In advanced periodontal disease, when scaling and root planning have been unsuccessful in eliminating the entire pocket of decay, or when there has been bone loss that needs to be surgically corrected, then a dentist may perform periodontal flap surgery.

Flap surgery can be described as the loosening of the gum from bone to expose and clean underlying tooth structures by means of an incision on the gum close to the tooth under local anesthesia. The entire area is then carefully cleaned and all tartar and infected granulation tissue are removed and the bone is examined. Because periodontal disease causes bone loss, often the bone will need to be re-contoured or grafted in order for the gum to heal properly. When the procedure is done, the gums are sutured in to place on top of the bone.

The entire flap procedure typically requires from 1 to 3 hours to perform with only two quadrants of the mouth being addressed in a single visit. The sutures will remain in place for approximately one week, and a patient will likely be given a prescription for pain medication and antibiotics.

It is very important for you to keep your mouth as clean as possible while the surgical site is healing. This means you should brush and floss the rest of your mouth normally. If the surgical site is not covered by a periodontal pack (A type of dental ‘band–aid'), you can use a toothbrush to gently remove plaque from the teeth. Mouth rinses containing chlorhexidine are commonly prescribed following periodontal surgery. Although these rinses do not remove plaque from the teeth, they kill the bacteria and help your mouth heal. Post-surgical swelling is also possible, and this can be minimized by applying an ice pack to the outside of your face in the treated area.