Periodontal surgeries are indicated when there is loss of gingival attachment. This is measured with a periodontal probe. Normal probing depth in a dog is 0-2 mm and in a cat is 0 to 1 mm. Any measurements greater than these is an indication for some form of periodontal surgery.

The most basic form of periodontal surgery is closed root planing and subgingival curettage. This is performed when the pocket is 3 to 4 or 5 mm deep. This is usually accomplished with hand instruments called curetts, which are what your dentist uses to clean your teeth. The curette is carefully inserted into the pocket until the bottom is reached. The curette is then rotated to engage the calculus on the root and the curette pulled out of the pocket scraping the root surface. This will also scrape the inside of the gum tissue. This is important as it removed the diseased tissue on the surface. This allows for better reattachment to the root and also causes shrinkage of the gum tissue to decrease the depth of the pocket. This procedure is continued in overlapping strokes until the root feels smooth. The root surface is then polished to smooth the tooth to retard plaque reattachment. The success or failure of any periodontal procedure is dependent on the cleanliness of the tooth surface. If these pockets are above the level of bone (supraboney pockets or horizontal bone loss) a sustained release doxycycline product can be used in the pocket. This will exert its antibacterial effect for 6 weeks and allow for soft tissue reattachment to the tooth. It is, however, contraindicated if the level of the pocket is below the level of the bone (intrabony pocket or vertical bone loss).

Periodontal pockets greater than 4 to 5 millimeters cannot be cleaned effectively without direct visualization of the root surface. This can be accomplished in one of two ways. If these surgeries are contemplated, the owner must be willing to perform homecare or represent the animal for routine prophylaxis, or the procedure will ultimately fail.

The first is by removal of some of the gingival (gum) tissue in a procedure called a gingivectomy. This is indicated in pockets where there is sufficient attached gingiva remaining. It is accomplished by cutting the gum tissue away starting at the base of the periodontal pocket. This will expose the root for cleaning, as well as remove the pocket for future home care of the area. Unfortunately it does decrease the amount of attached gingiva, which is the most important line of defense, so it is only used in area with sufficient attached gingiva. This is usually over the upper canines.

The second way is by a reverse bevel flap procedure. This requires that a gingival flap be elevated to allow the operator to view the calculus and remove it completely. This is accomplished by severing the gingival attachment around the tooth or teeth and elevating it off the bone to allow for visualization and cleaning. After this is done, the flap is reopposed by placing the tissue back in place. Finally the flap is sutured between the teeth and the flap held with digital pressure for five minutes to start the reattachment process. This will clean the tooth, but the pocket will remain to a certain extent. This will make homecare a little more challenging, but can be rewarding if the soft tissue reattachment can be maintained. A variation of the flap procedure is a repositioning flap. The gingiva is typically repositioned apically (towards the bottom of the root) to lower the height of the gingiva to decrease pocket depth for ease of home cleaning as gingivectomy does. However, unlike gingivectomy, the attached gingiva remains, just lower down the tooth. This is a much more difficult procedure than gingivectomy, and is used in areas where there is limited attached gingiva, or where the pocket extends to close or below the mucogingival line (where the attached gingiva ends and the alveolar mucosa starts).

An additional procedure that can be performed when there is an intraboney pocket is guided tissue regeneration. This is performed to allow bone to regrow in an area where it has been lost due to periodontal disease. It is accomplished by placing an osseoconductive material (a product that encourages bone formation like a bone graft) in the cleaned defect. In addition, a barrier is placed to allow the bone to regrow in the area before the faster growing soft tissue invades the area. This is an expensive procedure, but can be rewarding and tooth saving if performed correctly.