If the periodontitis has progressed so far that the conventional measures are no longer promising or if the extent of the gingival pockets is too large, periodontal surgery is necessary. Resective, reparative and regenerative methods or a combination of all are used.
The spectrum of resective surgical methods includes root resections (amputation, hemisection) of apical shifting flaps (extension of the clinical tooth crown and exposure of deep-seated caries) and gingivectomy.
Repair methods include closed and open curettage and flap surgery.
With the regenerative method a predictable regeneration of the diseased or lost tissue is possible. Guided tissue regeneration using membrane technology, bone grafts, a combination of both, coronal displacement flaps or enamel matrix proteins can lead to a genuine regaining of lost periodontal structures with the new formation of root cement, desmodont and alveolar bone.