Procedures

Periodontal surgery

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What defines a successful treatment outcome? It is very important to prioritize your treatment goals in advance of the procedure so that the success or failure of the outcome can be measured. For example, if treatment goals for a soft tissue graft include producing a wide band of abrasion-resistant "keratinized" tissue around a tooth, and secondary goals are elimination of sensitivity and coverage of the exposed tooth root, several scenarios are possible. All three goals may be achieved. However, it is possible that only one or two of them will be met.

Are the dentist's goals in agreement with the patient's? Knowing which goals are the most important ahead of time allows the dentist (or periodontist) to more accurately estimate the likelihood that a patient will be satisfied with the treatment result if all of them are not met. Be sure to let your dentist know what matters most to you. The dentist may believe that functional goals (getting to keep your tooth long-term) are more important than cosmetic outcomes. Some patients may not agree, or may have unrealistic expectations going into the procedure.

How will the underlying cause be treated? Sometimes gums recede a slight amount and remain stable indefinitely. It is important to establish whether the condition is progressing or not. If so, it is important to identify what is causing the recession to occur so that the cause can be treated. Otherwise, a graft may not be successful.

What is the clinical urgency for treatment? Many people have moderate or advanced gum recession, and experience few symptoms. If a patient has long-standing gingival recession that appears stable between recall visits, no symptoms, no inflammation, and no cosmetic concerns, treating the condition may not have much clinical urgency.

Early is more predictable. How do I decide when it's time? Gingival recession is most predictable to treat in the early stages, when the bone level has not been affected and there is adequate bone present to support a gum graft.

Is the recession active? Treatment of gingival recession should be recommended if it is found to be actively progressing. This can be determined by your dentist or periodontist, who can track movement of the free gingival margin with photographs and periodontal measurements at successive checkups.

Inflammatory Gum Disease and Systemic Health—Gingival recession does not always mean a patient has the type of periodontal disease that leads to systemic health problems. Unless the gum recession was caused by bacterial infection of the gums and the resulting inflammation of the tissue by the patient's immune system, it is probably not a risk factor for systemic health problems; however, abnormal gingival contours may provide an environment where food collects and is not easily removed. That situation supports the formation of bacterial colonies and subsequent inflammatory periodontal disease.

If your gums do not bleed when you floss or when the hygienist probes them; if they are not red and puffy; if they are not tender—then they are not inflamed. If they are not inflamed and your immune system is normal, you probably don't have inflammatory periodontal disease. Only your dentist or periodontist can tell you for sure.

Help me to decide how I should proceed—If crown lengthening surgery has been recommended for your tooth, what other procedures (such as root canal treatment, a core buildup, and/or a crown) will be required? What is the final cost likely to be, and what are the options? If this were the dentist's tooth, how would he or she want it treated? Many times it is better to have a questionable tooth removed and explore the options for replacing it (which may include dental implants, fixed bridgework, and removable partial dentures).

Risks of Future Systemic Health Problems—The strongest link between periodontal disease and systemic health problems like heart disease, stroke, peripheral vascular disease, etc., have been made in those who have advanced periodontal disease. However, even patients with incipient (early) or moderate periodontal disease should take it seriously and treat it aggressively to avoid progression of the disease and subsequent systemic health problems.