Procedures

Periodontal surgery

The process

When you have invasive dental procedures like periodontal surgery done, the dentist will review your health history. If you have replacement joints (e.g. total knee, hip, etc.), you may be pre-medicated with antibiotics for the procedure. If you have certain types of heart murmurs or replacement heart valves, you may also need to take an antibiotic pre-medication prior to the procedure.

If you take blood thinning medications like warfarin (the generic name for Coumadin® and others), or drugs that inhibit platelet aggregation like clopidogrel (the generic name for Plavix®), particularly if you take either with aspirin, your dentist and/or physician may require you to suspend those medications temporarily to have any oral surgical procedures, including periodontal surgery. This is due to the possibility for prolonged bleeding.

If you are anxious about dental procedures, your dentist may recommend sedating you for the procedure. There are several methods of relaxing patients for dental treatment, including oral anti-anxiety pills like Valium®; inhaled anti-anxiety medication like nitrous oxide; and intravenous anti-anxiety medication, such as Versed®. Your dental plan may not pay benefits toward sedation.
Learn more: Procedures › General anesthesia/sedation

Periodontal surgery procedures vary widely, but have several things in common. Your dentist or periodontist can more accurately describe the details of the procedure you require. Common steps in periodontal surgical procedures include:

Anesthetic—The surgical area is anesthetized by injecting local anesthetic around the nerve(s) that supply sensation to the area. Discomfort from the injection can be minimized by use of a topical numbing gel for a minute or two prior to the injection. Use of local anesthetics containing "vasoconstrictors" is common in periodontal surgery to reduce the amount of bleeding at the surgical site for improved visibility. Most commonly the ingredient is epinephrine.
Learn more: Procedures › Local anesthetic

Surgical Access—An incision will be made through the gums, exposing the area of interest. The tissue is often reflected away from the site producing a surgical "Flap". There are many different flap designs used, depending on the procedure. Also, the incision may extend part way through the gums ("partial thickness"), or all the way through to the underlying bone ("full thickness").

If a soft tissue graft is being performed, and the patient's own tissue will be harvested for the graft, there will be at least two surgical access points—the "donor site", from which tissue is taken, and the "host (or recipient) site", to which the graft is placed. If the donor tissue is obtained from a tissue bank, a surgical access point is eliminated.

You shouldn't be charged separately for a surgical access flap for procedures that require surgical access to accomplish them. Billing in such a way is an example of fee unbundling, a practice which can exhaust any dental benefits a patient may have with a minimum amount of treatment.

The surgical goal(s) is/are accomplished—Whether the goal is to remove a frenum, to recontour the bone, to remove bacterial plaque and calculus (also called tartar), or treat other disease process, once the surgical access has been established, these procedures are accomplished next. Your dentist or periodontist can describe the intended surgical goals of your procedure before your surgery begins.

Accelerated Healing Using Platelet-Rich Plasma—Some periodontists now obtain a small amount of the patient's blood pre-operatively, and use a device called a "centrifuge" to separate out the platelets (a type of cell involved in healing and formation of blood clots). The platelet-rich plasma ("PRP") is mixed with a surgical gel and applied to the wound to significantly accelerate healing of the surgical site. Use of PRP is optional, requires blood to be drawn from a vein pre-operatively, and adds cost to the procedure. Ask your periodontist for more information, and whether use of PRP may be helpful in your case.

Closure of the Surgical Access Flap—Once the goals of the procedure are accomplished, gums over the surgical site(s) are repositioned over the area and held in place with sutures ("stitches" in Figure 1). A "periodontal dressing" may be placed to protect the sutures and help stabilize the soft tissue. Your dentist or periodontist will tell you if and when the sutures require removal.

Post-operative instructions—You will be given specific instructions on what to expect following the procedure, how to take care of the surgical area(s), any dietary modifications that may be suggested, and when to return for follow-up.

Post-operative follow-up—You may be asked to return to the dentist/periodontist to have sutures removed, to evaluate the healing progress, and to address any concerns you may have.