Periodontal Surgery
What is Periodontal Surgery?
Periodontics is a surgical specialty of dentistry that involves treatment of disease processes affecting the gums and tooth supporting bone; in other words, the tissues surrounding the teeth. A periodontist is a dentist who has obtained two to three years of advanced training in diagnosing and treating periodontal disease processes.
Most often, the first course of treatment for periodontal conditions involves non-surgical procedures. However, some periodontal conditions are most effectively treated with surgical techniques.
Periodontal surgery procedures can be divided into two basic types: removal of diseased tissue (resective treatment) and building back gums and bone which have been lost to disease processes (regenerative treatment).
The process of Periodontal Surgery
Before periodontal surgery
When you have invasive dental procedures like periodontal surgery done, the dentist will review your health history. If you have replacement joints such as knees or hips, 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 or drugs that inhibit platelet aggregation, 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.
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 numbed 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, but other vasoconstricting agents are also in common use.
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). It depends on the procedure.
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.
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 draw 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 generally adds cost to the procedure. Ask your dentist or 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.
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