Osseous surgery, sometimes referred to as pocket reduction surgery, refers to a number of different surgeries aimed at gaining access to the tooth roots to remove calculus and disease-causing bacteria.
Goals of Osseous Surgery
Osseous surgery is used to reshape deformities and allow access the tissues surrounding the teeth. The ultimate goal of osseous surgery is to reduce or eliminate the bacterial products within the periodontal pockets that cause periodontal disease. The specific goals of surgery include:
Reducing Bacterial Spread: Bacteria from the mouth can spread throughout the body and cause other life-threatening conditions such as heart disease and respiratory disease. Removing deep calculus and it associated bacteria can help reduce the risk of bacteria spreading.
Facilitating Home Care: As the gum pocket deepens, it can become nearly impossible to brush, interproximal brush and floss adequately. Osseous surgery makes it easier to brush, interproximal brush and floss, and thereby prevent further periodontal disease.
What does the procedure entail?
A local anesthetic will be used to numb the area prior to surgery. First, your periodontist will cut around each tooth of the affected area to release the gum tissue from the bone. This allows access to the bone and roots of the teeth. After the roots have been thoroughly cleaned through scaling, a drill and hand tools will be used to reshape the bone around the teeth where necessary. Bone is removed in some areas to restore the normal rise and fall of the bone, but at a lower level.
Next, the gums will be placed back over the remaining bone and sutured in place. The site may also be covered with a bandage (periodontal pack) or dressing. Pain medicine and mouth rinses containing chlorhexidine are generally prescribed following the surgery.
Do not be alarmed if bleeding and swelling occur after the surgery. This can be controlled easily by placing an ice pack on the outside of the affected area. In cases where the bleeding and swelling is in excess, it is advised that you call to notify our office. Follow up visits may be necessary and you must fulfill a meticulous maintenance program especially during the initial phases of healing to avoid post-operative infection.
The gum tissue can be very thick and large covering the tooth surface making the teeth look short. This can happen because of medications, bone that extends too close to the surface of the teeth, or inflammation due to gum disease.
A gingivoplasty is a periodontal procedure that eliminates excess gum tissue.
The following are some reasons a gingivoplasty might be needed:
Cosmetics: To make the teeth look normal in size when the gum is covering too much of it, making the teeth look longer and more proportional.
Functional/Esthetics: To remove excess gum tissue (gingival overgrowth) that has formed as a result of certain drugs such as anti-seizure and organ-transplant medications, and certain high blood pressure medications.
We first will anesthetize the area(s) to be treated. The excess of gum tissue is removed either with a scalpel blade and sometimes some rotary instruments. In most cases no sutures (stitches) are required. The surgical sites will be sore for 24-48 hours, and medication will be provided to alleviate any discomfort experienced. A week follow-up appointment is usually needed to ensure proper healing.
A frenum is a naturally occurring muscle attachment, normally seen between the front teeth (either upper or lower) but also noted between some premolar teeth on the sides of the mouth. The frenum connects the inner aspect of the lip with the gum. A lack of attached gingiva (the firm gum around the teeth), in conjunction with a high (closer to the biting surface) frenum attachment, which exaggerates the pull on the gum margin, can result in recession. Additionally, an excessively large frenum can prevent the teeth from coming together resulting in a gap between the front teeth. If pulling is seen or the frenum is too large to allow the teeth to come together, the frenum may be surgically released from the gum with a frenectomy. A frenectomy is simply the surgical removal of a frenum.
When Orthodontic treatment is planned or initiated, the removal of an abnormal frenum, with or without a gingival graft, can increase stability and improve the success of the final orthodontic result.
Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek advice from an appropriately qualified health practitioner.