Periodontal Surgery

Why do I need periodontal surgery?

Surgery is recommended to correct or improve a problem with your gums that is affecting your periodontal health. The choice of surgical technique depends on the type and severity of the disease, as well as existent conditions in your mouth.

Some reasons why surgery may be indicated include:

To clean and reduce periodontal pockets

- Some gum pockets are too deep for you to clean with daily oral home care and for your dentist to clean during professional care visits. Surgery is thus necessary to remove plaque and calculus below the gum line.

The pockets and position of the gums are reduced to minimise areas where disease-causing bacteria can hide. During this procedure, the gum tissue is folded away from the tooth and disease-causing bacteria removed from the root surface through scaling and root planing with hand and ultrasonic instruments, before securing the tissue into place with stitches.
This type of surgery is known as open flap debridement / pocket reduction surgery.

To reshape damaged bone

- In some instances where bone loss has occurred around teeth, aside from gaining access to clean the root surfaces of affcted teeth, surgery might be done to smoothen the uneven or irregular surface of the damaged bone. This allows the gum tissue to be repositioned, promoting healing of the gum pocket. This type of surgery is known as osseous surgery.

To regenerate or "regrow" tissue

- If a disease is left untreated, damage to gum and bone attachment to the teeth will continue. Plaque accumulates along the roots of the teeth and this results in infection that can cause more serious damage to the bone supporting the teeth.

Some surgical procedures may be recommended to regenerate part of the bone and supporting tissues previously lost to disease. These techniques (i.e. use of membranes and bone grafts) aim to partially restore and strengthen the support of the teeth so they can function longer. This type of surgery is known as guided tissue regeneration / bone graft surgery.

To expose more of the tooth structure for dental restoration

- When a tooth is decayed, badly worn below the gum line or has a short clinical crown height, there is insufficient tooth structure for a restoration such as a crown or a bridge.

In such instances, your dentist may advise surgery to adjust the gum and bone level to expose more of the tooth structure.

During this procedure, gum and bone tissue are reshaped to expose the extent of the decay or fracture or more tooth structure. This will provide both sufficient tooth structure and accessibility for subsequent placement of a restoration. This type of surgery is known as crown lengthening surgery.

Teeth before surgery
Before crown lengthening surgery

Teeth after surgery
After crown lengthening surgery

Teeth with crown fitted
After crown is fitted

To improve appearance / aesthetics of your gum line

- Exposed root surfaces of teeth due to gum recession may affect your smile (i.e. "toothy smile") and / or may be sensitive to hot or cold foods and liquids. The gums may have receded for a variety of reasons, including aggressive toothbrushing or periodontal disease.

Your periodontist will help you to identify contributing factors to the problem. Once these factors are controlled, a soft tissue graft procedure can repair the defect and help to prevent additional recession.

During this procedure, gum tissue from the roof of your mouth (palate) or from other areas in your mouth is taken to cover the exposed root. This can even out your gum line and reduce root sensitivity. This type of surgery is known as mucogingival surgery.

Correcting a Toothy Smile

Teeth with short crowns
Before surgery - Short clinical crowns

Teeth with longer crowns
2 months after surgery

Mucogingival Surgery

Teeth with excessive gum tissue
Before surgery

Teeth with acceptable amount of gum tissue
3 months after surgery

If you have a "gummy smile" because your teeth appear short (i.e. teeth are of proper length but covered with excessive gum tissue), a crown lengthening procedure may be done to improve your gum line and expose a broad, natural smile.

Will surgery hurt?

Your periodontist will use a local anaesthetic to numb the surgical area. During the procedure, you should feel little or no discomfort. Following surgery, the treated area may be slightly tender, sore or swollen. You may be prescribed analgesics (painkillers) to relieve post-surgical discomfort; antibiotics to prevent infection and an antibacterial rinse to keep the surgical site clean.

If you take your medicine as directed and follow your periodontist's instructions, you will most likely experience minimal discomfort following surgery. Most patients resume their normal routines the day after surgery.

Will I be able to speak and eat normally after surgery?

You should be able to speak normally after the local anaesthetic has worn off. It is important to maintain a well-balanced diet after surgery. Avoid chewing hard foods in the surgical area for several days. Following some types of periodontal surgery, the teeth may be more sensitive to hot and cold sensations. The sensitivity will lessen during the first few weeks after surgery.

When will I need to return to my periodontist?

Patients usually need to be reviewed one to two weeks after surgery. At this post-surgical visit, stitches may need to be removed and surgical area cleansed. Additional follow-up appointments will be needed to evaluate the healing response and to review proper oral hygiene procedures.

Will I need to have surgery again?

In most cases, you will not need surgery in the same area again. However, in certain cases, retreatment or additional surgery may be needed. Proper oral hygiene  procedures at home and regular professional care are key factors to achieving successful long-term results.

What can I do to help control the disease?

Periodontal disease can and will recur if you do not follow a strict programme of supportive therapy. You play a major role in preventing further outbreaks of the disease. In addition to regular professional dental check-ups, your home oral care is important. Daily removal of plaque through proper brushing, flossing and other recommended cleaning methods will help ensure you keep your teeth for a lifetime.

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