Gum health
Gum surgery and grafts: treatment options and what affects the cost
Gum surgery treats pockets that do not respond to deep cleaning, covers exposed roots with grafts, or exposes more tooth for a crown. Usually done by a periodontist and priced per tooth or quadrant.
No public price is listed for this treatment. Fees depend on your exam, and offices confirm whether they provide it.
What the treatment is
Periodontal surgery lets the dentist clean roots directly and reshape bone or gum where non-surgical treatment has not reduced pockets.
Gum grafts add tissue where gums have receded. Crown lengthening removes gum and sometimes bone so a tooth broken near the gumline can be restored.
Why it may be recommended
- Deep pockets remaining after scaling and root planing.
- Receding gums with sensitivity or thin tissue.
- A tooth that needs a crown but has too little tooth above the gum.
Treatment types and variations
Tap a type to see when it is used and what to weigh. Your dentist recommends options after examining you.
Common procedures
Osseous (pocket reduction) surgeryGum flaps are opened to clean roots and reshape bone.
- Codes to ask about
- D4260, D4261
GingivectomyRemoving excess gum tissue.
- Codes to ask about
- D4210, D4211
Bone graft or guided tissue regenerationMaterials placed to try to regrow lost bone around a natural tooth.
- Codes to ask about
- D4263, D4266
Connective tissue graftTissue from the palate placed to cover a receded root.
- Codes to ask about
- D4273
Donor tissue graftUses processed donor tissue instead of your own.
- Codes to ask about
- D4275
Free gingival graftThickens thin gum tissue.
- Codes to ask about
- D4277
Pedicle graftMoves nearby gum over a receded area.
- Codes to ask about
- D4270
Crown lengtheningExposes more tooth before a crown.
- Codes to ask about
- D4249
Materials and techniques
- Graft sources
- Your own tissue, donor tissue or animal-derived materials.
Benefits, limitations and possible risks
Benefits
- Can reduce pockets and make them easier to keep clean.
- Can cover roots and reduce sensitivity.
- Can save a tooth for a crown.
Limitations
- Results vary; regeneration is not predictable in every case.
- Requires healing time and excellent home care.
Possible risks
- Pain, swelling and bleeding.
- Sensitivity or gum recession.
- Graft failure.
- Infection.
What happens during treatment
- 1
Evaluation
Measurements and imaging.
- 2
Surgery
Under local anesthetic, with sedation if needed.
- 3
Healing
Follow-up visits and suture removal.
Recovery and maintenance
- Soft diet and gentle cleaning as instructed.
- Avoid smoking.
- Results are evaluated after healing.
What affects the cost
- Procedure and number of teeth
- Priced per quadrant, per tooth or per site.
- Graft material
- Donor tissue adds material cost.
- Specialist
- Periodontist fees differ.
Common additional charges
These are billed separately at many offices. Not every patient needs them.
| Sedation | If used. |
|---|---|
| Post-op visits | Usually included; ask. |
Procedure fee or total case cost?
Surgery may follow deep cleaning and precede crowns or implants. Ask for the full sequence and fees.
Paying with insurance or without insurance
Coverage depends on medical necessity and plan; many plans cover surgery as a major service. Ask for a pre-treatment estimate.
Alternative treatments
Alternatives depend on your teeth and health. Ask your dentist to explain the trade-offs of each option, including doing nothing.
- Continued non-surgical care
- More frequent maintenance in some cases.
- Extraction
- For teeth with a poor outlook.
Codes to ask your insurer about
Insurers price treatment by ADA CDT procedure code. The office confirms the exact code for your treatment; labels here are plain-English summaries.
| D4260 | Osseous surgery, four or more teeth per quadrant |
|---|---|
| D4261 | Osseous surgery, one to three teeth per quadrant |
| D4210 | Gingivectomy, four or more teeth per quadrant |
| D4211 | Gingivectomy, one to three teeth per quadrant |
| D4263 | Bone replacement graft, natural tooth, first site |
| D4266 | Guided tissue regeneration, resorbable barrier, per site |
| D4270 | Pedicle soft tissue graft |
| D4273 | Connective tissue graft, own tissue, first tooth |
| D4275 | Connective tissue graft, donor tissue, first tooth |
| D4277 | Free soft tissue graft, first tooth |
| D4249 | Clinical crown lengthening, hard tissue |
Questions to ask your dentist
- What happens if I do not have surgery?
- Which graft material do you recommend?
- Who performs it?
Frequently asked questions
Is gum surgery covered by insurance?
Many plans cover it as a major service when medically necessary; cosmetic procedures may not be covered.
Related procedures
- Gum disease treatment and deep cleaningsTreatment for gum disease ranges from a routine cleaning for healthy gums to scaling and root planing (deep cleaning) and ongoing periodontal maintenance. Which you need depends on gum measurements and X-rays, not preference.
- Dental crownsA crown is a cap that covers a damaged, weak or root-canal-treated tooth to restore its shape and strength. The price depends on the material, the lab and whether the tooth needs a build-up or post first.
- Dental implantsAn implant replaces a missing tooth root with a post placed in the jawbone, topped with an abutment and a crown, bridge or denture. It is usually priced as several parts, which is why quotes vary so much.