A periodontal procedure is any dental treatment designed to address gum disease or repair damage it has caused to the gums, bone, and other structures supporting your teeth. These range from deep cleanings that take about an hour to surgical interventions that rebuild lost bone. About 42% of American adults over 30 have some form of gum disease, and nearly 60% of those over 65 are affected, so periodontal procedures are among the most common treatments in dentistry.
Which procedure you need depends on how far the disease has progressed. Dentists measure the depth of the pockets between your gums and teeth in millimeters: 1 to 3 mm is healthy, 4 to 5 mm indicates moderate disease, and 6 mm or more signals severe periodontitis. That number largely determines whether you’ll need a non-surgical cleaning or something more involved.
Scaling and Root Planing: The First-Line Treatment
The most common periodontal procedure is scaling and root planing, often called a “deep cleaning.” It’s typically the first treatment for mild to moderate gum disease. Your dentist or hygienist numbs the area with local anesthesia, then uses hand instruments or ultrasonic tools to scrape plaque and hardite tartar from your teeth, both above and below the gumline. That’s the scaling portion.
Root planing goes a step further. After removing the buildup, your provider smooths the surfaces of your tooth roots. Rough root surfaces give bacteria a place to cling and recolonize. Smoothing them makes it harder for plaque and tartar to reattach, giving your gums a chance to heal and tighten back around the teeth. The whole process usually takes one or two visits, depending on how many areas of your mouth need treatment.
Pocket Reduction (Flap) Surgery
When gum disease is too advanced for a deep cleaning alone, your periodontist may recommend osseous surgery, sometimes called flap surgery or pocket reduction surgery. This is considered the gold standard for moderate to severe periodontitis.
During the procedure, the periodontist makes small incisions along your gumline and carefully folds the gum tissue back, exposing the tooth roots and underlying bone directly. This gives them full visibility to remove bacteria, tartar, and infected tissue that a deep cleaning can’t reach. If the bone around your teeth has developed an uneven, cratered surface from disease, the periodontist reshapes it to eliminate deep pockets where bacteria thrive. The gums are then repositioned snugly against the bone and stitched closed. Reducing pocket depth makes it far easier to keep the area clean with normal brushing and flossing going forward.
Bone Grafts and Regenerative Procedures
Gum disease doesn’t just inflame soft tissue. In advanced cases, it destroys the bone that holds your teeth in place. Regenerative periodontal procedures aim to rebuild that lost bone and tissue rather than simply managing the disease.
Bone grafting involves placing material into the areas where bone has been lost. That material acts as a scaffold, encouraging your body to grow new bone. The graft can come from several sources: your own bone harvested from another site in your mouth, processed bone from a donor, animal-derived material (commonly from cows), or entirely synthetic options like bioactive glass or calcium-based ceramics. Your own bone has the best biological potential because it contains living cells, but donor and synthetic materials work well and avoid a second surgical site.
Research comparing regenerated teeth to dental implants found comparable long-term survival and success rates, with regenerated teeth lasting an average of about 9 years and implants about 12.5 years. For many patients, saving a natural tooth through regeneration is a viable alternative to extraction and implant placement.
Gum Grafts for Receding Tissue
Not all periodontal procedures target infection. Gum grafting repairs tissue that has receded, exposing tooth roots and leaving them vulnerable to sensitivity, decay, and further recession. There are a few approaches, each suited to different situations.
A connective tissue graft is the most common type. The periodontist takes a small piece of tissue from beneath the surface of your palate and stitches it over the exposed root. It blends well with surrounding tissue and provides predictable root coverage, making it a good option for visible areas like front teeth.
A free gingival graft takes tissue directly from the surface of the palate instead of from underneath it. It’s highly effective at creating a thick, durable band of gum tissue that resists further recession. The tradeoff is that the grafted tissue doesn’t always match the color of the surrounding gums, so it’s generally reserved for less visible areas like the lower front teeth, where thin tissue and other anatomical challenges make recession particularly stubborn.
In some cases, especially in the back of the upper jaw, your periodontist can use tissue from near the treatment site itself. These local tissue flaps have excellent blood supply, which lowers the risk of complications and typically produces a good color match.
Laser-Assisted Treatment
Laser periodontal therapy offers an alternative to traditional surgery for some patients. The most well-known protocol uses a specialized laser with a fiber about the width of three human hairs. It selectively targets and removes diseased tissue and bacteria while leaving healthy gum tissue intact. Because there’s no scalpel incision and no sutures, patients typically experience less swelling, less gum recession from the procedure itself, and a faster recovery compared to conventional flap surgery. Laser treatment is FDA-cleared and works best for patients who want a less invasive option, though it’s not appropriate for every case of advanced disease.
What Recovery Looks Like
Recovery varies by procedure. A deep cleaning may leave your gums sore and sensitive for a few days, but most people return to normal activities immediately. Surgical procedures require more time and care.
For the first 24 to 48 hours after surgery, expect swelling and discomfort. Stick to soft foods and avoid hot drinks. During the first week, a soft diet protects the healing tissue, and you’ll want to avoid brushing directly on the surgical site. Between two and four weeks, the tissue begins to regenerate. Sutures either dissolve on their own or are removed at a follow-up visit. You can slowly reintroduce firmer foods and resume gentle brushing and flossing around the treated area.
Maintenance After Treatment
Periodontal procedures treat active disease, but gum disease is a chronic condition. Without ongoing maintenance, bacteria repopulate the pockets in as little as a month after treatment. That’s why periodontal maintenance appointments are different from the standard cleaning you get at a six-month checkup.
A standard prophylaxis, or “prophy,” is a preventive cleaning for people with healthy gums. Periodontal maintenance is a therapeutic procedure for people who have already been treated for gum disease. During these visits, your hygienist measures pocket depths, checks for signs of returning infection, and carefully instruments below the gumline in every area that was previously affected. Most periodontal patients need these appointments every three to four months rather than every six. The goal is to keep bacteria under control and preserve the results of whatever procedure you’ve had.