Sometimes patients with advanced periodontal disease or in some areas having localized advanced periodontal diseases may need periodontal surgery. Surgical treatment is used in advanced gum infections for gum pockets too deep to reach with the scalers in the scaling and root planing (know as the deep cleaning) or in teeth that fail to respond to the initial therapy. At Reston Sunrise Dentistry, to allow the most conservative gum treatment, all of our patients with gum disease beyond gingivitis will go through initial therapy of gum treatment. The initial therapy of gum treatment encompasses a full quadrant of deep cleaning, reevaluation, and polishing. At the reevaluation, we will assess which teeth will need to go further to periodontal surgical therapy. However, most teeth will be on their way to periodontal maintenance, or more frequent gum cleanings and checkups. Periodontal maintenance is so important to maintain the health of patients with a history of gum disease. The last thing a patient wants is to go through another deep cleaning and/or surgical therapy again!
In periodontal surgical treatment, a local anesthetic is administered by Dr. Hanah Pham to eliminate pain, and she will open the gums to get to the deep, inaccessible areas to give a thorough scaling and root planing, thus removing the deep deposits of bacteria and calculus (tartar). Periodontal surgery in general heals much faster than other dental surgeries such as extractions and implants, and often has a high success rate. In some cases, gum reduction, osseous surgery (contouring of the bone and remove minor bone defects if possible), and bone grafting (in severe bone loss forming craters) are required to save the teeth and allow future stability. This will also enable to reduce the depth of the pockets and make it easier for patients to keep clean at home, however this will expose a little more of the teeth as it heals.
This remove the overgrowth of gum tissues, thus reduces the pockets or spaces where bacteria can hide and grow . Sometimes, children with metal braces have overgrown gums due to poor oral hygiene during the braces treatment, a gingivectomy can be perform afterwards to reduce the gums and pseudo-pockets formed.
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Open Flap Periodontal Surgery With or Without Osseous Surgery
A flap surgical procedure is needed with scaling and root planing to save teeth with deep pockets that are normally inaccessible to the initial therapy of deep cleaning. The gum is gently separated from the tooth creating a "flap" and allows access to the infected pockets deep in the gums. The goal is to remove the bacteria and deep deposits of plaque and tartar deep down at the bottom of the pockets. Sometimes there are no gum tissue needed to be removed and other times a pocket-reduction is necessary with the removal of gum tissue. In some severe cases, bone craters and surrounding tooth need to be smoothed and reshaped to allow optimal gum architecture and reduction of pocket formation.
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Open Flap Periodontal Surgery With or Without Osseous Surgery With Bone Grafting
In more severe cases of untreated gum disease, deep pockets form and gums pull away from teeth (gum recession), craters of bone form (a form of bone loss with walls of bone around the root), and other forms of severe deterioration of gum and bone due to severe gum disease occur. A flap surgical procedure is needed with scaling and root planing to save teeth with deep pockets and bone loss forming craters that are normally inaccessible to the initial therapy of deep cleaning. In addition, the bone also needs to be recontoured and pocket reduction in the same manner of any typical periodontal surgery and gum disease, and bone grafting is also needed in this type of open-flap periodontal surgery with bone craters and the bone. This enables us to put bone fragments (bone grafting) and these grafts eventually turn into the patient's own bone, reducing the defects and the pockets, therefore saving the tooth and allowing stability to the tooth.
After cleaning, the graft material is packed into the area where bone has been lost.
The gum is then closed and new bone growth may be stimulated by the graft. New bone tissue fills in the crater, providing strong support for the tooth.
Gingivitis and in its advanced state, periodontitis, has a profound effect on the gums. As gingivitis progresses, more and more bacteria and plaque builds up, causing the gums to stretch. The end result it large pockets, that once they are cleaned out, remain on your gum line. These pockets cause the gums to recede, which aesthetically not pleasing to the eye. When the gums recede, an abnormal amount of tooth structure is exposed.
Gum grafting is the corrective procedure that restores the gum to its natural, healthy state. Using soft gum tissue from the roof of the mouth, the receded gums are grafted. The goal if the graft is to cover exposed tooth and root surfaces with grafted on oral tissue. This grafting encourages new tissue growth that will enable the gums to return to its original position around the teeth. The procedure is routine and entails a minimal amount of downtime and discomfort.
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