When gum disease has progressed beyond what non-surgical care can address, or when the health and appearance of your gum and bone structures require more direct intervention, surgical treatment offers precise, lasting solutions. Dr. Madan is a highly trained periodontist with deep expertise in a full range of surgical procedures — all performed with the goal of restoring function, preserving your natural teeth, and giving you the healthy, confident smile you deserve.
Every surgical treatment at Madan Periodontics is planned and performed with your comfort and long-term outcomes as the priority. Dr. Madan takes time to thoroughly explain your diagnosis, walk you through your options, and answer every question before any treatment begins.
Soft Tissue Grafting & Gum Recession
Gum recession — the gradual pulling back of gum tissue from the tooth surface — is one of the most common consequences of periodontal disease, and it can also result from aggressive brushing, genetics, bite problems, or natural aging. As gum tissue recedes, the root surfaces of the teeth become exposed, leading to sensitivity, increased risk of decay along the root, a longer-looking smile, and eventually tooth instability if left untreated.
Soft tissue grafting is the most effective treatment for restoring lost gum tissue, protecting exposed roots, and improving the appearance of the gum line. Dr. Madan offers several types of grafting procedures tailored to your specific needs and anatomy:
- Connective Tissue Graft — The most commonly performed gum graft, this technique uses a small amount of tissue taken from beneath a flap in the roof of the mouth (palate). The donor tissue is then carefully placed over the exposed root and sutured into position. This method provides excellent coverage and a natural-looking result.
- Free Gingival Graft — A thin layer of tissue is taken directly from the surface of the palate and placed at the site of recession. This technique is often used in patients who have very thin gum tissue and need to increase the thickness and volume of the gumline, rather than simply cover an exposed root.
- Pedicle Graft — In cases where adequate gum tissue exists adjacent to the recession site, a flap of nearby tissue can be pivoted over to cover the exposed root without the need for a separate donor site. This preserves the blood supply to the graft and tends to heal well.
What to expect: Soft tissue grafting is typically performed under local anesthesia, with sedation options available for patients who prefer added comfort. Most patients return to normal activities within a few days, with full healing occurring over several weeks. Dr. Madan will provide detailed post-operative instructions and is available to answer any questions throughout your recovery.
The results of soft tissue grafting are both functional and aesthetic — protecting your teeth from further damage while restoring balance and symmetry to your smile.
Frenectomy
A frenum is a small fold of soft tissue that connects the lips or cheeks to the gums. Most people have several: one under the upper lip (maxillary labial frenum), one under the lower lip, and one beneath the tongue (lingual frenum). When a frenum is too thick, too tight, or attached too close to the gumline or the edges of the teeth, it can create a range of functional and cosmetic problems.
A frenectomy is a simple, minimally invasive surgical procedure to remove or release an overly restrictive frenum. At Madan Periodontics, frenectomies are commonly performed to address:
- Gum recession caused by frenum tension — A frenum that pulls tightly against the gum tissue can contribute to recession over time, particularly in the front of the mouth. Releasing the frenum removes this mechanical stress and helps protect gum attachment.
- Gaps between front teeth (diastema) — A prominent maxillary labial frenum can create or maintain a gap between the upper front teeth that resists orthodontic closure. A frenectomy is often performed in conjunction with orthodontic treatment to achieve a stable result.
- Tongue-tie (ankyloglossia) — A tight lingual frenum can restrict tongue movement, affecting speech, swallowing, and in infants, breastfeeding. A lingual frenectomy releases this restriction and restores full range of motion.
The procedure is quick, well-tolerated, and associated with a smooth recovery. Dr. Madan performs frenectomies using precise surgical technique to ensure minimal discomfort and excellent cosmetic outcomes.
Tooth Extractions
While preserving natural teeth is always the priority at Madan Periodontics, there are situations in which a tooth is too severely compromised to save, and extraction becomes the most appropriate course of action. Advanced periodontal disease, significant bone loss, vertical root fractures, or severe decay can leave a tooth unable to function or support surrounding structures, at which point removal is the healthiest option for the patient.
Dr. Madan performs tooth extractions with the same level of care and precision she brings to every procedure. As a periodontist, she has specialized training in managing the bone and soft tissue at the extraction site — an important consideration, particularly when dental implants or other restorative work is planned for the future.
What to expect: Most extractions are performed under local anesthesia, with sedation available for anxious patients or more complex cases. Dr. Madan will discuss what to expect before, during, and after the procedure, as well as your tooth replacement options so you can move forward with a clear plan. In many cases, bone grafting at the time of extraction is recommended to preserve the socket and maintain the ridge for future implant placement.
Losing a tooth is never easy, but with thoughtful planning and the right specialist, it can be the beginning of a seamless path to a healthy, restored smile.
Crown Lengthening
Crown lengthening is a versatile surgical procedure in which Dr. Madan removes excess gum tissue, and in some cases a small amount of underlying bone, to expose more of the natural tooth structure. It is one of the most commonly performed procedures in periodontics and serves both functional and cosmetic purposes.
Functional Crown Lengthening
When a tooth is severely decayed, broken below the gumline, or otherwise lacks sufficient structure for a dental crown or other restoration, your restorative dentist may not have enough tooth to work with. Functional crown lengthening creates the necessary access by reshaping the gum and bone around the tooth, allowing the restorative work to be placed properly and ensuring a secure, long-lasting fit. Without adequate tooth structure above the gumline, crowns are prone to failure — crown lengthening provides the foundation your restoration needs to succeed.
Cosmetic Crown Lengthening
A “gummy smile” — where the gums appear to cover an excessive portion of the teeth — is one of the most common cosmetic concerns that brings patients to a periodontist. Whether due to genetics, the way the teeth erupted, or excessive gum tissue that simply never receded, a gummy smile can make teeth appear short, uneven, or disproportionate, affecting the overall harmony of the face.
Cosmetic crown lengthening — sometimes called a gum lift or gum contouring — is a precise surgical procedure in which Dr. Madan carefully removes and reshapes excess gum tissue to reveal more of the tooth’s natural crown. The result is a smile that appears longer, more proportionate, and beautifully balanced.
Cosmetic crown lengthening can be performed on a single tooth to correct asymmetry, or across the entire arch for a complete smile transformation. It is often performed in combination with other cosmetic dental work such as veneers or bonding to achieve the full desired result. The procedure is performed under local anesthesia, and most patients are pleasantly surprised by how smooth and brief the recovery is.
If you’ve always felt self-conscious about showing too much gum when you smile, cosmetic crown lengthening may be the straightforward solution you’ve been looking for.
Gingivectomy
A gingivectomy is a surgical procedure in which a portion of the gum tissue is removed and reshaped. It is one of the oldest and most well-established procedures in periodontics, used to treat specific conditions that affect the health, function, or appearance of the gums.
When is a gingivectomy recommended?
Gingival enlargement (overgrowth) — Certain medications — including some blood pressure drugs, anti-seizure medications, and immunosuppressants — can cause the gums to thicken and overgrow significantly, a condition called drug-induced gingival hyperplasia. In other cases, overgrowth may result from chronic inflammation or genetic factors. When overgrowth is substantial, it creates pockets where bacteria accumulate and makes proper oral hygiene difficult. A gingivectomy removes the excess tissue and restores a healthy gum architecture.
- Persistent deep pockets — In some cases, gum pockets remain too deep to clean properly even after scaling and root planing and other non-surgical therapies. Removing the excess gum tissue that forms the pocket wall reduces pocket depth and allows for more effective oral hygiene and maintenance.
- Cosmetic reshaping — A gingivectomy can also be performed for purely aesthetic reasons, to even out an irregular or uneven gumline and create a more symmetrical, polished appearance.
The procedure is performed under local anesthesia, is well-tolerated, and results in a meaningful improvement in both the cleanability of the teeth and the overall appearance of the smile.
Bone Grafting & Ridge Augmentation
Bone is the foundation upon which everything in the mouth depends. When periodontal disease, tooth loss, or trauma leads to bone deterioration, the consequences extend far beyond the affected teeth — neighboring teeth can shift, the jaw can change shape, and options for tooth replacement become significantly more limited.
Bone grafting is a surgical procedure in which bone graft material is placed in an area of deficiency to stimulate the regeneration of natural bone. Dr. Madan uses a variety of graft materials — including processed donor bone, synthetic bone substitutes, and in some cases, bone from the patient’s own jaw — depending on the specific needs of each case.
Periodontal Bone Grafting — When gum disease has caused bone loss around an existing tooth, a bone graft can be placed to help rebuild the supporting structure. This is often performed in conjunction with osseous surgery and may include the use of barrier membranes or regenerative proteins to optimize bone and tissue regeneration. The goal is to stabilize the tooth, reduce pocket depth, and, in many cases, restore bone that would otherwise be permanently lost.
Ridge Augmentation — When a tooth is lost or extracted, the bone that once surrounded the root begins to resorb (dissolve) within weeks. This process can result in a visible indentation in the jaw ridge and, more critically, insufficient bone volume to support a dental implant. Ridge augmentation rebuilds the height and width of the jaw ridge using grafting materials, restoring the natural contour of the bone and recreating the proper foundation for an implant. In many cases, bone grafting is performed at the time of extraction — called a socket preservation graft — to minimize bone loss from the outset.
Whether you’re hoping to preserve a natural tooth, prepare for an implant, or restore the structural integrity of your jaw, Dr. Madan will guide you through every step of the grafting process with clarity and expertise.
Osseous Surgery
When gum disease has advanced to the point where significant bone loss and deep periodontal pockets are present — and non-surgical treatments have not been sufficient to fully resolve the problem — osseous surgery offers a highly effective path to stabilization and long-term health.
Also known as pocket reduction surgery or flap surgery, osseous surgery involves Dr. Madan gently folding back the gum tissue to gain direct access to the tooth roots and underlying bone. This access allows her to:
- Remove tartar deposits and bacterial biofilm from deep below the gumline that cannot be reached during a standard cleaning or even scaling and root planing
- Smooth irregular bone surfaces (a process called osseous recontouring) that harbor bacteria and prevent the gum tissue from reattaching properly
- Address bone defects — such as craters or ledges formed by the pattern of bone loss — by reshaping the bone to create an architecture that is easier to clean and maintain
- Place bone graft material or regenerative membranes if indicated to encourage bone regrowth
Once the root and bone surfaces have been thoroughly cleaned and reshaped, the gum tissue is sutured back into place — typically at a level that reduces pocket depth, brings the tissue closer to the bone, and makes ongoing maintenance more effective.
What to expect: Osseous surgery is performed under local anesthesia, with sedation available for patient comfort. Most patients experience mild to moderate discomfort in the days following the procedure, which is well managed with prescribed or over-the-counter medication. Dr. Madan and her team provide thorough post-operative guidance and schedule follow-up visits to monitor healing and ensure optimal results.
Osseous surgery is not a cure for gum disease — no treatment is — but it is one of the most powerful tools available to halt disease progression, save teeth that might otherwise be lost, and establish a stable baseline from which regular periodontal maintenance can keep the disease under control indefinitely.
Sinus Augmentation
The upper back teeth — the molars and premolars — have roots that sit in close proximity to the maxillary sinuses, the air-filled cavities on either side of the nose. When these teeth are lost, and bone begins to resorb, the sinus can gradually expand downward into the space where the tooth roots once were, leaving insufficient bone depth to place a dental implant.
A sinus augmentation — also called a sinus lift — is a specialized bone grafting procedure designed to address this specific problem. By carefully lifting the sinus membrane and placing bone graft material in the space beneath it, Dr. Madan creates the necessary bone height for a stable, successful implant to be placed in the upper jaw.
Types of sinus augmentation
- Lateral Window Sinus Lift — For patients requiring a significant increase in bone volume, Dr. Madan creates a small access point through the side of the upper jaw, gently elevates the sinus membrane, and carefully packs bone graft material into the newly created space. After a healing period of several months, the grafted area matures into solid bone capable of supporting an implant.
- Crestal (Internal) Sinus Lift — When only a modest amount of additional bone height is needed, a less invasive technique can be used. The sinus membrane is elevated from below through the same site used to place the implant, allowing the graft and implant to be placed in a single procedure or with minimal additional steps.
Sinus augmentation is a routine, well-established procedure in the hands of a skilled periodontist, and Dr. Madan performs it routinely as part of comprehensive implant treatment planning. If you’ve been told that you don’t have enough bone for dental implants in the upper jaw, a sinus augmentation may be the solution that makes implant treatment possible for you.