Procedures

Periodontal surgery

Disadvantages & risks

If you are taking bisphosphonate medications (a drug to reduce the effects of osteoporosis), you may be required to go off of the medication for a period of time prior to undergoing certain periodontal surgery procedures (those involving bone). Bisphosphonates decrease the blood circulation in the head and neck bones, possibly enough to impair healing and invite infection following surgical procedures like tooth extractions. This is especially true if you receive the medication intravenously, or are also taking immunosuppressive drugs like corticosteroids.

If you have a history of radiation treatment that may have involved the head and neck, you may be at risk for developing osteoradionecrosis following periodontal surgical procedures that involve bone. Essentially, this means "bone death" secondary to radiation, which destroys small blood vessels that supply the bone.

Periodontal surgery requires the use of anesthetic, which has risks of its own. Your dentist may provide you with specific information.
Learn more: Procedures › Local anesthetic

Periodontal surgery, like any surgical procedure, has general post-surgical risks: pain, swelling, bruising, bleeding, and infection. Most of the early symptoms (pain, swelling, bruising) can be managed with anti-inflammatory medications (check with your physician or dentist before taking any unprescribed medications). Your dentist may provide other specific instructions for addressing your symptoms following tooth extractions.

Most of the time, dentists will prescribe pain relievers for periodontal surgery procedures, but the specific medication will depend on the age and health history of the patient. Bleeding after periodontal surgery is normally minimal. If you feel you're experiencing an abnormal amount, apply direct pressure to the area and call your dentist. Post-operative infections generally don't occur in the first few days after periodontal surgery. When they do occur, your dentist will evaluate you and may prescribe antibiotics.

Periodontal surgery in a few areas of the mouth can be accompanied by the risk of nerve injury. If this occurs, the worst case scenario includes permanent numbness in the area supplied by the injured nerve. The incidence of this is relatively low, but you should discuss the possibility with a dentist ahead of time.

Since periodontal disease is not curable, Pocket Reduction surgery is only a means of helping a patient manage the disease more effectively. There are periodontal treatment regimens available which offer up cures for the disease. These involve laser debridement (cleaning) of infected gum pockets, and nutrition supplements which are sold as "cures" for the disease. Unfortunately, these programs have not withstood the test of time. It may be best to approach these "magic bullet" periodontal therapies with healthy skepticism and to continue to maintain excellent oral hygiene until better long-term data are available to validate their claims of a cure.

Resective periodontal surgery that involves removal of healthy bone as part of a recontouring procedure may not be the best solution to the problem. In general, ideal treatment involves preserving as much healthy bone as possible.

It has been said that control over periodontal disease is 25% up to the dental professionals managing the problem, and 75% up to the patient. Although periodontal surgery can help a patient retain their teeth long-term, if a patient is not motivated to keep the teeth, and cannot commit to the practice of effective daily oral hygiene, treatment is unlikely to succeed.

Periodontal surgical procedures are not always successful. A graft can "slough", or fail to be integrated into the host site (i.e. the place on you that needs the graft). In such cases, the procedure can generally be repeated, once the causes for its lack of integration can be identified. The most common reason a graft will fail is infection. Be sure to follow the specific instructions given by your dentist. Again, the likelihood of success is increased by patient compliance with the dental professional's home care instructions.

A graft may successfully integrate, and still may not satisfy all of the intended goals of treatment. For example, a connective tissue graft may be performed to widen the band of tough, fibrous gum tissue AND to cover the exposed root on a certain tooth. Sometimes the graft will integrate and satisfy the first goal—a wider band of abrasion-resistant tissue; but the second goal (root coverage) is not achieved. In such a case, the procedure is a partial success. Good stability for the long-term health of the tooth has been achieved. However, the esthetic goal may not have been met, and the tooth may remain sensitive.

A dentist and patient may have a different view on whether the outcome was a success in such cases. Some studies have shown root coverage to be stable in as few as 70% of cases, while others show the procedure to be successful up to 98% of the time. Success rates are affected by many factors, including patient selection, the amount of recession (dentists use multiple classification systems to rate the location and severity of gingival recession), surgical technique, and the degree to which the underlying cause(s) of the patient's gum recession has been addressed.

Early healing may be cosmetically unappealing, and may lead the patient to conclude that the procedure was unsuccessful. Generally, a soft tissue graft requires four to six weeks before it appears normal. Even then, the tissue is not "mature" for several weeks after that. If you are concerned about the outcome, talk it over with your dentist with these facts in mind.