Periodontal Flap Surgery

Pocket Reduction Surgery

Pocket reduction surgery (also known as osseous surgery and flap surgery) is a collective term for a series of several different surgeries aimed at gaining access to the roots of the teeth in order to remove bacteria and tartar (calculus). Following surgery, access for maintaining your teeth becomes easier.

The human mouth contains dozens of different bacteria at any given time. The bacteria found in plaque (the sticky substance on teeth) produce acids that lead to demineralization of the tooth surface, and ultimately contribute to periodontal disease.

Periodontal infections cause a chronic inflammatory response in the body that literally destroys bone and gum tissues once they invade the subgingival area (below the gum line). Gum pockets form and deepen between the gums and teeth as the tissue continues to be destroyed.

Periodontal disease is a progressive condition which, if left untreated, causes massive bacteria colonization in gum pockets, eventually leading to teeth falling out. Pocket reduction surgery is an attempt to alleviate this destructive cycle and reduce the depth of the bacteria-harboring pockets.

Reasons for the pocket reduction surgery

Pocket reduction surgery is a common periodontal procedure, which has been proven effective at eliminating bacteria, reducing inflammation, and saving teeth.  The goals of pocket reduction surgery are:

  • Reducing bacterial spread – Oral bacteria has been connected to many other serious conditions such as diabetes, heart disease, and stroke.  Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize.  It is important to decrease bacteria in the mouth in order to reduce the risk of secondary infection.
  • Halting bone loss – The chronic inflammatory response induced by oral bacteria leads the body to destroy bone tissue. As the jawbone becomes affected by periodontal disease, the teeth lose their rigid anchor.  When the teeth become too loose, they may require extraction.
  • Facilitate home care – As the gum pockets become progressively deeper, they become incredibly difficult to clean by the patient. The toothbrush and dental floss cannot reach to the bottom of the pockets, increasing the risk of further periodontal infections.
  • Improve access for maintenance recalls - As pockets get deeper, recalls become less effective because of limited access.

What does pocket reduction surgery involve?

Before recommending treatment or performing any procedure, the dentist will perform thorough visual and x-ray examinations in order to assess the condition of the teeth, gums, and underlying bone. Pocket reduction surgery may be performed under local or general anesthetic, depending on the preferences of the patient.

The gums will be gently pulled back from the teeth and bacteria and calculus (tartar) will be eliminated.  Scaling and root planing will generally be required to fully remove the ossification (tartar) from the surface of the tooth root.  If the root is not completely smooth, a planing procedure will be performed to ensure that when the gums do heal, they will not reattach to rough or uneven surfaces.

The final part of the surgery is usually the administration of an antimicrobial liquid to eliminate any remaining bacteria and promote healing. The gum is then sutured with tiny stitches that are left in place for 5-10 days.

Though the gums will be more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums.

If you have any questions about pocket reduction surgery or treatment for periodontal disease, please ask your periodontist.

 

Crown Lengthening Surgery

Crown lengthening is generally performed in order to improve the health of the gum tissue, or to prepare the mouth for restorative or cosmetic procedures.  In addition, crown lengthening procedures can also be used to correct a “gummy” smile, where teeth are covered with excess gum tissue.  Crown lengthening exposes more of the natural tooth by reshaping or recontouring bone and gum tissue.  This treatment can be performed on a single tooth or many teeth  to expose an aesthetically pleasing smile.

Reasons for crown lengthening surgery

Crown lengthening is a versatile and common procedure that has many effective uses and benefits.  The vast majority of patients who have undergone this type of surgery are highly pleased with the results.

Here are some of the most common reasons for crown lengthening:

  • Restoration of damaged teeth – Periodontal disease can cause severe damage to the teeth, as can trauma and decay. Where teeth have been broken beneath the gum line, crown lengthening can be used to prepare the area for a new restoration to correct the damaged teeth.
  • Dental crowns – Crown lengthening serves to provide more space between the supporting jawbone and dental crown. This prevents the new crown from damaging gum tissues and bone once it is in place.

What does crown lengthening surgery involve?

Crown lengthening is normally performed under local anesthetic. The amount of time this procedure takes will largely depend on how many teeth are involved and whether a small amount of bone needs to be removed in addition to the soft tissue.

The periodontist will make a series of small incisions around the soft tissue in order to separate the gums away from the teeth. Even if only one tooth requires the re-contour, neighboring teeth are usually treated to provide a more even reshaping. Separating the gums provides the dentist with access to the roots of the teeth and the underlying bone.

In some cases, the removal of a small amount of tissue will provide enough tooth exposure to place a crown.  In other cases, the dentist will also need to remove a small amount of bone from around the teeth. The bone is usually removed using a combination of special hand instruments and rotary instruments.  The rotary instruments roughly resemble the drill that is used in cavity treatment.

When the dentist is satisfied the teeth have sufficient exposure, the wound will be cleaned with sterile water and the gum tissue will be sutured with small stitches. The teeth will look noticeably longer immediately after surgery because the gums have now been repositioned.

 Prescriptions may be provided for pain medication, and a chlorhexidine (antimicrobial) mouth rinse may be given to help reduce any bacteria attempting to re-colonize.  The surgical site will be completely healed in approximately two to three months.

If you have any questions about periodontal flap or crown lengthening surgery, please ask your periodontist.