Perio Surgery

The periodontal tissues include the alveolar bone and gingival tissues, which both form the foundation for the teeth. The damages that occur from periodontal disease result in recession of the bone and gingiva, and can eventually lead to tooth loss if nothing is done to stop the disease process and repair the periodontal tissues. In some cases, loss of tissue can result from trauma or mechanical damage from aggressive brushing, tooth grinding, and other forms of irritation. It is important to remember that if periodontal disease is the cause of receding tissue, the first phase of the treatment involves removal of the causative factor: bacterial plaque and calculus, which is removed by scaling and root planning (deep cleaning). Listed below are some descriptions of periodontal surgical procedures we perform in our office:

The periodontal tissues include the alveolar bone and gingival tissues, which both form the foundation for the teeth. The damages that occur from periodontal disease result in recession of the bone and gingiva, and can eventually lead to tooth loss if nothing is done to stop the disease process and repair the periodontal tissues. In some cases, loss of tissue can result from trauma or mechanical damage from aggressive brushing, tooth grinding, and other forms of irritation. It is important to remember that if periodontal disease is the cause of receding tissue, the first phase of the treatment involves removal of the causative factor: bacterial plaque and calculus, which is removed by scaling and root planning (deep cleaning).  Listed below are some descriptions of periodontal surgical procedures we perform in our office:

Free Gingival Graft: This procedure is done to correct areas of minimal attached gingiva. Normally, we have at least 3 to 4 mm of attached, keratinized (thick) gingiva along the border of the crown. This tissue is firmly attached to the bone and serves as a protective barrier for the teeth and underlying bone. Below the attached gingival is the unattached, softer oral mucosal tissue that is more susceptible to damage. In areas where thick, attached gingival is receding, we recommend having this procedure done to prevent complete loss of attachment around the tooth. The graft is harvested from the patient’s upper palate and placed in the defect site, with about 4 to 6 weeks until complete healing occurs.

Crown Lengthening: This procedure is done when decay of a tooth crown extends below the gingival tissue and approaches the crest of the bone. In order to prepare the tooth for a new restoration, such as a crown, some of the bone adjacent to the site of decay must be removed in order to lengthen the crown and provide more tooth structure to hold the new crown. This procedure can also be done to lengthen the crowns in the anterior region where there is an excess of gingival tissues showing when smiling. This is purely an elective esthetic procedure.

Scaling and Root Planing with Gingival Reflection: When the depths of the pockets are excessively deep (greater than 8 mm) with heavy amounts of calculus, it may be necessary to reflect the gingiva in order to better access the area of the root that needs cleaning. Once the area has been thoroughly cleaned and irrigated, the tissue is sutured and usually heals very quickly with a minimal amount of discomfort.

Gingivectomy: In some cases, where there is an overgrowth of gingival tissues, a gingivectomy is performed to remove excess gingiva, resulting in a harmonious relationship between the teeth and gums. This in turn leads to a more beautiful smile and an environment that is easier for the patient to clean.

Bone Graft: Bone grafting is done for guided bone regeneration or tooth socket preservation. Guided bone regeneration is done when an alveolar bone ridge is inadequate for implant placement. The gingival tissues are reflected, and a bone graft material is placed in the area of the defect and sutures are placed to hold everything in place. After 4 to 6 months of healing time, if the bone graft is stable, the next step of treatment is implant placement. When a functional tooth needs to be extracted, we often place a bone graft into the socket, hence the term “socket preservation.” Preserving the bone in and around the socket allows for implant placement, thereby preventing the need for guided bone regeneration.

Although the aforementioned surgical procedures may sound invasive, it is important to remember that we always ensure thorough use of local anesthesia and utilize an oral sedative prior to surgery to prevent patient discomfort. Furthermore, the mouth’s rich blood supply gives it an incredible ability to heal, which translates to highly predictable and successful outcomes.

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