However, if pathological changes persist, which cannot be removed during phase I (“interrupting the spread of infection”), they must be treated surgically, whereby the focus is on the following treatment methods:

• Deep scaling,
• Open flap curettage or parodontal flap operation,
• Gingivectomy (internal or external),
• Gingivoplastics,
• Guided tissue regeneration (GTR),
• Insertion of a mucosal transplant,
• Vestibuloplasty,
• Osteoplastics.

Since the 1970’s, the trend has moved away from radical surgical flap reduction. The gums are no longer shortened on principle and the flap thus removed. In modern parodontal treatment, cleaning the tooth root surface removes the cause for inflammation related deepening of the pocket. Although the gingiva will not regrow, the infection does decrease noticeably.