Periodontal (Gum) Surgery

Problems gum surgery may address

• Pockets that stay deep after deep cleaning. In periodontitis, the gum comes away from the tooth and pockets form. If some are still deep when your gums are measured again, surgery gives access to clean them.
• A bone defect beside the root. Where a deep pocket sits over a bone defect 3 mm or deeper beside the root (an intrabony defect), the guideline recommends regenerative surgery¹. It aims to help some of the lost support grow back.
• Disease between the roots of a back tooth (furcation involvement). Where pockets remain, the guideline says these back teeth should receive gum treatment, and that furcation involvement is no reason to take the tooth out¹.
• Receding gums. A graft can reduce how much root is exposed. Not every receded area needs one (see below).
• A narrow band of firm gum around a tooth. A graft can widen it, for example before a crown or orthodontic treatment. The evidence on how much firm gum a tooth needs is weak³.
• Too little tooth above the gum for a crown or filling. Crown lengthening removes some gum, and often a little bone, so that more of the tooth shows. Changing the gum line for appearance is covered on the cosmetic gum contouring page.

When surgery is not the next step

• Before deep cleaning. Surgery for gum disease is considered only after the first two steps of treatment and a re-assessment. These are described on the deep cleaning and root planing page.
• When cleaning at home is not yet good enough. The guideline recommends not doing gum surgery in people who are not achieving and keeping up good enough cleaning at home¹. Your dentist judges this by checking how much plaque is left on your teeth.
• Moderately deep pockets. For pockets of 4 to 5 mm that remain after deep cleaning, the guideline suggests repeating the deep cleaning¹ rather than surgery.
• Receding gums without signs of disease. Monitoring the receded area⁴ is considered the appropriate approach. Exposed roots are often linked with concerns about appearance, sensitivity, and decay or wear near the gum line⁴. In some cases, surgery may be considered⁴. A graft covers the root; ask what else can be done first for sensitivity, decay or wear.

Tell your dentist before treatment

If you take a blood thinner or any other regular medicine, have diabetes or heart disease, smoke, or are pregnant, tell your dentist before treatment. Bring a written list of your medicines. Do not stop or change⁵ your blood thinner for dental treatment unless your doctor or dentist tells you to. The guideline says surgery needs its own consent, and your risk factors and any medical reasons against it should be considered¹.

Whether you need gum surgery cannot be decided from photographs. It is decided from a gum chart. The dentist measures the depth of the pocket around each tooth with a thin probe. They also record where the gums bleed, how loose the teeth are and how much support has been lost. X-rays show the bone. From these, the stage of the disease and your risk are established.

For surgery, the chart that matters is the one taken after deep cleaning. The gums first need time to heal; then they are measured again¹. This is the re-assessment (dentists also call it re-evaluation). The guideline's aim for the first two steps has two parts. No pocket should be deeper than 4 mm and bleed when probed, and none should be 6 mm or deeper¹. Where this aim has not been reached, the third step is considered. For pockets of 6 mm or more that remain, the guideline suggests access flap surgery¹.

So if surgery is suggested to you, ask which teeth it is for, and which measurements it is based on. Ask when those measurements were taken: before deep cleaning, or at the re-assessment after it. Copies of both charts let your own dentist in the UK see the same picture.

Surgery works only on top of the earlier steps. Before any surgery, the guideline's first two steps are:

• Daily care and risk factors. You are shown how to brush and clean between your teeth in the way that suits you. Smoking and diabetes are discussed. Plaque and tartar above the gum line are cleaned off.
• Cleaning below the gum (deep cleaning). The pockets and the root surfaces are cleaned, usually under local anaesthetic. The details are on the deep cleaning and root planing page.

Once the gums have healed, they are measured again. Areas that have responded well go on to supportive care. For areas that still have pockets, cleaning them again is one option; surgery is another, mainly for deeper pockets. One NHS hospital in London tells its surgery patients that they will already have had their teeth cleaned and been taught how to clean them⁶. It says surgery is used for gum disease that still needs treatment after deep cleaning.

Your own cleaning matters as much as the operation. The same hospital says the result depends on how well you brush your teeth in the future⁶. It also depends on how severe the disease was at the start. Smoking weakens⁷ the response to gum treatment; stopping can prevent further deterioration.

Which procedure is used depends on what the re-assessment shows. For the third step, the guideline lists repeated deep cleaning, access flap surgery, resective surgery and regenerative surgery¹. Gum grafts and crown lengthening are used for other problems.

• Access flap surgery (open flap debridement). The gum is lifted so that the root surfaces can be cleaned under direct view. It is then stitched back in place. The guideline found not enough evidence to recommend one flap design over another¹.
• Resective (pocket reduction) surgery. As well as the cleaning, the gum and sometimes the bone are reshaped so that the pockets become shallower and easier to clean. The guideline suggests it for deep pockets, while taking into account that the gum may recede more¹. The teeth can then look longer.
• Regenerative surgery. After cleaning, a material is placed to help lost attachment and bone grow back around the tooth. The guideline recommends barrier membranes or a protein gel (enamel matrix derivative), with or without bone-derived grafts¹. Some regenerative materials are of pig or cow origin¹. Ask what will be used if this matters to you.
• Gum graft for receded gums (root coverage). The gum next to the exposed root is moved to cover it. This is often done with a small graft of connective tissue from the roof of your mouth. In a Cochrane review, this graft reduced recession more than a barrier membrane under the flap⁸. It also gave a wider band of firm gum than a membrane or a protein gel⁸. The quality of this evidence was low or very low, and only one of the 48 trials was at low risk of bias. A collagen material of animal origin can be used instead of your own tissue. In three of four trials, there was less pain after surgery⁹ with it, and the review's authors describe a shorter operation⁹. But complete root coverage was more frequent with your own tissue¹⁰ in trials of several receded teeth.
• Graft to widen the firm gum (free gingival graft). A thin piece of gum from the palate is placed where the band of firm gum is narrow. Your own tissue is still considered the established method³. Options that avoid taking tissue from the palate also exist. Patients treated with them appear to have reported more satisfaction and less discomfort³. This evidence comes mainly from case reports and case series.
• Crown lengthening. Gum, and often a little bone, is removed so that more of the tooth shows before a crown or filling. The gum margin may creep back, mostly in the first three months¹¹.
• Removing a tooth. If a tooth cannot be kept, extraction is an alternative. You may then need replacement teeth, such as a denture, a bridge or implants⁶. Which teeth can be kept is decided after the examination and measurements. More on dental implants.
• No further treatment. The gum disease could get worse, your teeth might become painful, and you might lose them sooner⁶.

For deep cleaning, the European guideline suggests not using lasers in addition to cleaning below the gum¹. We hold no source on lasers in gum surgery. If a laser is suggested, ask what it adds and what evidence supports it.

Gum surgery is usually done under local anaesthetic: injections numb the area and you stay awake. One NHS hospital in London describes it like this. A cut is made around the edge of the gum, and the gum is lifted so the roots can be seen and cleaned⁶. A few stitches then hold it back in place. Sometimes the gum and bone are reshaped, or a material is placed to help support grow back. At another NHS hospital, a gum graft procedure usually takes one hour¹². How long yours takes depends on the procedure and on how many teeth are treated.

If sedation is suggested, ask what kind it is and why. The UK standards for dental sedation require an escort for all forms of sedation other than inhalation sedation in adults¹³. Without an escort, treatment under sedation must not go ahead. The same standards expect written and spoken aftercare instructions for you and your escort, and arrangements for advice out of hours¹³. Ask whether the clinic follows the same rule, and plan who will accompany you, especially if you are travelling alone.

After-effects you may notice

The NHS hospital information quoted above lists what patients may notice after gum surgery.

• The gums feel sore⁶, and painkillers may be needed for a few days.
• Some bleeding, and bruising or swelling of the gums or the face near the treated teeth. Swelling can take 2 to 3 days to appear and up to 2 weeks to go down completely⁶.
• Teeth that feel looser after the surgery; this is usually temporary.
• Teeth that are sensitive to hot, cold or sweet food and drink. For dentine sensitivity, toothpastes containing stannous fluoride or arginine are recommended among the first options¹⁴. This recommendation is based on studies of dentine sensitivity in general, not on gum surgery.
• Teeth that look longer, and larger spaces between them. As the gum heals and shrinks, more of the tooth shows. How much depends on how much the gum was reshaped⁶. One year after resective surgery, gum recession was greater than after an access flap¹.

Other risks and problems

• An NHS hospital leaflet on gum grafts lists bleeding, infection, swelling, an uneven gum line and the need for further surgery¹² among the risks.
• In the trials of regenerative surgery the guideline reviewed, no serious adverse event was reported. The problems reported were local wound problems and the usual after-effects of surgery¹.
• The palate, if tissue is taken from it. Gum may be taken from the roof of the mouth and left to heal as an open wound. Pain there is most pronounced in the first three days¹⁵. A protective dressing or plate can reduce it, although results vary. The review notes that such an open wound can take up to four weeks to heal completely¹⁵.

We cannot say on this page how often each of these happens; the sources above give no rates.

Limits of what surgery can do

• Not every tooth reaches the target. The guideline notes that the aims of treatment may not be achievable in all teeth¹ in severe periodontitis.
• Lost bone largely does not come back. Damage caused by periodontitis is irreversible, but the disease can be stabilised¹⁶. Regenerative surgery aims to regain some support, and only in suitable defects.
• A graft does not always cover the whole root. Some studies followed single receded areas, with no loss of gum or bone between the teeth, for 5 years or more. With a flap and a connective tissue graft, they reported complete root coverage in 66.7 to 88.2 per cent¹⁷. With a flap alone, the figure was 33 to 60 per cent¹⁷, leaving out one flap-alone group with much poorer results. The studies were small and differed from each other, so their results were not pooled. Several of them counted treated teeth or sites, not patients. These figures come from published studies, not from our own records.
• The gum line can move again. After root coverage, the gum margin showed a tendency to recede again over time¹⁸. Grafts shrink somewhat while they heal³, and the source gives no figure for how much. After crown lengthening, the gum can creep back, mostly in the first three months.
• The disease can come back. After treatment for periodontitis, the risk of it coming back remains increased². See supportive care below.

Benefits

• Surgery gives access to deep pockets that deep cleaning did not bring under control. At one year, access flaps reduced pocket depth more than repeated deep cleaning, especially in pockets that were 6 mm or deeper¹ to start with. In the trials the guideline reviewed, there was no significant difference in what patients reported¹.
• In deep pockets over a bone defect, regenerative surgery gave shallower pockets and more attachment than flap surgery alone¹ in most studies.
• The NHS hospital quoted above says that reshaping the gum can make your teeth easier to keep clean⁶.

Follow the written instructions your dentist gives you, because they depend on the procedure. As an example of what to expect, this is how one NHS hospital in London advises its patients after gum surgery.

• Brushing. Do not brush the area where you had surgery⁶; brush the rest of your mouth as usual. At the review, you are told when you can clean the area normally again.
• Mouthwash. A chlorhexidine mouthwash is used 2 or 3 times a day for 2 to 3 weeks⁶. After a gum graft, it is used for 2 to 4 weeks¹⁹. Used for 4 to 6 weeks, chlorhexidine can stain the teeth²⁰; altered taste and irritation inside the mouth have also been reported. If you are allergic to chlorhexidine, ask your dentist about another mouthwash.
• Painkillers. It is best to start painkillers such as paracetamol or ibuprofen before the local anaesthetic wears off⁶. Do not take more than the recommended dose. Do you take a blood thinner or other regular medicines, or have you had problems with these painkillers before? Then ask your dentist or pharmacist which painkiller to use. Discomfort should start to feel better after a week⁶.
• Food and activity. Eat a soft diet for a week⁶, and chew on the other side. Avoid vigorous exercise for 24 hours⁶. After a gum graft, avoid activities that could knock your mouth or face for 2 to 4 weeks¹⁹.
• Swelling. On the day of surgery, a cold pack wrapped in a cloth can help. Do not put ice directly on your skin.
• Bleeding. Some bleeding in the first two days is expected. If bleeding does not stop, press firmly on the area with gauze or a clean cotton handkerchief for at least 30 minutes⁶.
• Antibiotics. Some people are given antibiotics⁶ after surgery to lower the risk of infection. If you are, finish the course, and tell your dentist about any allergy.
• Smoking. If you smoke, stop. If you cannot stop completely, the same hospital advises stopping for at least 2 weeks after the surgery⁶ to help the gums heal.
• Stitches and review. Stitches that do not dissolve are usually removed at a review appointment. This is 1 to 2 weeks after gum surgery⁶, or 2 to 4 weeks after a gum graft¹⁹. Another NHS hospital gives 7 to 21 days¹² for graft stitches. Ask before you book which kind of stitches you will have, and who will remove them once you have flown home.
• Healing plate. After a gum graft, you may be given a plastic plate that protects the area¹⁹.

Once the area has healed, clean between your teeth every day again. For people who have been treated for periodontitis, interdental brushes are recommended as the first choice¹. Floss is an option where the brush does not fit. After brushing, spit the toothpaste out and do not rinse²¹ your mouth with water.

Flying. We have found no guidance that sets a waiting time before flying after gum surgery specifically. A 2023 review of flying after dental treatment suggests waiting about a week after most dental interventions²². The authors note that the research is limited and comes mainly from military aviation. Ask your dentist when you can fly, and plan your stay so that the wound is checked first.

Surgery does not end the treatment. After treatment for periodontitis, the risk of the disease coming back remains increased², and it needs close monitoring. The European guideline recommends supportive care at intervals of at least 3 and at most 12 months¹, set according to your risk. One NHS hospital says the routine its surgery patients follow is often decided about 3 months after surgery⁶.

Supportive care means regular check-ups, gum measurements and professional cleaning, with your own daily cleaning in between. A review looked at 33 studies of people who kept up professional gum care for at least 5 years after treatment. On average, 0.1 teeth per patient were lost each year, and most patients lost no teeth²³. Most of these studies looked back at records, and they include only people who kept coming to their appointments. These figures come from published studies, not from our own records, and they cannot predict what will happen to one person.

If you were treated in Antalya, supportive care usually continues with your own dentist or hygienist in the UK. National guidance in England (NICE) says the interval between check-ups should be set for each person according to their risk²⁴ and discussed with them. Ask your own dentist before you travel whether they will take this on.

After gum surgery, contact the dentist who treated you, or your own dentist, if you notice any of the following.

• Bleeding that does not stop after you have pressed firmly on the area⁶
• Pain that is not getting better, or is getting much worse, after 7 days⁶
• Pain or swelling that keeps getting worse, or a high temperature
• A rash or other side effects from antibiotics

If you do not have a dentist, the NHS in England says to call 111 or get help from 111 online²⁵. The same applies if you cannot get an emergency appointment.

Swelling that appears suddenly after dental treatment and crackles when touched should be checked without waiting²⁶. If you cannot reach your dentist straight away, see a dentist where you are or go to an emergency department.

Emergencies. The following need urgent medical help²⁵. Do not wait for a dental appointment or for the clinic's reply. In the UK, call 999 or go to A&E. In Turkey, the emergency number is 112.

• Swelling that makes it hard to breathe, speak or swallow
• Swelling of the eye or the neck²⁷, a painful eye, or sudden problems with your eyesight
• A lot of swelling inside the mouth
• Finding it hard to open your mouth

Before you fly home

Make sure you have a written record of the surgery. It should say which teeth were treated, with which procedure, and which graft or material was used. It should include the gum measurements and any X-rays. Take written aftercare instructions with you. Know whether your stitches dissolve; if they do not, know who will remove them and when. Know whom to contact about the wound, how, and in which language.

Once you are back in the UK

If a problem comes up that is not urgent, write to the clinic and send photographs. For anything that needs someone to look in your mouth, see your own dentist in the UK. If you have no dentist, use NHS 111 as described above. In the emergencies above, do not wait for a reply.

Your treatment is provided by our clinic in Antalya, Turkey, and carried out there by the clinic's dentists.

The European guideline says gum surgery is effective but frequently complex. It recommends that surgery is provided by dentists with additional specific training, or by specialists¹. Periodontology, the branch of dentistry that deals with the gums, is one of the nine dental specialties set by law in Turkey²⁸. Turkish law ties the specialist title to a specialist certificate²⁸, issued and registered by the Ministry of Health²⁹. In the UK, a dentist may call themselves a specialist only if they are on the GDC's specialist list³⁰. On this page, "your dentist" means the dentist who examines and treats you. "Your own dentist in the UK" means the dentist you see at home.

Ask who will measure your gums, who will decide that surgery is needed, and who will carry it out. Ask what their titles are, where they qualified, and what training in gum surgery they have. Ask whether any of them holds a Ministry-registered specialist certificate in periodontology. Ask for the answers in writing.

Gum surgery sits inside a course of care that usually takes months. It runs from deep cleaning and healing to a re-assessment, then surgery only for the areas that need it. The surgery is followed by more healing, another re-assessment and supportive care. Agree before you book how each part will work, and where it will happen. This sequence applies to surgery for gum disease. A gum graft or crown lengthening is planned for other reasons, but the wound review and the stitches still need planning.

Why surgery rarely fits into one trip

The re-assessment comes only once the gums have healed¹ after deep cleaning, and surgery is decided only then. So do not expect the deep cleaning, the re-assessment and any surgery to fit into one stay. After surgery, the wound needs a review, and some stitches need removing. The NHS hospital quoted above holds this review 1 to 4 weeks after surgery⁶.

This can be planned in two ways:

• Deep cleaning first, surgery later. The deep cleaning is done in Antalya or by your own dentist in the UK. The re-assessment follows once the gums have healed, with your own dentist or on a return visit. Surgery, if it is still needed, is a separate trip.
• Deep cleaning and re-assessment already done in the UK. If your own dentist or hygienist has done both, bring the recent charts and X-rays. The clinic's dentist still examines you and measures your gums before any surgery.

What can be done in Antalya

• Examination and gum measurements, with X-rays if needed
• Deep cleaning, if it has not already been done
• Surgery for the areas that still need it after a re-assessment, with a check of the wound before you fly

What usually continues in the UK

• The re-assessment after deep cleaning, unless you return to Antalya for it
• The re-assessment once the surgical area has healed
• Supportive care, at intervals set by your risk

What to agree in writing before you book

The General Dental Council says you should be assessed by a qualified dentist before being given a treatment plan and cost estimate³¹. Before you book, you receive a written preliminary plan. It is based on what you send, such as recent X-rays and gum charts from your own dentist, and it is not a diagnosis. The examination in Antalya confirms or changes it, and with it the days and the cost.

Ask for the plan to answer these questions:

1. Who decided that surgery is needed, and on which chart? Was that chart taken after deep cleaning, once the gums had healed?
2. Can the re-assessment be done by your own dentist in the UK before you travel, and will the clinic accept that chart?
3. Which procedure is planned, for which teeth, and which graft or material will be used?
4. Will the stitches dissolve? If not, when is the review, and will it be before you fly?
5. Who checks the wound and answers your questions after you are home, and how do you reach them?
6. Who carries out the re-assessment after surgery and the supportive care, and at what interval?
7. Which records will you take home for your own dentist?

You can also ask a dentist in the UK for an independent opinion before you decide. Ask whether surgery is the right next step for you, and what having it in the UK would involve. After the examination in Antalya, you can still decide not to go ahead. You can say no, or ask to stop, at any stage.

Your own dentist or hygienist

The General Dental Council suggests talking to your own dentist³¹ before you go. They need to know the plan, because the re-assessment and the supportive care that follow are usually theirs. Ask them before you travel whether they will take it on, and what that care will cost. If you do not have a regular dentist, find one before you travel. The NHS lists exchanging medical records and arranging aftercare back home³² among the things to consider before treatment abroad.

Your records

Ask the clinic for a written record of the surgery to take back to your own dentist. It should show the gum measurements before and after deep cleaning, and later after surgery. It should name the teeth treated, the procedure, and any graft or regenerative material used. Ask for copies of any X-rays too. In Turkey, the health tourism regulation entitles international patients to an itemised bill. On request, they also get free copies of the records of the materials used, the tests and the imaging³³.

What the NHS does and does not do

In England and Wales, an NHS dental practice may accept you for a course of treatment, not only an urgent appointment. If it does, it provides clinically necessary treatment, with your consent³⁴. This means the treatment that every NHS dental contract must offer. Having been treated abroad does not change that. But the NHS rules on further treatment within 2 months, and on free repair or replacement, do not apply³⁴ to work that another provider did. The NHS also states that it is not liable for negligence or failure of treatment³² when you have treatment abroad. On the NHS England routes that fund planned treatment abroad, you cannot get reimbursement for dental treatment³⁵.

The NHS guidance quoted on this page is for England, and for England and Wales where stated. Scotland and Northern Ireland have their own NHS rules, and we hold no source for them on this page. If you live there, check the local arrangements.

Travel insurance

The NHS says that most travel insurance policies will not cover you for planned treatment abroad, so you may need specialist cover³². Tell your insurer about your plans. Before you book, ask whether anything linked to the treatment is covered, such as a complication or an extra trip.

The General Dental Council lists questions to ask before treatment abroad³¹. Below are most of them, with what this page can answer today and what to ask for in writing.

1. Who will carry out my treatment, and what are their qualifications? The treatment is provided by our clinic in Antalya, Turkey. Ask for the name of the dentist who will carry out the surgery. Ask where they qualified, what their title is and what training in gum surgery they have (see who carries out the treatment, above).
2. Are you regulated by a professional body and registered with it? In Turkey, a health facility needs an authorisation certificate³³ from the Ministry of Health to treat international patients. Authorised facilities appear in a register the Ministry publishes³⁶, so you can check it yourself. The authorisation belongs to the facility, not to the dentist, and it says nothing about the result of your treatment. Ask for the treating dentist's own registration details as well. See health tourism authorisation.
3. Will someone explain the treatment in my language? Ask who will explain the plan, the consent form and the aftercare instructions to you in English, and whether you get them in writing.
4. How often have you done this treatment, and what are your success and complication rates? The figures on this page come from published studies, not from the clinic's own results. Ask the clinic whether it keeps its own figures for gum surgery, and how they were collected.
5. Is the work guaranteed, and for how long? Surgery can help bring gum disease under control, but the disease can come back, and a grafted gum margin can recede again. This page makes no guarantee. Ask what the clinic's written terms cover, for example further treatment if pockets are still deep after surgery, or if a graft does not take.
6. What happens if I am not happy with the result? For gum surgery, the result is judged at the re-assessment, once the area has healed. Ask for the clinic's answer in writing.
7. What aftercare do you provide, and who can I contact after the treatment? Your written plan should say who reviews the wound, who removes any stitches, and who carries out the re-assessment and the supportive care. It should also say whom to contact, how, and in which language.
8. If there are complications, who pays for further treatment, extra flights and the hotel? Ask for the answer in writing before you commit.
9. What happens if the examination shows that surgery is not the right treatment for me? For example, your gums may need more deep cleaning first. Ask in advance what you pay for the examination, and what happens to anything you have already paid.
10. Do you have a complaints system, and can I see a copy? Ask for it before treatment. The GDC says it cannot resolve complaints or help with refunds³⁷; its investigations concern the dentists on its own register. Turkish regulation makes the facility responsible for complications and medical malpractice arising after the health service it provided³³.
11. Do you have insurance to cover this treatment? In Turkey a facility treating international patients must take out complication insurance for surgical and interventional procedures carried out in an operating theatre³³. That does not by itself tell you whether your treatment is covered, so ask which procedures in your plan, if any, fall under it. Ask too, in writing, whether the clinic or the treating dentist holds insurance for complications or errors, what it covers and whom it protects.

The NHS names warning signs to think about before booking any treatment abroad. They are a hard sell, a lack of information, pressure to make a quick decision, no discussion of possible complications, and no mention of aftercare³⁵. Apply them to this clinic too.

This page does not give prices. Your treatment plan is prepared for you after the examination. The main factors that shape the plan are:

• Whether deep cleaning and a re-assessment are still needed before any surgery
• Which procedure is planned, and for how many teeth or areas
• Whether a graft or a regenerative material is used
• X-rays, if needed
• The wound review and stitch removal
• The re-assessment after surgery and the supportive care, and whether they take place in Antalya or in the UK
• How many trips the plan needs

Ask for the plan in writing, showing what is included and which procedures will be assessed separately. Ask too who pays for further treatment and extra travel if there is a complication.

If you are comparing with a plan from a UK practice, compare what each one includes, item by item.