There are situations where non-surgical treatment may not resolve advanced levels of periodontitis including advanced bone loss, deep vertical bone defects, complex root anatomy, root furcation (where the roots divide in back teeth) and where the gum tissue is of a thick and fibrous nature. Periodontal surgery can facilitate access to remove plaque and calculus (tartar) that is located deep under the gum and also provides the opportunity to reshape the gum in order to minimize or eliminate pocketing. Periodontal surgery is often delayed until after non-surgical treatment has been provided and can be directed at specific sites where it is beneficial.

Periodontal regeneration: Where bone loss associated with periodontal disease is vertical in nature (creating gutters of bone loss), there may be an opportunity to regenerate both the lost bone and periodontal attachment. Regenerative techniques employ surgical placement of membranes, bone graft materials and/or stem cells (Enamel matrix proteins). Regenerative techniques require careful site selection and the results can be very effective and impressive.