Surgical periodontology
Surgical treatment of advanced periodontal disease and correction of the bone and gum defects caused by periodontitis.
Periodontal surgery comes into play when non-surgical therapy is not enough to control periodontitis, or when the disease has already destroyed part of the bone supporting the teeth. The goal is twofold: to eliminate deep pockets that cannot be kept clean and, wherever possible, to regenerate the lost tissues.
Regenerative techniques, using membranes, biomaterials and enamel matrix proteins, now make it possible to recover bone and attachment in defects that once led to tooth loss. Resective surgery instead reshapes the bone architecture so that the tooth can be maintained over time. The choice depends on the shape of the defect, the tooth involved and the overall prognosis of the mouth.
This has been the heart of my work for thirty years: deciding, case by case, when a tooth deserves to be saved and when an implant is the more reasonable option. A natural tooth with adequate remaining support, well treated and maintained, often has a better prognosis than any alternative.
When it is indicated
- Residual periodontal pockets after non-surgical therapy
- Vertical bone defects and furcation lesions
- Teeth with a compromised but recoverable prognosis
- Site preparation before an implant
- Crown lengthening for prosthetic or restorative needs
How it works
- 01Re-evaluation after cause-related therapy: full periodontal probing and radiographs to locate residual defects.
- 02Planning: choice between a regenerative and a resective approach based on the morphology of the defect and the prognosis of the tooth.
- 03Surgery under local anaesthesia, using microsurgical techniques and, where indicated, biomaterials and membranes.
- 04Healing: close follow-up in the first weeks and hygiene instructions tailored to the treated area.
- 05Supportive periodontal therapy: periodic sessions to preserve the result in the long term.
Frequently asked questions
Is it really possible to regenerate bone lost to periodontitis?
In defects with a favourable morphology, such as multi-walled vertical defects, yes: the literature documents stable gains in bone and attachment over time. In widespread horizontal defects regeneration is limited, and the focus shifts to stabilisation.
How long is the recovery after surgery?
Post-operative discomfort is usually mild and lasts a few days. Sutures are removed after one to two weeks; full maturation of the regenerated tissues takes several months.
When is it better to extract the tooth and place an implant?
When the remaining support is too poor, the tooth is mobile and the prognosis stays unfavourable even after treatment. Before that point, saving the tooth is almost always the more conservative choice and often the more durable one.
Do the results last?
Yes, on one condition: maintenance. Without periodic sessions and good home care, periodontitis tends to recur, with or without surgery.