The sequence of eventa during gum surgery unfolds differently depending on what kind of procedure is being performed. The patient likely will receive a local anesthetic to numb the gums so that little or no pain or discomfort is felt during the surgery.

In most cases, gingivectomies and gingivoplasties are performed with a scalpel. Special instruments with angled blades may be used to get around the teeth. Other instruments used for these procedures include electrosurgery, laser surgery or dental burs (dental tools designed for cutting or grinding). Researchers are investigating ways to improve these surgical methods.   

Soft tissue grafts involve taking a piece of soft tissue from a donor site (e.g., roof of the mouth) and moving it to a recipient site (e.g., where the gum tissue needs to be replaced). Soft tissue grafts are placed in areas where gums have receded or are of poor quality. Some of the soft tissue grafts used are:

• Connective-tissue graft. A flap is cut in the roof of the mouth to create a “trap door.” The underlying connective tissue is then removed so that only the outermost (epithelial) layer of tissue is left. The outer layer is stitched back into place and the tissue that was removed is slipped under the gum tissue around the exposed root surface and stitched into place. This is the most common treatment for tooth root exposure.
  
  
• Free gingival graft. A strip of tissue is removed from the roof of the mouth (palate) and stitched to the gum in the area being treated. This may be performed on patients with very little gum tissue around their teeth.
  
  
• Pedicle graft. A flap of gum tissue from an adjacent tooth is partially cut away and the flap (pedicle) is slid sideways over the exposed root before being stitched into place. This can only be done if the adjacent tooth has enough gum tissue to share. Pedicle grafts may be more successful than free gingival grafts because some of the original blood vessels remain in the area to help feed the grafted section. 

During gingival flap surgery, the periodontist uses a scalpel and other instrument to pull the pull tissue awaay from the bone. This allows the periodontist access to the tooth root and bone supporting the tooth. Any inflamed tissue is then removed. Scaling and root planing is performed to remove excess dental plaque and tartar (calculus). A process called osseous recontouring may be used to smooth out the edges of bone where holes or defects are present. After the procedure is complete, the gums are stitched back into place. Either these stitches dissolve or they have to be removed later.

Crown lengthening also begins with an incision that separates the gums from the tooth. The gum is then moved back off the bone to expose the roots of the teeth and the surrounding bone. The bone level is then adjusted so more of the tooth is exposed, thereby allowing a better fit of a dental restoration (e.g., crown). The soft tissue is then sutured pack into place. Crown lengthening can be performed on a single tooth or on multiple adjacent teeth.

In some cases, the periodontist may only have to remove a little bit of gum tissue to expose enough of the tooth to permit the restoration to take place. More often, the periodontist needs to remove bone from around the roots of the affected tooth and adjacent teeth. Hand instruments resembling chisels and rotary instruments resembling dental drills are used to remove the bone.

After enough tooth structure has been exposed, the periodontist stitches the gum flaps together. Gum surgery can take anywhere from a few minutes to several hours to complete, depending upon the type of procedure and the amount of tissue to be removed.