Some treatments for gum disease are surgical. Some examples are:

• Flap surgery/pocket reduction surgery. During this procedure the gums are lifted back and the tarter is removed. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. The gums are then placed so that the tissue fits snugly around the tooth. This method reduces the size of the space between the gum and tooth, thereby decreasing the areas where harmful bacteria can grow and decreasing the chance of serious health problems associated with periodontal disease.
• Bone grafts. This procedure involves using fragments of your own bone, synthetic bone, or donated bone to replace bone
  destroyed by gum disease. The grafts serve as a platform for the regrowth of bone, which restores stability to teeth. New
  technology, called tissue engineering, encourages your own body to regenerate bone and tissue at an accelerated rate.
• Soft tissue grafts. This procedure reinforces thin gums or fills in places where gums have receded. Grafted tissue, most often
  taken from the roof of the mouth, is stitched in place, adding tissue to the affected area.
• Guided tissue regeneration. Performed when the bone supporting your teeth has been destroyed, this procedure stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth.
• Bone surgery.Smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.

In some patients, the nonsurgical procedure of scaling and root planing is all that is needed to treat gum diseases. Surgery is needed when the tissue around the teeth is unhealthy and cannot be repaired with nonsurgical options.

AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment.

Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.

Scaling And Root Planing

Scaling and root planing is a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. Scaling and root planing is often followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis.

Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment. However, the majority of patients will require ongoing maintenance therapy to sustain health.

Tray Delivery System

A tray delivery system consists of a custom-fit tray made from impressions of the patient’s mouth. Patients use the tray at home to deliver medications that have been prescribed by their dentist. Tray delivery systems were cleared by the Food and Drug Administration (FDA)
since they are similar to fluoride trays traditionally used to prevent tooth decay. However, the FDA clearance process did not determine that any specific medication delivered via tray delivery systems has been proven to be a safe or effective way to treat gum disease. Additionally, numerous clinical studies have suggested that topically applied medicines do not reach the source of periodontal infections. When determining the best course of treatment for your specific case, be sure to discuss the pros and cons of all available treatment options with your dental professional.