Periodontal surgery
Gum and bone treatment led by Dr. Tsubasa Yoshizawa
When deep gum pockets, bone loss or receding gums remain after cleaning, periodontal surgery can help keep teeth that would otherwise be at risk. We start with a full examination, explain the options and costs in writing, and follow you with regular maintenance afterwards.
Consultations in English or Japanese. Self-pay treatment; Japanese National Health Insurance is not accepted.
Periodontitis develops quietly: the gums can bleed little and hurt little while the bone around a tooth is lost. In Japan's national survey, the share of people with periodontal pockets of 4 mm or more grows with each age group.
We follow the stepwise approach of the European Federation of Periodontology (EFP) clinical practice guideline [2]. Surgery is considered only for the areas that do not heal enough after cleaning.
01
Examination with pocket charting and X-rays, home-care coaching, professional cleaning above the gum line, and attention to risk factors such as smoking and diabetes.
02
Scaling and root planing below the gum line, followed by a re-evaluation. The aim is no pockets deeper than 4 mm that bleed, and none of 6 mm or more.
03
Pockets of 6 mm or deeper, or 5 mm pockets that still bleed, may need flap surgery. Where the bone loss forms a defect 3 mm deep or more, regenerative surgery can be considered.
04
Regular maintenance visits, at intervals of 3 to 12 months set by your risk, to keep the results stable.
Steps and thresholds from the EFP S3-level clinical practice guideline (Sanz et al., 2020) [2].
Which procedure suits you depends on the depth and shape of the pockets, the bone around the tooth and the gum tissue. Each option is explained with its expected benefit, limits and cost before you decide.
Saving teeth
The gum is gently lifted so the root surfaces and the bone around them can be cleaned under direct vision, then the gum is stitched back in place.
It is used for deep pockets that remain after deep cleaning, where instruments cannot reach the base of the pocket from outside.
Saving teeth
For bone loss that forms a vertical defect next to a tooth, regenerative surgery aims to rebuild part of the lost bone and attachment.
The EFP guideline recommends regenerative surgery for residual deep pockets with intrabony defects of 3 mm or more, using barrier membranes or enamel matrix derivative, with or without bone substitutes [2]. How much is regained varies from person to person.
Bone regeneration
After a tooth is lost or extracted, the jawbone shrinks. Guided bone regeneration (GBR) uses bone graft material and a membrane to rebuild bone where an implant is planned or where volume is lacking.
When a tooth is extracted, the socket can be grafted at the same visit. A systematic review found that ridge preservation reduces the loss of bone width and height compared with leaving the socket to heal on its own [4].
Gum grafting
For receding gums, a small piece of connective tissue, usually taken from the palate, is placed under the gum to cover exposed roots and thicken thin gum tissue.
A Cochrane review found that a connective tissue graft with a coronally advanced flap may give slightly better root coverage and more keratinised gum than some alternatives; the certainty of the evidence was low [3].
Gum shaping
Removes overgrown gum tissue to reduce false pockets that trap plaque, or to even out the gum line before a crown or veneer.
Periodontitis can return. After active treatment, regular maintenance is what keeps pockets shallow and the bone stable.
The EFP guideline recommends supportive periodontal care at intervals of 3 to a maximum of 12 months, set according to each person's risk [2].
Pocket charting and bleeding checks compared with your previous records, so changes are found early.
Removal of plaque and tartar above and below the gum line (PMTC + Airflow).
Coaching on brushing and interdental cleaning for the areas that need it most.
Smoking and blood-sugar control affect healing and stability; we discuss them with you.
Oral Surgery & Periodontal Care
Dr. Yoshizawa leads oral surgery and periodontal care at Rodin. He examines, plans and performs the surgery, and works with the hygienists who look after your maintenance.
All prices in JPY, tax included. Self-pay treatment. Your plan and fees are explained in writing before treatment; IV sedation is available at an additional fee.
See the full fee schedule →Gums usually settle within a few weeks; bone and attachment changes are re-evaluated over several months. Results vary from person to person.
Not always. Many people improve with home care and deep cleaning. Surgery is considered only for areas where deep pockets remain after cleaning and re-evaluation.
Sometimes, partly. Regenerative surgery can rebuild some bone in defects of a suitable shape, typically vertical defects 3 mm deep or more. How much is regained varies, and not every defect is suitable.
It is done under local anaesthesia. Discomfort and swelling for a few days afterwards are common and are managed with pain relief. IV sedation is available if you are anxious.
Most people return to normal activities within a day or two. The gums usually settle over a few weeks; results are re-checked over several months.
Usually from the palate. The donor site heals on its own; it can feel sore for a while.
An implant needs enough bone around it. When the bone is thin or low, bone regeneration (GBR) may be done before or at the same time as the implant.
Every 3 to 12 months, depending on your risk. Most people start at shorter intervals after surgery.
Rodin is a self-pay clinic and does not accept Japanese National Health Insurance. We issue itemised invoices and treatment certificates in English for overseas or private insurance claims.
Bring any X-rays or records you have. We will examine your gums and explain the options and costs in writing.
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