significant bone access and grafting are required. A comprehensive evaluation will determine if a laser protocol is appropriate as part of your individualized treatment plan. Your clinician will explain the expected outcomes, benefits, and limitations of laser-assisted therapy relative to traditional options.

Long-term success after periodontal surgery depends on a combination of effective home care, professional maintenance, and lifestyle factors such as smoking cessation and diabetes control. Daily brushing with proper technique, interdental cleaning, and the use of adjunctive antimicrobial rinses when indicated help minimize plaque accumulation and reduce the risk of recurrent disease. Professional periodontal maintenance visits at intervals recommended by your clinician provide thorough cleaning, monitoring, and early intervention if pockets begin to deepen again.

Consistent communication with your dental team at M. Kurt Berky, DDS, PC and prompt attention to changes in oral health will help preserve surgical outcomes. Your clinician may tailor recall intervals and supportive therapies based on your individual risk profile, healing response, and overall oral health. Staying engaged in preventive care is the most reliable way to protect your investment in periodontal treatment and maintain a healthy smile.