Common Periodontal Procedures
Periodontal procedures are used to treat and restore the gingival (gums), bone and other support structures that hold teeth in place. Gum disease treatment is the most common indication for periodontal therapies. However, a periodontist may also perform surgeries to correct congenital defects or damage from trauma. Here are some commonly performed periodontal procedures:
This is the physical removal of calculus (tartar) and plaque from the tooth surface above and below the gum line. Tartar that is visible above the gum line may be treated with a combination of scraping and ultrasound removal. Tartar buildup below the gum line is removed carefully with manual dental tools to prevent damage to the gum tissue. Some periodontists also use lasers during the scaling process to limit bleeding.
This periodontal procedure involves smoothing the root of the tooth where it is overlaid by the gums. The goal is to give the gums an easy surface to adhere to while making it difficult for bacteria to colonize the area. A thin, curved blade called a curette is used for this procedure and the area is flushed regularly with a sterile solution to wash away debris. There is usually some gum and tooth sensitivity during this treatment. So, anesthetics may be used to numb the area and increase patient comfort.
Pocket Debridement and Treatment
When periodontitis develops, tartar, dead tissue, bacteria and debris from the activity of white blood cells builds up in the space (pocket) between the gum and the tooth root. This causes the normally-shallow pocket to deepen and makes the gums pull away from the teeth. The gum and the underlying jaw bone can begin to deteriorate when this happens. This infected and dead material is surgically removed (debrided) during the deep cleaning process of scaling and root planing. An antibiotic gel may be applied to the pockets after debridement to help limit re-infection. Or, antibiotics may be given in pill form as an adjunct therapy for gum disease treatment.
Gingival Flap Surgery
If the pockets of infected material along the gum line are deep, the gum may need to be temporarily lifted away from the tooth root to provide adequate access for debridement, scaling and planing. In a gingival flap procedure, the gum is incised and pulled downward to clear the area for the cleaning. Then, it is stitched back in place. If this treatment is performed as part of a pocket reduction surgery, a small portion of the gum tissue may be removed as well to ensure a tighter fit between the gum and tooth root. This results in a shallower pocket that is easier to keep clean.
Stitches are removed after about a week. The gums may take a month or more to fully heal from this procedure. However, any pain associated with recovery usually resolves within the first week and is generally managed with ice packs and over-the-counter pain medications. As with all periodontal procedures, post-treatment care does include daily oral hygiene to prevent plaque buildup from recurring. This includes gentle brushing with a very soft toothbrush once the area is sufficiently healed.
A gingivectomy is surgical excision of gum tissue to reduce the depth of pockets. This provides less space for bacteria to colonize and makes it possible for the patient to brush plaque out from under the gum line daily at home. Gingivectomy may also be recommended to remove excess gum tissue that has grown in response to a hereditary disorder, medical condition or certain prescription drugs (such as anti-seizure medications).
Gingivoplasty is a cosmetic procedure to re-contour the gum line either as part of a gingivectomy or as a standalone treatment for irregular gum tissue. Patients who have a “gummy” smile may seek a gingivoplasty to make their teeth look less stubby.
When gums have receded from advanced periodontitis, a graft may be used to restore the normal shape, function and appearance of gum tissue. Replacement tissue may be taken from the roof of the mouth or other areas where it can regenerate easily. Or, gum tissue may be harvested from a donor. Gum grafting may be done around existing teeth or as a step in restoring normal appearance to the gum line after an implant is placed.
This term describes several periodontal procedures involving the bone beneath the gum tissue. Like the tooth root, the surface of the bony socket supporting the tooth may need to be planed to remove irregularities. Reconstructive osseous surgery may also be done to stimulate growth of new bone tissue with the use of special dental matrix placed over the bone. Or, bone from a donor may be grafted into the damaged area. Ridge augmentation which restores the normal contour to the jaw bone after a tooth has been lost is one form of bone surgery that involves grafting.
A periodontist may need to remove one or more badly damaged teeth during gum disease treatment. This gap may be filled with a dental implant. In this procedure, the periodontist drills a small hole in the jaw and fills it with a titanium post. When the bone has grown in around the post, an abutment is attached, followed by a ceramic crown. This procedure can also be performed on patients who have already lost teeth to periodontal disease. Some patients may need an implant supported bridge or dentures to replace multiple teeth.