Severe gum disease is treated surgically when deep pockets and bone loss put the infection beyond the reach of a deep cleaning, and the main options are pocket reduction surgery, bone grafting, gum grafting, and guided tissue regeneration. At Sola Dental Spa in Staten Island, periodontal surgery is planned and performed by Dr. Daniel Nejat, DMD, a board-certified periodontist who has handled the surgical side of the practice since 2007. The word surgery sounds drastic, but in experienced hands these are precise, well-tolerated procedures with one shared goal, keeping your teeth. You can see how periodontal care fits into the services we offer.
Pocket reduction surgery cleans the roots directly and shrinks the pockets where bacteria hide. Bone and gum grafts rebuild support that disease destroyed, and guided tissue regeneration encourages new attachment. The right choice depends on pocket depth and how much bone remains.
"By the time I see six and seven millimeter pockets, home care and cleanings alone cannot reach the bacteria driving the damage. Surgery lets me clean the root surface directly, reshape the bone, and in many cases regrow support the disease took away. The goal is simple, keep the tooth."
Dr. Daniel Nejat, DMD, Board-Certified Periodontist, Sola Dental Spa
A patient in his fifties came to us from the North Shore with a loose lower molar and gums that bled at a touch. He expected to lose the tooth. Instead, Dr. Nejat staged his care: scaling and root planing first, a re-evaluation six weeks later, then flap surgery with a bone graft only where the pockets had not resolved. Two years on, the molar is stable and his maintenance visits are uneventful, which is exactly how we like them.
When does gum disease actually need surgery?
When pockets stay deeper than about five millimeters after non-surgical treatment, when bone loss is visible on imaging, or when teeth begin to loosen. Non-surgical therapy always comes first.
Periodontitis is common, not rare. Chronic periodontitis affects 47.2 percent of adults over 30 in the United States, according to the American Dental Association, and most cases are managed without a scalpel through scaling, root planing, and disciplined maintenance. Surgery enters the conversation when deep pockets persist after that first phase, because instruments simply cannot reach the bottom of a seven millimeter pocket through the gum. At that depth, the infection keeps dissolving bone in the dark.
What happens during pocket reduction surgery?
The gum is gently lifted back, the roots are cleaned under direct vision, damaged bone is reshaped, and the gum is repositioned snugly so pockets become shallow enough to maintain.
Pocket reduction, also called flap surgery, is the workhorse of periodontal surgery. Under local anesthesia, Dr. Nejat lifts a small flap of gum tissue, removes the hardened deposits and inflamed tissue clinging to the roots, and smooths bone defects that trap bacteria. The gum is then sutured back at a healthier level. Shallower pockets change the long game entirely, because your hygienist and your floss can finally reach everything that matters.
How do grafts and regeneration rebuild lost support?
Bone grafts fill defects so new bone can form, gum grafts restore tissue where recession has exposed roots, and guided tissue regeneration uses a membrane to direct healing where it is needed.
Where periodontitis has hollowed out bone around a root, a graft gives the body scaffolding to rebuild. Guided tissue regeneration places a thin membrane between gum and bone so slower-growing bone and ligament cells can reclaim their territory before gum tissue fills the space. Soft tissue grafts address receded gums, covering sensitive roots and thickening fragile tissue. This foundation work matters well beyond the gums themselves, which is why we insist on a healthy foundation before veneers or implants in every treatment plan.
What is recovery like after periodontal surgery?
A few days of soft food and careful hygiene, mild soreness managed with over-the-counter medication, sutures out within a couple of weeks, and then a strict maintenance schedule.
Most patients are surprised by how manageable recovery is. Expect some tenderness and swelling for a few days, a soft menu for the first week, and specific instructions on cleaning near the surgical site. The real work is what follows: periodontal maintenance visits every three to four months, because periodontitis is controlled rather than cured. Our guide to gum surgery aftercare walks through the day-by-day details.
| Procedure | What it does | Best suited for |
|---|---|---|
| Pocket reduction (flap) surgery | Cleans roots directly and reduces pocket depth | Persistent deep pockets after non-surgical therapy |
| Bone grafting | Rebuilds bone destroyed around tooth roots | Localized bone defects threatening tooth support |
| Gum (soft tissue) grafting | Covers exposed roots and thickens thin tissue | Recession, sensitivity, and fragile gumlines |
| Guided tissue regeneration | Directs new bone and ligament growth with a membrane | Defects where regrowth is biologically possible |
Frequently asked questions
Is periodontal surgery painful?
The procedure itself is done under local anesthesia and patients feel pressure rather than pain. Afterward, most describe a few days of soreness controlled with over-the-counter medication. It is consistently milder than people expect, and sedation options are available for anxious patients.
Can severe gum disease be cured?
Periodontitis is managed, not cured. Surgery removes the infection and rebuilds what it can, but the result only holds with maintenance cleanings every three to four months and honest home care. Patients who keep that schedule routinely keep their teeth.
Will insurance help with gum surgery?
Many dental plans contribute toward periodontal treatment because it is medically necessary care rather than elective. Coverage varies by plan, so our Staten Island team reviews your benefits and gives you a clear written estimate before anything is scheduled.
How long does recovery take?
Plan on a soft diet and gentle activity for about a week, with sutures typically removed within two weeks. Complete healing of bone beneath the surface continues quietly for months, which is why follow-up imaging matters.
Can I get dental implants if I have gum disease?
Not until the disease is controlled. Implants placed into infected, shrinking bone fail at much higher rates. Dr. Nejat treats the periodontitis first, rebuilds bone where needed, and only then moves to implant planning, which protects the investment from day one.