If non-surgical treatments cannot reduce pocket depth, surgery may be needed. In most cases osseous surgery is performed. Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease.

Osseous surgery is a procedure performed on bone and the overlying tissue. The surfaces of damaged bone are reshaped and smoothed to limit areas where disease causing bacteria can hide. This allows the gum tissue to better attach to healthy bone.