Periodontal or Gum Surgery

Periodontal or Gum Surgery

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Periodontal surgery can take many forms. In this

page, we discuss the type of surgery to arrest and treat periodontitis. These

procedures are often also called "flap" or "osseous" surgery..

Periodontal or flap surgery in the simplest sense is designed to

gain access to deeper areas of the roots of teeth and to clean the damaged areas.

The main advantage in using this procedure is that visual access

is obtained and therefore the thoroughness of the debridement (cleaning) is improved.

Flap surgery is essentially similar to other various

periodontal surgical procedures. The area to be treated will be numbed profoundly with a

local anesthetic. After it is determined that the area is fully anesthetized, the surgery

will open an access to the roots by elevating a "flap" of gum. The

roots are thoroughly cleaned to achieve the desired result. Often a few sutures

(stitches) are necessary and usually the area is covered with a putty-like packing

material to protect the site for a week. Most patients are back to work the next

Once the pocket is cleaned, the gum may be returned to its original level. This results

in a clean root, but the deepened space is still present. Frequent cleanings by the

hygienist are necessary to remove the plaque in the residual pocket that the patient

cannot reach with flossing and brushing (See Periodontal

Maintenance). Even when there is good oral hygiene and regular quarterly recalls, the

bacteria may still continue to cause the pocket to become reinfected. When cosmetics are

not a concern (on the lower teeth, the inside of the upper teeth, and the outside of the

upper back teeth), the surgeon may elect to suture the gum down to where the bone has

resorbed, reducing the depth of the space. If the space is reduced to 3 millimeters or

less, the patient is able to reach the bottom of the space with daily brushing and

Gum sutured back to normal height, leaving a deepened space

Gum sutured down to bone to reduce residual space.

In the majority of advanced cases, the bacteria has caused

the bone to resorb and become pitted. In these cases flap surgery gives access not only

for root cleansing, but allows for recontouring of the bone itself. By performing this osseous surgery, and reshaping the bone to its natural scalloped

shape, it is generally possible to eliminate moderate pockets.

The patient is then able to prevent recurrence of the disease by keeping the shallow

space clean with brushing and flossing.

Flap surgery is also needed if regeneration procedures are to be performed. Here the

gum is reflected back to allow insertion of bone or guided tissue regeneration membranes

In summary, for most moderate and advanced cases, it is important to be able to reach

far under the gum to treat the infection and diseased tissues. By using flap surgery, the

periodontist is able to access these areas to provide the optimal care available. With

today''s medications, surgery should be painless with only a minimal amount of

post-operative discomfort (See What to Expect from