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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