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Flap surgery and osseous (bone) surgery are often required when deep pockets (spaces under your gums) remain after the completion of non-surgical treatment. This generally indicates that there has been significant bone loss and the ongoing infection is likely to continue.

Flap surgery is a procedure in which the gum tissue is gently pushed away from the roots of the teeth after the patient has been thoroughly anesthetized. This provides the periodontist with access and visualization for root planing.

Sometimes it is necessary to smooth out damaged bone while the tissue is pushed back and this is called osseous surgery.  Following these procedures the gum and bone tissue will heal naturally.

Conceptually this is similar to fresh paint continuing to peel off wrought iron which hasn't had the underlying rust removed. The real problem is inadequate preparation not the paint. The situation in periodontics is similar in that the condition beneath the gum line must be made biologically acceptable if the gingiva and bone are to heal properly and remain healthy.