Short answer: Flap surgery is a periodontal surgical procedure in which the gum is lifted in a controlled way to reach the tartar and inflamed tissue inside deep pockets in advanced gum disease. It is generally performed when deep pockets persist despite non-surgical deep cleaning. It is done under local anesthesia; the aim is to reduce pocket depth and make the area cleanable at home.
When gum disease is noticed early, it can often be brought under control with tartar removal and regular oral care. However, once the disease progresses and deep pockets form around the teeth, reaching the bottom of these pockets without lifting the gum can become difficult. Flap surgery, popularly known as gum surgery, is a periodontal surgical procedure that provides direct access to these deep areas. In this article we look at what flap surgery is, when it is needed, the steps of the procedure, the healing process and the expected results.
What is flap surgery?
Flap surgery is a procedure in which the gum is separated from around the teeth in a controlled way and lifted, the root surfaces and bone underneath are cleaned under direct vision, and the gum is then sutured back into place. In surgery, a "flap" refers to the section of tissue that is lifted. With this procedure, the dentist can see and clean the tartar, bacterial plaque and inflamed tissue inside deep pockets that cannot be reached with closed methods.
Flap surgery is not a treatment on its own but part of a comprehensive gum treatment plan. It is usually performed in the areas where it is deemed necessary after the non-surgical treatment carried out in the first phase. During the procedure, irregularities on the bone surface can be reshaped if needed, or regenerative methods can be used in suitable bone defects.
When is flap surgery needed?
Flap surgery is generally needed in patients with advanced gum disease (periodontitis), in areas where deep pockets and inflammation persist despite non-surgical deep cleaning. Gum treatment usually follows a stepwise approach:
- First phase: Oral hygiene instruction, tartar removal and cleaning of the root surfaces inside the gum pockets with special instruments (root planing) are performed.
- Re-evaluation: A few weeks later, pocket depths are measured again and the tissues' response to treatment is assessed.
- Surgical phase: In areas where deep pockets and bleeding persist, surgical procedures such as flap surgery are planned.
The main situations that may require flap surgery are:
- Gum pockets that remain deep and bleed despite initial treatment
- Tartar on root surfaces that cannot be reached with closed methods
- Bone loss affecting the areas between the roots of molars
- Bone defects of certain shapes that are suitable for regenerative treatment
- A tendency for pockets to recur because of irregular bone structure
Not every gum disease patient needs surgery; for many patients, non-surgical treatment and regular maintenance are enough. The decision for surgery is made by evaluating measurements, X-rays and the patient's general health together.
Pocket depth is determined by measuring the groove between the gum and the tooth with a probe marked in millimeters. In healthy gums this groove is shallow and there is no bleeding during measurement. Deeper measurements accompanied by bleeding are signs of inflammation and loss of supporting tissue. These measurements are repeated at every stage of treatment so that healing can be monitored objectively.
What are the steps of flap surgery?
Flap surgery is performed under local anesthesia, and how long it takes depends on the size of the area being treated. Usually the whole mouth is not treated in a single session but in sections over different sessions. The procedure typically follows these steps:
- Anesthesia: The area to be treated is numbed with local anesthesia.
- Incision and lifting the gum: Fine incisions are made around the teeth, and the gum is gently separated from the bone.
- Cleaning: Tartar and bacterial plaque on the root surfaces are removed, and inflamed tissue inside the pockets is cleaned out.
- Bone reshaping or regeneration: If necessary, irregularities on the bone surface are reshaped. In suitable bone defects, bone grafts, membranes or materials that support regeneration may be used.
- Suturing the gum back into place: The gum is repositioned in a way that reduces pocket depth and secured with sutures. In some cases, a temporary dressing may be placed over it to protect the area.
For anxious patients or extensive procedures, a sedation option can also be discussed based on the dentist's evaluation. If you take blood-thinning medication or have a chronic illness, it is important to share this with your dentist before the procedure; whether any changes to your medications are needed is decided together with your treating physician.
What should healing and care look like after flap surgery?
In the first few days after flap surgery, mild pain, swelling and tenderness may occur; in most patients these symptoms gradually ease. The main points to keep in mind during the healing period are:
- Applying cold to the outside of the cheek at intervals on the first day helps limit swelling.
- In the first days, soft, lukewarm, non-spicy foods should be preferred, and food should be chewed on the untreated side.
- Smoking significantly impairs healing and the success of treatment; if possible, it should be stopped completely.
- The treated area should be cleaned gently with a soft brush as your dentist recommends. Your dentist may recommend a mouthwash for this period.
- Sutures are usually removed within one to two weeks, or, if they are dissolvable, they disappear on their own.
- Medications recommended by your dentist should be used as directed.
During healing, some patients may notice that the gum line has receded somewhat. This is a natural result of the reduced pocket depth; the teeth may look a little longer and the spaces between them may become more visible. Sensitivity to cold may also occur because root surfaces are exposed, and it usually decreases over time. Your dentist can recommend suitable products for the sensitivity.
What are the results of flap surgery?
The main aim of flap surgery is to reduce deep pockets, shrinking the areas where bacteria can hide, and to make the area cleanable both at home and at checkups. After successful treatment, gum bleeding decreases, pockets become shallower and the disease progresses more slowly. In suitable cases where regenerative methods are used, the goal can be to regain part of the lost supporting tissues.
The long-term result depends largely on care after treatment. Gum disease is a chronic disease, and even when treated it requires regular follow-up. Your dentist will usually recommend a supportive maintenance program with checkups and professional cleanings every few months. Daily toothbrushing, using interdental brushes or floss, and staying away from smoking are decisive in maintaining the result. Keeping systemic diseases such as diabetes under control also has a positive effect on gum health.
For more information about the symptoms of gum disease and the stages of treatment, you can visit our frequently asked questions page. Once gum treatment is complete and the disease is under control, orthodontic treatment can also be planned for suitable patients; our article on who clear aligners are suitable for may give you an idea.
When should you seek care for gum complaints?
If you notice bleeding gums when brushing, bad breath, receding gums or loose teeth, having gum disease evaluated before it progresses can reduce the need for surgical treatment. At our polyclinic in Park Oran Ofis in Çankaya, Ankara, the stage of the disease is determined with gum measurements and X-rays, and non-surgical or surgical treatment options are explained to you in detail.
Frequently asked questions
Is there pain after flap surgery?
Because the procedure is performed under local anesthesia, no pain is felt during it. Mild pain, swelling and tenderness may occur over the next few days and usually ease gradually. The care instructions and medications recommended by your dentist make this period more comfortable.
When can you return to work after flap surgery?
Most patients can return to daily life within a day or two, depending on the nature of their work. It is advisable to avoid strenuous physical activity in the first days. Your dentist will recommend a suitable period based on the size of the treated area.
Does gum surgery stop loose teeth from wobbling?
Bringing gum disease under control can help reduce looseness caused by inflammation to some extent. However, if bone loss is advanced, the looseness may not go away completely. The result depends on the amount of remaining supporting tissue and on care after treatment.
