In cases where periodontal surgery is needed, gum tissue is almost always receded so that it no longer covers the entire tooth root or reaches high enough up on the tooth to attach well and maintain tooth stability. Teeth can become loose, and the goal of surgery will be to rebuild lost gum tissue on a clean foundation. Using a technique called flap surgery, a periodontist or oral surgeon will cut back areas of the gums needing restoration, and while the gum tissue is flapped back, the exposed parts of teeth can be deep cleaned and treated with bacteria-killing topical agents.
Because periodontitis, or gum disease, causes the gums to pull away from teeth, plaque and bacteria are drawn to the open, moist pockets between teeth and gums. The body then sends cells to fight the infection, and these natural fighters often destroy bone and tissue along with the infection. Cleaning away the buildup in the pockets allows for a clean slate to build upon. A numbing agent or local anesthesia may be used for flap surgery, and a periodontist may recommend taking pain relievers prior to the procedure to reduce pain during and after as well.
Once flap surgery is completed and roots have been debrided, the flaps are either sutured or stitched up to heal or a second surgical procedure may be necessary. If bone loss is advanced, flap surgery might include bone and tissue grafting as well. Bone may be smoothed, or recontoured, along its sides and synthetic or natural bone with be grafted in and given time to attach. Bone growth actually can occur through surgical grafting, and proteins, which promote bone regeneration naturally, also can be used to encourage bone generation.
Gum tissue, however, has a limited ability to heal or regrow. Once gum tissue is lost, it is irreversible. After bone grafts are set in place and healing is progressing or complete, a procedure called guided tissue regeneration can begin. Soft tissue doesn't actually regenerate out of nowhere, but it can be taken from other areas (usually from the roof of the mouth) and grafted in places where gum tissue has receded and roots may be exposed. Sometimes a piece of material similar to mesh is placed between the hard tooth or bone surface and the gum tissue, and the new tissue regrows and connects around the tooth. Another method is to remove a portion of tissue, which is also called a flap, from another site and then to graft it underneath the remaining, receded tissue. The new tissue is placed above the area of recession to cover exposed root areas and is stitched to the tissue around the tooth [sources: AAP; CUCDM].
We haven't mentioned something obvious about all of this cutting, stitching and flapping: whether or not it's painful and for how long. What to expect after gum surgery, next.