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Periodontal Flap Surgery

Open flap surgery from a periodontist can restore the health of your oral cavity when non-surgical techniques fail to address the consequences of gum disease.

The primary purpose of flap surgery is to decrease the pocket depth and establish healthy tissues and environments for the patient to manage and maintain without disease recurrence.  

Regenerative procedures in indicated areas are also usually done during the flap operation when the bone defects can be directly visualized. Regenerative porcine stem cells and bone substitutes are usually used.

What happens before periodontal flap surgery?

If you're getting periodontal flap surgery, your dental professional will first determine which tooth sites need surgical intervention. The need and indication for conjunctive regenerative procedures will also be evaluated and identified. Materials used for regenerative procedures are:


  • Enamel matrix derivative (stem cells from porcine embryos)

  • Barrier membranes

    • Resorbable collagen membranes made from porcine pericardium. ​

    • Non-resorbable membranes made of PTFE or titanium.

  • Bone substitutes

    • Alloplastic bone: synthetic bone

    • Xenograft: bone from a cow

X-rays and clinical periodontal probing on re-evaluation after non-surgical periodontal treatment will guide the periodontist on which tooth sites need surgical and possible regenerative treatment.


Periodontal flap surgery procedure

Now, we'll go over what you can expect in surgery so that you're fully prepared and confident as you go into your periodontal flap surgery procedure. Here's a general sequence of events that take place during surgery after the area is numbed:

  1. A flap-like incision in the gum tissue is created to access the tooth roots and surrounding bone.

  2. This makes it possible to remove the diseased tissue from the pocket and adequately clean the root surfaces of the teeth, which aids in the removal of toxic plaque and tartar.

  3. Shaping of the bone to physiologic and cleansable contours is done by drilling and scraping.

  4. Regenerative materials may be placed in planned defects to restore function and stability of the teeth.

  5. The flap is then placed back on its original position and secured with sutures.

  6. The healing process starts soon after.


The duration of the procedure depends on the amount of sites that needs to be treated, and may range between 45 minutes to 2 hours.


After about 3-4 months of healing, a periodontal re-evaluation will be performed to evaluate your response to treatment. 


What to expect after surgery?


  • It is normal to expect some minor bleeding, even though it will be sufficiently controlled during the procedure.

  • Any provided gauze should be kept in your mouth for about 1-2 hours, but you can replace it as needed.

  • If bleeding continues, you can manually apply pressure or gently bite down on the gauze over the site; a wet teabag can also be used if you run out of gauze.

  • It is also important to avoid intense rinsing and spitting for at least the first 24 hours in order to aid blood clot stabilization.



  • You can expect to swell to some degree, this is normal and is nothing to worry about.

  • The swelling usually reaches a peak in about 3-4 days so do not worry if it continues to swell.

  • Use of ice packs for the first 48 hours and application of moist heat after 48 hours can minimize the swelling. Please post-operative instructions section for more detail.

  • If swelling or jaw stiffness has persisted for several days, there is no cause for alarm. This is a normal reaction to surgery. 



  • The amount of pain that you feel varies from patient to patient.

  • Some level of discomfort is to be expected from any oral surgical procedure.

  • To stay ahead of the discomfort, you should take the first dose of pain medication before the local anesthesia wears off.

  • If you do have a lot of pain it may indicate an infection and should be checked.



  • Bruising over the face, eye, and neck can occur and is nothing to worry about.


  • Stitches are used to close the gums back together.

  • Doctors may use either dissolvable or non-dissolvable stitches, depending on your particular case.

  • The dissolvable variety will begin to disintegrate in 10 - 14 days, while the doctor will remove the non-dissolvable type at the first or second post-operative visit.

Diet and chewing


  • After your surgery, you will have to maintain a SOFT diet for at least 2 weeks.

  • A diet of soft foods will serve to minimize trauma to the surgical sites, and this can have a positive effect on healing.

  • Sometimes an even longer period of time is necessary, and the doctor will inform you if the period needs to be longer or if a liquid diet is required.

  • Try to chew on sides not affected by surgery when possible.


Post-opertative instructions



  • Mouthwash should be used regularly to lower the chances of infection,

  • Do not dilute the mouthwash, it is to be used twice a day 30 minutes after you brush your teeth to prevent inactivation of the mouth rinse active ingredients by the toothpaste. Rinse your mouth for one minute then spit out.

  • Do not rinse, brush, or eat for at least an hour after using mouth wash.



  • If antibiotics are prescribed, please use it as per prescription instructions.

  • Anti-inflammatory painkillers are important to reduce the level of discomfort as well as to reduce the swelling. These must be taken even if you do not feel any discomfort. Take 2 tablets/capsules immediately after surgery and then two tablets 4 – 6 hourly thereafter.

Other instructions


  • You must eat soft foods like soups and yogurts etc. for at least one week.

  • Use of ice packs for the first 48 hours can minimize the swelling.

    • The ice packs provided by our office (or bags of frozen peas) should be applied to the sides of the face continuously while awake where surgery was performed.

    • After 48 hours, ice has no beneficial effect, then moist heat can be applied to the respective area.

  • No exercise for at least 3 days.

Tooth brushing & flossing/interdental brushes


  • Avoid the surgical area with a toothbrush for 10 - 14 days.

  • Start brushing gently as soon as you can.

  • Brush all other areas that have not been treated and try to dislodge any food that may be sitting in the area of the surgical site.

  • No flossing or interdental cleaning with brushes for 12 weeks.


Dentures & Prostheses

  • Partial dentures, flippers, or full dentures should not be used immediately after surgery until your post-operative appointment unless specifically instructed otherwise.

  • When it is placed it should not touch the gums in the area of the surgery. If it does, this can cause ulceration of the wound edges and breakdown of the suture margins. 

* This list serves merely as a guideline should you encounter any of these complications. Please call us if anything worries you. We will easily
be able to put your mind at rest.

Get in Touch

078 972 2702

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