Periodontal (Osseous Surgery)

If you're diagnosed with periodontal disease, Dr. Forrest may recommend periodontal surgery. Periodontal surgery is necessary when Dr. Forrest determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. The two types of surgical treatments most commonly prescribed are Pocket Reduction Procedures and Regenerative Procedures.

In advanced cases of periodontal disease, the first line of treatment, scaling and root planing, combined with excellent home care to keep new bacterial deposits from forming, is sometimes not enough to bring the disease under control. In some cases, periodontal surgery is necessary.

When is periodontal surgery necessary?

Surgery is only rarely needed to control periodontal disease, a disease that affects almost everyone. Most people can keep their teeth and gums healthy by careful daily removal of the bacterial film which causes the disease, in combination with periodic visits to a dentist or dental hygienist for the removal of bacterial deposits below the gum line. However, when there is periodontal disease, and the gum has unzipped so far down the root of the tooth that dental instruments are no longer effective (about 5-6 millimeters), periodontal surgery may be necessary. If not done, the bacterial deposits will remain on the tooth and cause further bone destruction; ultimately causing the teeth to develop painful abscesses or simply to loosen and fall out.

What exactly is periodontal surgery?

It is a minor surgical procedure generally done in the dental office with a local anesthetic. It involves folding the gum back away from the tooth just enough so that a Periodontist, a dentist specializing in the treatment of gum diseases, can see the tooth root surfaces. Once they are seen, the deep bacterial deposits crusted on the tooth can be removed. In this way, the root surfaces can be made once again acceptable to the body, and the gum can reattach, at least to a degree. Surgical access also makes it possible to graft bone into defects to repair some of the damage. After root preparation, the gum is closed back with sutures and a dressing is often placed to keep the area undisturbed, especially for the first week.

Is periodontal surgery a cure for periodontal disease?

No, it is not. The bacteria which cause the disease are normally in the mouth, and continually form on the teeth as a thin film, requiring meticulous personal removal on a daily basis. Periodontal surgery can achieve a complete cleansing of deeply hidden bacterial deposits at a point in time. If the bacteria are kept off of the teeth long enough afterward for re-attachment and healing to occur, then a healthy and maintainable periodontal attachment can be achieved, and the teeth can be saved. However, if the bacterial film is allowed to build up during the healing period when the gum is actually less resistant to the destructive effects of bacteria, the result may be less than desired. Many people have undergone periodontal surgery to little avail when bacterial deposits have been allowed to quickly accumulate afterward, and consequently further extensive treatment has been necessary. To prevent a poor result, Periodontists are extremely choosy as to which patients receive periodontal surgery. Excellent home care is a strict requirement, and numerous postoperative visits are insisted upon to ensure frequent and complete removal of bacteria.

How much will it hurt?

Of course, some soreness is normal the first day or so after periodontal surgery. Many persons, however, have very little discomfort. A more common complaint afterward is sensitivity to hot or cold liquids. This is caused by exposure of more of the tooth root surface, and may last for a short period of time.

Finally, what else do I need to know about periodontal surgery?

Depending on exactly what types of defects or problems are present, many techniques may be used. These may include grafting of gum tissue and bone if needed, the correction of gum contours to improve their appearance and the ability to be cleaned more easily, the placement of dental implants, and the use of recent techniques for guided tissue regeneration. By the appropriate use of these of surgical procedures, as well as proper use of antibiotics, antiseptics, and anti-inflammatory agents, much can be done to control periodontal disease and save teeth from otherwise certain loss.

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