Periodontal procedures for gingivitis involve gingival curettage, in which the surgeon cuts away some of the most hygienically unhealthy tissue, reducing the depth of the pocket. This surgery is usually done under a local anesthetic and is done on one quadrant of the mouth at a time. Gingival or periodontal flap surgery (gingivectomy) is indicated in advanced periodontal disease, in which the stability of the teeth are compromised by infection, which displaces ligament and bone. In gingivectomy, the gingival flap is resected or separated from the bone, exposing the root. The calculus buildup on the tooth, down to the root, is removed. The surgery is performed under local anesthetic.
Small incisions are made in the gum to allow the dentist to see both tooth and bone. The surrounding alveolar, or exposed bone, may require reforming to ensure proper healing. Gum tissue is returned to the tooth and sutured. A putty-like coating spread over the teeth and gums protects the sutures. This coating serves as a kind of bandage and allows the eating of soft foods and drinking of liquids after surgery. The typical procedure takes between one and two hours and usually involves only one or two quadrants per visit. The sutures remain in place for approximately one week. Pain medication is prescribed and antibiotic treatment is begun.
Diagnosis/Preparation Many factors contribute to periodontal disease, and the process that leads to the need for surgery may occur early or take many months or years to develop. Early primary tooth mobility or early primary tooth loss in children may be due to very serious underlying diseases, including hereditary gingival fibromatosis, a fibrous enlargement of the gingiva; conditions induced by drugs for liver disease; or gum conditions related to leukemia. Patient- related factors for chronic periodontal disease include systemic health, age, oral hygiene, various presurgical therapeutic options, and the patients ability to control plaque formation and smoking. Another factor includes the extent and frequency of periodontal procedures to remove subgingival deposits. Gum inflammation can be secondary to many conditions, including diabetes, genetic predisposition, stress, immuno-suppression, pregnancy, medications, and nutrition.
The most telling signs of early gum disease are swollen gums and bleeding. If gingivectomy is considered, consultation with the patients physician is important, as are instruction and reinforcement with the patient to control plaque. Gingiva scaling and root planing should be performed to remove plaque and calculus to see if gum health improves.
The protective responses of the body and the use of dental practices to overcome the pathology of periodontal disease may be thwarted and the concentration of pathogens may be such that plaque below the gum line leads to tissue destruction. Refractory periodontitis, or the form of periodontal disease characterized by its resistance to repeated gingival treatments, and often also associated with diabetes milletis and other systematic diseases, may require surgery to remove deep pockets and to offer regenerative procedures like tissue and bone grafts.
The level of damage is determined by signs of inflammation and by measuring the pocket depth. Healthy pockets around the teeth are usually between 0.04 - 0.11 in (1 - 3 mm). The dentist measures each tooth and notes the findings. If the pockets are more than 0.19 - 0.23 in (5 - 6 mm), x rays may be taken to look at bone loss. After conferring with the patient, a decision will be made to have periodontal surgery or to try medications and/or more gingival scaling.
Risks for infection must be assessed prior to surgery. Certain conditions, including damaged heart valves, congenital heart defects, immunosuppression, liver disease, and such artificial joints as hip or knee replacements, put the oral surgery patient at higher risk for infection. Ultimately, the decision for surgery should be based upon the health of the patient, the quality of life with or without surgery, their willingness to change such lifestyle factors as smoking and bad nutrition, and the ability to incorporate oral hygiene into a daily regimen. Expense is also a factor since periodontal surgery is relatively expensive. Long-term studies are still needed to determine if such medications as antibiotic treatments are superior to surgery for severe chronic periodontal disease.
Aftercare Surgery will take place in the periodontists office and usually takes a few hours from the time of surgery until the anesthetic wears off. After that, normal activities are encouraged. It takes a few days or weeks for the gums to completely heal. Ibuprofen (Advil) or acetaminophen (Tylenol) is very effective for pain. Dental management after surgery that includes deep cleaning by a dental hygienist will be put in force to maintain the health of the gums. Visits to the dentist for the first year are scheduled every three months to remove plaque and tartar buildup. After a year, periodontal cleaning is required every six months.
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