Gum surgery is any surgical procedure performed on the gum tissue or underlying bone to treat periodontal disease, repair receding gums, or reshape the gumline for functional or cosmetic reasons. Most gum surgeries become necessary when pockets between your teeth and gums reach 5 millimeters or deeper and haven’t responded to non-surgical cleaning. The specific procedure depends on whether the goal is eliminating infection, rebuilding lost tissue, or exposing more of the tooth surface.
Why Gum Surgery Becomes Necessary
Healthy gums fit snugly around teeth, with pocket depths of 1 to 3 millimeters. When gum disease progresses, bacteria push the gum tissue away from the tooth, creating deeper pockets that trap more bacteria and accelerate bone loss. Professional deep cleaning (scaling and root planing) is the first line of treatment, but when pockets of 5 mm or more remain afterward, that’s a clear risk factor for further disease progression and tooth loss. At that point, surgery is typically the next step.
Gum surgery isn’t always about disease, though. Some people need it because their gums have receded and exposed sensitive root surfaces. Others have a “gummy smile” where excess tissue covers too much of the tooth. And sometimes a tooth is broken or decayed below the gumline, and a surgeon needs to access it.
Flap Surgery
Flap surgery, also called open flap debridement, is the most common periodontal surgery for treating deep pockets. The concept is straightforward: your periodontist numbs the area with local anesthetic, then lifts a section of gum tissue away from the teeth like opening a flap. This gives direct access to the tooth roots and underlying bone, allowing thorough cleaning of surfaces that instruments can’t reach through the gumline. If the bone has been damaged, it can be reshaped or grafted at the same time.
Once the roots are clean and any bone work is done, the gum flap is stitched back into place and covered with gauze. Stitches typically come out a few days later. The procedure reduces pocket depth by allowing the gum tissue to reattach more tightly to the cleaned tooth surface.
Gum Grafting
When gums have receded, exposing the root of a tooth, gum grafting rebuilds that lost tissue. There are a few approaches, but they all involve moving tissue from one area of the mouth to another.
Connective tissue grafts are considered the gold standard for treating gum recession. Your surgeon takes a small piece of tissue from beneath the surface of your palate (the roof of your mouth) and tucks it under the gum tissue surrounding the recession. Free gingival grafts work similarly but use a block of tissue taken directly from the palate’s surface rather than the layer underneath. A third option, the pedicle graft, rotates nearby gum tissue over the exposed root without fully detaching it from its blood supply.
The palate is the most common donor site, offering longer grafts but with limited thickness. The area behind the upper back molars provides thicker grafts that may integrate well due to better blood flow. A 20-year follow-up study of connective tissue grafts found that mean root coverage started at about 74% after one year and held relatively stable at 68% two decades later. Complete root coverage was achieved in roughly 57% of simpler recession cases at one year, with about 48% maintaining full coverage at the 20-year mark. Smokers and people with less than 2 mm of firm attached gum tissue were more likely to see some recession return over time.
Gingivectomy
A gingivectomy removes excess gum tissue rather than adding it. This procedure is used when gums are abnormally thick or overgrown, creating “pseudopockets” that aren’t caused by bone loss underneath. Gum overgrowth can happen because of genetics, certain medications (particularly some blood pressure drugs and anti-seizure medications), or teeth that haven’t fully erupted through the tissue.
The procedure trims away the extra tissue to restore a normal gumline and eliminate pockets where bacteria can collect. It’s one of the more straightforward gum surgeries, with a shorter recovery than procedures involving bone.
Crown Lengthening
Crown lengthening removes gum tissue, and sometimes a small amount of bone, to expose more of the tooth’s surface. It serves both functional and cosmetic purposes.
On the functional side, crown lengthening lets a dentist access decay or fractures that extend below the gumline. It also creates enough exposed tooth structure for a crown or other restoration to grip onto (called a ferrule). Your teeth have a natural zone of tissue attachment, roughly 2 mm, between the bone and the visible tooth. Restorations that encroach on this zone cause chronic inflammation, so crown lengthening moves the gumline down to maintain that buffer.
Cosmetically, crown lengthening treats the appearance of a “gummy smile,” where teeth look short because excess tissue or a low gumline covers too much of the crown. The procedure is most commonly done on the front teeth, reshaping the gumline to reveal a more proportional tooth-to-gum ratio.
Bone Grafting and Regeneration
When periodontal disease has destroyed the bone supporting your teeth, bone grafting can rebuild what’s been lost. This is often done during flap surgery: once the area is open and cleaned, graft material is placed into the bone defect to serve as a scaffold for new bone growth.
The graft material can come from several sources. Your own bone (harvested from another site in the mouth) carries the lowest risk of rejection and resorbs naturally within 3 to 6 months as new bone replaces it. Donor bone from a tissue bank is another option and avoids the need for a second surgical site. Bovine-derived bone grafts are commonly used around dental implants and in larger defects because they resorb very slowly, providing long-lasting structural support. Synthetic materials made from calcium and phosphate compounds round out the options, with some varieties breaking down within weeks and others persisting for months.
Your periodontist selects the material based on the size and location of the defect, whether you’re also getting an implant, and how quickly the area needs to remodel.
Laser Gum Surgery
Laser-assisted procedures offer an alternative to scalpel-based surgery for some patients. The most well-known protocol, called LANAP, uses a specialized laser fiber inserted into the gum pocket. The laser energy targets pigmented bacteria and diseased tissue while leaving healthy tissue largely intact. After the infected tissue is removed and the roots are cleaned, the laser is applied a second time at a higher setting to form a blood clot that seals the pocket.
Studies comparing LANAP to scaling and root planing alone show modest advantages: a 44% reduction in pocket depth versus 40% with deep cleaning, and a 93% reduction in bleeding versus 88%. Laser surgery generally involves less bleeding, less swelling, and no stitches. However, long-term controlled trials comparing it directly to traditional surgical approaches are still limited, so it hasn’t fully replaced conventional surgery for all cases.
What Recovery Looks Like
The first day after gum surgery brings swelling, discomfort, and minor bleeding. Pain typically peaks on day one and begins easing by days two and three, while swelling usually peaks around day three before gradually subsiding. By the end of the first week, the surgical site is actively integrating. For gum grafts, it’s normal for the transplanted tissue to look white or yellowish during this stage.
During the second week, swelling drops noticeably and the area starts feeling more stable. By days 11 to 14, graft tissue feels firmer, and your periodontist will likely schedule a follow-up to check healing. Full tissue maturation takes longer, often several months, but most people feel functionally normal within two to three weeks.
For the first one to two weeks, stick to soft, room-temperature foods. Yogurt, scrambled eggs, mashed potatoes, smoothies (no straw), and lukewarm soups are all good options. Avoid crunchy, spicy, acidic, or sticky foods, and skip alcohol, which slows healing. Chew on the opposite side of your mouth, sip water gently, and rinse with warm salt water after meals if your surgeon recommends it. Avoid vigorous chewing even on soft foods for the first several days.
Oral hygiene around the surgical site needs to be gentle. Your surgeon will give you specific instructions, but generally you’ll avoid brushing the area directly for a period and rely on rinses to keep it clean. Normal brushing and flossing resume gradually as healing progresses.