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Periodontal surgery is indicated when non-surgical treatment — scaling and root planing — has not fully resolved gum disease, or when structural problems (recession, bone loss, altered gum architecture) require surgical correction. The right surgery depends on what the problem is, not on a standard protocol applied to all gum disease. At Dazzle Dental Clinic, periodontal surgical decisions are made after reassessment 6–8 weeks post-scaling, when the response to initial therapy is known.
Pocket Reduction Surgery: When Non-Surgical Treatment Doesn’t Fully Resolve
Periodontal pockets — the spaces between tooth and gum that form when gum disease destroys the supporting attachment — deepen as disease progresses. Pockets of 4–5mm can often be managed with scaling and root planing and diligent home hygiene. Pockets of 6mm+ are difficult to access with hand instruments from above the gum margin; bacteria persist in the base of the pocket and disease continues to progress.
Flap surgery (access flap, osseous surgery) elevates the gum from the tooth to provide direct access to the root surface and bone. Root surfaces are thoroughly debrided under direct vision. Any irregular bone contours that create ledges where bacteria pool are smoothed (osseous surgery). The flap is repositioned and sutured. Recovery: 7–10 days of soreness; gum margin changes (some recession) are typical as swelling resolves. Long-term benefit: residual probing depths of 3–4mm that are maintainable; arrest of bone loss progression. See our periodontal diagnosis guide for how disease stage is assessed before surgery planning begins.
Regenerative Surgery: Attempting to Rebuild Lost Bone
In specific defect configurations — particularly vertical (angular) bone defects with 3 intact bone walls — guided tissue regeneration (GTR) or enamel matrix derivative (Emdogain) application can stimulate new bone and attachment formation rather than simply arresting further loss. GTR uses a resorbable membrane to prevent fast-growing epithelial cells from colonising the healing space, allowing bone and periodontal ligament cells to regenerate.
Soft Tissue Grafting for Recession
Gum recession exposes root surfaces that are sensitive, more susceptible to decay than enamel, and aesthetically concerning when visible in the smile zone. The decision to graft depends on: how much keratinised gum remains; whether the exposed root surface shows active wear or sensitivity that is affecting quality of life; and the aesthetic impact.
At Dazzle, three grafting approaches are used depending on the extent and location of recession: connective tissue graft (subepithelial), free gingival graft, and pinhole surgical technique (PST) for mild-to-moderate multi-tooth recession.
Crown Lengthening
Crown lengthening removes excess gum and sometimes bone to expose more of the clinical crown. It is indicated before crown placement when insufficient tooth structure is present above the gum, and is also used for aesthetic gum recontouring (gummy smile correction) where excess gum covers normal-length teeth.
Peri-Implantitis Management
Peri-implantitis is infection and bone loss around an integrated implant. Non-surgical management handles early cases. Surgical access (resective or regenerative) is required for moderate-to-severe peri-implantitis with significant bone loss. This is a growing clinical challenge as the implant population ages.
FAQs
Q1: How is periodontal surgery different from scaling and root planing?
Scaling and root planing is non-surgical: instruments are inserted under the gum margin to clean root surfaces, but the gum is not elevated. Periodontal surgery involves making incisions to fold the gum back, providing direct visual access to root surfaces and bone. Surgery achieves more complete debridement in deep or complex defects that non-surgical treatment cannot fully reach.
Q2: Does periodontal surgery hurt?
The surgery is performed under local anaesthesia — no pain during the procedure. Post-operatively: soreness for 3–7 days depending on the extent of the surgery. NSAIDs manage this adequately for most patients.
Q3: How long after periodontal surgery before I can eat normally?
Soft diet for 1–2 weeks depending on the procedure. Sutures are removed or dissolve at 10–14 days. Full dietary freedom resumes after that, though avoiding hard foods near the surgical site for an additional week is advisable.
Q4: Can gum recession be prevented?
Yes, where the cause is modifiable. Toothbrush trauma (horizontal scrubbing with a hard brush) is the most common cause of recession and is entirely preventable with brushing technique correction and an electric brush with pressure feedback. Gum disease-related recession requires periodontal treatment to arrest. Thin gum biotype with minimal keratinised tissue may benefit from prophylactic grafting before recession becomes symptomatic.
