Periodontal surgery

[2] Periodontal surgery is a form of dental surgery avoiding/corrects anatomical, traumatic, developmental, or plaque-induced defects in bones, gingiva, or alveolar mucosa.

periodontal: relating to/affecting structures surrounding and supporting the teeth

etm: Greek roots: "peri-" means "around" + "odont" (from odous) = "tooth"

Such surgery's goal may be instruments accessibility to the root surface, inflammation elimination, oral environment creation for plaque control, periodontal disease control, oral hygiene maintenance, better embrasure space, addressing gingiva–alveolar mucosa issues, and esthetic improvement. Surgical procedures include crown lengthening, frenectomy, and mucogingival flap surgery.

[2] In case of periodontal disease, a serious gum infection, dentists may do a surgery, which can:

remove bacteria from under your gums
make it easier to clean your teeth
reshape the bones supporting your teeth
avoid future gum damage

Possible patients

[2] One with severe/advanced disease near their gums and tissues supporting their teeth are ofteb periodontal surgery candidates.

Having gum disease, your symptoms may be:

swollen/red/bleeding gums
deep pockets that form between your gums and teeth
loose teeth
pain by chewing
bad breath
gums receding/pull away from teeth

A doctor can let you know if you can benefit from periodontal surgery and may recommend more conservative treatment approaches if your gum disease isn’t advanced.

Preparation

[2] Weeks prior a procedure, one may need to stop taking some medications (aspirin (Bayer, Bufferin), pain relievers, and blood thinners). Most dentists advise to not smoke/drink alcohol a day prior the procedure can may give an antibiotic to take prior procedure to lower chances infection developing.

You must also arrange for someone to take you home after your procedure is finished. The anesthesia, sedation, or other medications you’ll receive during the procedure might affect your reaction times. That means it may be unsafe to drive afterward.

Post surgery instructions for patients

Instructions and tips offered by the Dendistry of Catherine Street clinic

Indications

Contraindications

[1] Contraindications include:

contraindication:

Patient with poor standard of plaque control
Questionable long-term prognosis of patient dentition
Pregnancy
Smoking
Severe cardiovascular disease
Malignancy
Bleeding disorders
Uncontrolled diabetes
Kidney disease
Liver disease
Considerations

The procedural selection in a periodontal surgery must rely on simplicity, predictability, efficiency, Mucogingival considerations, osseous topography, anatomic and physical limitations, age and systemic factors.[1]

The incisions should be clear, smooth, and well-defined to minimize the healing time. Such incisions prevent occurrence of uneven ragged flap edges.[1]

To maintain the functional zone of the attached keratinized gingiva, flaps should be designed for maximum use and retention of keratinized gingival tissue, as it prevents the need of secondary procedures.[1]

In the design of flaps, it needs to be ensured that there is adequate access and visibility. The design should also prevent bone exposure as it can lead to formation of dehiscence or fenestration.[1]

For prevention of excessive bleeding, hematoma formation, displacement, bone exposure, or infection, adequate flap stabilization should be ensured.[1]

The surgical procedure should be carried out such a manner that the postoperative healing takes place by primary intention and not by secondary intention.

Procedures

[2] A dentist/periodontist does the surgery, with many types of surgical options. They determine what surgery type(s) are needed for a condition.

Crown lengthening

[1] Crown lengthening is a teeth's crown height increasing method by flap surgery with/without bone surgery, with 2 main types:

Aesthetic crown lengthening is done if a "gummy" smile is an issue for a patient.

It's used to make an unrestorable tooth restorable. E.g., Atooth with caries extending under the gums may undergo crown lengthening so that the caries is no longer below the gums and a crown may be placed.

Contraindications: Untreated or unstable gum disease (periodontal disease) and gingival phenotype.

[1] Considerations:

Strategic value of tooth
Crown/root ratio that will remain following surgery
Aesthetics will be affected such as longer clinical crowns and loss of interdental papillae leading to "black triangles"
It can result in exposure of furcations
Mobility of teeth
Post-op sensitivity due to root dentine exposure
Patient may need long-term treatment until gingival margin stabilised (3–6 months).
Patient must also be made aware prior to surgery that relapse is possible
Method

[1] There are 3 main ways for surgical crown lengthening:

Gingivectomy
Apically repositioned flap (APF) surgery
Apically repositioned flap (APF) with osseous reduction (osteoplasty/ostectomy)

Flap surgery

[2] A common procedure, surgeons do small cuts in your gum and lift a section of tissue back. Then, they remove tartar and bacteria from your tooth and from under your gums. The gums are sutured back, so the tissue fits firmly around your teeth. Once you heal, it will be easier to clean areas on your teeth and gums.

Bone grafting

[2] If gum disease damaged the bone near a tooth root, a dentist may to replace as a graft. The bone graft can be made from small parts of your own bone, a synthetic bone, or donated bone. This procedure helps prevent tooth loss and may help promote natural bone regrowth.

Guided tissue regeneration

This technique involves placing a small piece of material between your bone and gum tissue to allow bone to regrow.

Soft tissue grafts

When gums recede, a graft can help restore some of the tissue you lost. Dentists remove a small piece of tissue from the roof of your mouth or use donor tissue to attach to the areas where tissue is sparse or missing.

Proteins

Sometimes, surgeons apply a gel that contains special proteins to the diseased tooth root. This can encourage healthy bone and tissue growth.

References

[1] Wikipedia
[2] Heathline

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Periodontal surgery

Possible patients

Preparation

Post surgery instructions for patients

Indications

Contraindications

Procedures

Crown lengthening

Flap surgery

Bone grafting

Guided tissue regeneration

Soft tissue grafts

Proteins

References

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