Periodontists perform a wide range of procedures focused on the gums, the bone supporting your teeth, and dental implants. After completing dental school, they train for an additional three years in both surgical and non-surgical treatments, making them specialists in everything from deep cleanings to complex bone grafts and implant placement. Their work falls into four main categories: non-surgical gum treatment, surgical gum and bone procedures, dental implant surgery, and cosmetic gum procedures.
Scaling and Root Planing (Deep Cleaning)
The most common non-surgical procedure a periodontist performs is scaling and root planing, often called a deep cleaning. It works like a regular dental cleaning but reaches much further beneath the gum line. Scaling removes plaque and hardite tartar from above and below the gums, while root planing smooths the tooth roots so bacteria have fewer places to cling. This is typically the first treatment for mild to moderate gum disease, and it’s the only way to remove plaque and bacteria trapped deep under your gums.
The goals are straightforward: reduce harmful bacteria, prevent tooth loss and gum recession, and stop the disease from progressing to the point where surgery is needed. A deep cleaning also eliminates the oral bacteria responsible for chronic bad breath. Because bacteria in your mouth can enter the bloodstream and affect other parts of the body, reducing that bacterial load has broader health benefits too.
Cost varies depending on how many teeth are involved. For four or more teeth in one quadrant of your mouth, expect to pay roughly $150 when done by a general dentist or around $210 with a specialist. You may need all four quadrants treated, sometimes split across two visits. After the initial deep cleaning, most patients return every three to four months for periodontal maintenance visits to keep things stable.
Pocket Reduction (Osseous Surgery)
When gum disease advances and deep pockets form between the teeth and gums, bacteria colonize those spaces and destroy bone. Pocket reduction surgery, also called osseous surgery, is designed to eliminate those pockets. Your periodontist numbs the area, makes incisions along the gum line, and carefully folds the gums back to expose the tooth roots and underlying bone. They then clean bacteria and plaque off the root surfaces, reshape damaged bone to eliminate the pockets where bacteria hide, and reposition the gums before closing with stitches.
If bone loss has already occurred, the periodontist may place a bone graft and a barrier membrane during the same procedure to encourage regrowth. The reshaped, tighter fit between gum and bone makes it much harder for bacteria to re-establish deep colonies.
Bone Grafts and Tissue Regeneration
Periodontists use regenerative procedures to rebuild bone and tissue destroyed by gum disease. Bone grafting fills in areas where the jawbone has deteriorated, using one of several material types: your own bone harvested from another site, donor bone from a tissue bank, animal-derived bone (usually bovine), or synthetic materials like calcium-based ceramics. All of these produce similar improvements in pocket depth and tissue attachment over the long term.
Guided tissue regeneration takes the process a step further. The periodontist places a thin membrane between the gum tissue and the bone defect. This barrier keeps fast-growing gum tissue from filling the space before slower-growing bone cells have a chance to repopulate it. Without the membrane, soft tissue wins the race and the bone never regenerates. With it, bone-forming cells get the time and space they need to rebuild the defect.
Dental Implant Placement
Replacing missing teeth with dental implants is a major part of what periodontists do. Their training in both hard and soft tissue makes them well suited to manage the entire implant process, from evaluating whether you have enough bone to support an implant, to surgically placing the titanium post, to coordinating with your general dentist for the final crown.
When bone quantity isn’t adequate, periodontists perform preparatory procedures before the implant itself. Two of the most common are:
- Sinus augmentation (sinus lift): The upper back jaw is one of the hardest places to put an implant because the bone is often thin and the sinus cavity sits right above it. A sinus lift raises the sinus floor and adds bone graft material underneath, creating a solid foundation for the implant.
- Ridge modification: When the jawbone has a deformity or has lost volume after tooth extraction, the periodontist lifts the gum to expose the deficient area, fills it with bone or a bone substitute, and lets it heal. This builds the ridge back up so an implant can be placed successfully.
Gum Grafts for Recession
When gums recede and expose tooth roots, periodontists use soft tissue grafts to restore coverage. The most common technique takes a small piece of connective tissue from the roof of your mouth (or occasionally from a donor source) and attaches it over the exposed root. The success of the graft depends on how much recession has occurred and the anatomy of the surrounding tissue. In straightforward cases where the bone between teeth is still intact, significant or even complete root coverage is typical. In more advanced recession where bone has been lost between teeth, the results are less predictable.
One thing to know: free gingival grafts (a slightly different technique using surface tissue rather than connective tissue) can shrink by up to 48% in the months after placement, depending on how thick the harvested tissue was. Your periodontist will account for this when planning the graft.
Crown Lengthening
Crown lengthening removes excess gum tissue, and sometimes a small amount of bone, to expose more of the tooth. It serves two distinct purposes.
Cosmetic crown lengthening corrects what’s commonly called a “gummy smile,” where the teeth appear short because too much gum tissue covers them. The periodontist reshapes the gum line in the front of the mouth to reveal more tooth surface and create a more balanced appearance. This can also fix uneven gum contours where one side sits lower than the other.
Functional crown lengthening is done when a tooth is broken, decayed, or worn down below the gum line and a dentist can’t place a crown or filling without accessing more of the tooth structure. By moving the gum and bone margin lower, the periodontist exposes enough healthy tooth for a restoration to grip onto. It’s also used when a filling or crown margin would otherwise sit too close to the bone, which can cause chronic inflammation.
What Recovery Looks Like
Recovery from periodontal surgery follows a fairly predictable pattern. Light bleeding or spotting is normal during the first 48 hours. Swelling typically begins on the second or third day, peaks around day five, and then gradually subsides. Ice packs in 15-minute intervals during the first 24 hours help minimize swelling. After that first day, switching to moist heat works better.
Your periodontist may place a pink dressing material over the surgical site to protect it for the first 48 hours. For diet, stick to soft foods at moderate temperatures for the first few days, avoiding anything acidic or heavily spiced for the first week. Eating small meals throughout the day (four to six) helps maintain your energy and supports healing. A multivitamin with extra vitamin C can speed the process along.
One common surprise: the teeth near the surgical site may feel like they’ve shifted. That’s because inflammation and fluid collection temporarily change how your bite comes together. Resist the urge to clench or grind, since that creates muscle pain and slows healing. Smoking is strongly discouraged throughout recovery, as it significantly impairs tissue repair.
Why You’d Be Referred to a Periodontist
Most people first see a periodontist because their general dentist identified gum disease that needs specialized care. Dentists use a staging and grading system to classify how far the disease has progressed and how quickly it’s getting worse. Staging looks at how much attachment and bone has already been lost. Grading estimates the speed of progression, factoring in bone loss relative to your age, along with risk factors like smoking and diabetes.
A referral typically happens when the disease is too advanced for a general dentist to manage effectively, or when treatment in the general dentist’s office hasn’t stabilized the condition. Smokers and people with poorly controlled diabetes tend to progress faster and are more likely to need specialist care. Early referral gives the periodontist the best chance of saving teeth and rebuilding what’s been lost.