Treatment of Advanced Periodontal Disease – Surgical & Non-Surgical

periodontal disease treatment

Periodontal diseases are often neglected or overshadowed by other dental conditions like caries and mal-aligned teeth. However, the fact is that it affects more than half the population. The good part is that this condition advances in stages, and in the early stages it is mostly reversible. Through this article, we will learn about the treatment of periodontitis which includes scaling, medicines and some surgical procedures for advanced cases.

Gingivitis & Periodontitis

In the early stages, gum disease is called gingivitis. Typically, it means inflammation of the gums. When the bacterial content around your gums increases and plaque accumulates, your gums begin to bleed during brushing.

You will notice redness and mild swelling around that region. Sometimes they may even be tender and painful. The gums begin to recede away from the tooth surface, and this is apparent in the form of sensitivity.

What these symptoms are telling you is that you must get your gums cleaned. If not, then the plaque turns to calculus which is hard and difficult to remove.

This calculus loosens the tooth in its socket and also weakens the gums. This is called periodontitis, which is an advanced stage of gingivitis.

Periodontal disease treatment

As we have read, gingivitis is a mild form of periodontal disease. Hence, it is mostly reversible with some dental procedures and practicing good oral hygiene.

To some extent, early intervention for periodontitis can also eliminate the need for surgical treatment.

The key to getting rid of gingival inflammation is getting rid of the irritants that are causing it. Just dental procedures are not adequate to maintain the health of your gums.

On your part, you must follow your dentist’s advise and practice good oral hygiene at home too.

Non-Surgical Treatment


Scaling is a treatment modality where the dentist removes the plaque, calculus and other debris from the gums using an ultrasonic scaler.

Sometimes a laser can also be used for this procedure. If required, your dentist may perform this under local anesthesia, but it is not binding.

Root Planing

Through root planing, the dentist smoothens the attachment surface of the exposed roots. By doing this, your dentist ensures that there are no bacterial remnants left after scaling.

It also makes the surface smooth and even for re-attachment of the gums. Bacteria tend to accumulate more on rough surfaces; hence root planing is critical to prevent the microbial population from collecting over those areas. (1)

Scaling and root planing may require multiple dental visits, depending on the number of bacteria, the condition of your gums and patient compliance.


Once scaling is over, your dentist will prescribe some medicines in the form of pills or mouth-rinses, for you to maintain a clean environment around your gums.

They may also prescribe dental floss and a particular de-sensitizing toothpaste, depending on how much your gums have receded.

Antibiotics help to reduce the inflammation and pain around the gums.

Follow up

Follow up visits are extremely important in this case because it helps the dentist to evaluate and eliminate the need for periodontal surgery.

If primary scaling and medicines are sufficient to bring out re-attachment of the gingiva, surgery is not required. However, if you are unable to maintain the health of your gums and if the doctor notices that plaque accumulation has begun again, surgery is usually the next step.

Surgical Treatment

Surgery is required when the gums do not heal properly even after scaling, and there is still a loss of attachment.

There are various surgical techniques, each having its indications and benefits. We will read about the most commonly practiced ones here.

Flap surgery

A pocket is formed between the gums and tooth when the recession is severe. Inside a pocket, the bacteria accumulate and spread the infection into the deeper layers.

It is difficult to get rid of a pocket by scaling alone and hence a flap surgery may be needed. In this surgery, your periodontist will remove all the debris from the pocket and then suture the gums snugly onto the tooth surface.

This helps to re-establish the attachment between the tooth and the gingiva and remove the microbes from there.


If the recession is so severe that attachment cannot be re-established by flap surgery, a soft tissue graft is placed there to make up for the lost gingiva.

The donor tissue is most commonly your palate. This procedure is carried out to cover the exposed root surfaces, and also improve the aesthetics of your gums.

If the periodontitis has progressed to the bone, and the bone contour is affected, then you also need bone grafting. This is a surgery where the dentist will first contour your irregular bone, and then place a bone graft.

This graft could be your bone, a synthetic bone or a donor’s bone. By doing this, the bone holds the tooth more firmly in place and strengthens the attachment. (2)

Guided Tissue Regeneration

Guided Tissue Regeneration (GTR) is a surgical method to stimulate bone growth. (3) In this technique, the dentist places a membrane or a separation between the bone and the tooth.

This membrane is made of a bio-compatible material. By doing so, the bone is given a clean undisturbed environment to regenerate.

A pack or a healing paste is helpful after surgery to protect the area. Your dentist will also prescribe some medication and mouth rinse following GTR. In a few weeks’ time, new bone will be formed.

Home Maintenance

Maintaining the health of your teeth and gums is not in the dentist’s hand alone. A large part of the prognosis depends on the patient’s ability to maintain oral hygiene.

After periodontal treatment, follow the practices and medications as prescribed by your dentist. (4) You must brush thoroughly and floss as recommended.

Keep your gums clean and follow up with your dentist bi-annually. Mouth rinses are helpful to chemically disinfectant the mouth and get rid of the foul smell.

If you get any symptoms like bleeding, pain or swelling of your gums visit your dentist for scaling immediately.

Habits like smoking and tobacco chewing are deleterious to gingival health. Quitting them gradually is beneficial to prevent eventual tooth loss. Smokers show a less favorable response to periodontal treatment along with delayed healing. (5)

You must also remember that periodontal health is a reflection of your systemic health, and always keep your dentist informed about your medical history or any other general body symptoms that you might be having.

Recently, periodontitis has been declared as a major complication of diabetes mellitus too. (6)

That’s it on periodontal treatment

As the old age saying goes, prevention is better than cure. Remember if you curb gingivitis in its initial stages, periodontitis is avoidable.

Various surgeries are available to treat severe periodontal problems, and it is advised to opt for these before irreversible damage is done, and the tooth has to be removed.

Baani has done BDS. She enjoys reading in her free time. Her weak spots are quirky stationery and witty puns. She is currently interning as a dentist and plans to pursue a career in the research-oriented domain of public health.