If your periodontal disease is severe, you may need surgery to thoroughly clean out bacteria that are too deep to be removed through scaling and root planing. You might also require surgery to restore tissue and bone that has been destroyed by periodontal disease. If you lose teeth you may be able to get dental implants.

Open Flap Surgery or Pocket Depth Reduction

This procedure involves cutting into the gum and revealing the bone and teeth underneath so the area can be carefully and completely cleaned. The disease-causing bacteria and any pieces of calculus are removed. Then the gum tissue is sewn securely back into place around the teeth.

Regenerative Procedures or Bone and Tissue Grafts

If you have severe tissue and bone destruction from periodontal disease, you might need another procedure after flap surgery called a graft. During a graft, your dentist or dental specialist may remove a bit of tissue or bone from another area of your body, and attach it to areas in your mouth that need new tissue (usually the gums) or bone growth. Alternatively, there are 2 other sources of graft tissue. One is a material harvested from donors called an allograft, the other is a biosynthetic graft material. In addition to grafting procedures, a tiny bit of mesh material or tissue-stimulating protein may be placed between your gum and bone. This technique encourages new gum growth but prevents the new tissue from growing into the area where bone should be.


Gum disease risk factors. American Academy of Periodontology website. Available at: https://www.perio.org/consumer/risk-factors. Accessed August 17, 2016.

Gum (Periodontal) Disease. NIH SeniorHealth website. Available at: http://nihseniorhealth.gov/periodontaldisease/riskfactorsandprevention/01.html. Accessed August 17, 2016.

Periodontal disease. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/OralHealth/periodontal_disease/. Accessed August 17, 2016.

Periodontal (gum) disease: Causes, symptoms, and treatments. National Institute of Dental and Craniofacial Research website. Available at: http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm#riskFactors. Accessed August 17, 2016.

Periodontal treatments and procedures. American Academy of Periodontology website. Available at: https://www.perio.org/consumer/treatments-procedures. Accessed August 17, 2016.

Last reviewed February 2021 by EBSCO Medical Review Board  Last Updated: 4/6/2021