Surgical Therapy

Just as there are many types of periodontal diseases, there are many treatment options. Your periodontist looks at you as an individual and develops a treatment plan that is tailored to your needs.

The following are some of the reasons why surgery might be necessary:

To clean and reduce periodontal pockets (flap surgery).: You cannot keep deep pockets clean and free of plaque just by brushing and flossing alone. The pockets may also be too deep even for your dentist or hygienist to clean. Therefore, your periodontist may decide that surgery is necessary to remove plaque and calculus below the gumline. The gums are lifted away from the teeth to allow access for cleaning and smoothing of the tooth roots. Your periodontist will reduce the pocket and reposition the gums with stitches to minimize areas where disease-causing bacteria can hide.

To reshape damaged bone (osseous surgery).: This is done to smooth the uneven or irregular surface of the damaged bone and to promote proper healing of the gum tissue. This is done along with flap surgery.
To regenerate or "regrow" tissue (bone grafting or guided tissue regeneration).: These techniques restore and strengthen the support of the teeth so they can function longer. There are many new technologies available to enhance bone regeneration. Angular bone defects and pockets 8mm or deeper usually require regeneration therapy. (These are often done together.)

To expose more of the tooth to make dental repair possible (crown lengthening).: (See below for more details).
To prevent, stop or repair gingival recession (gum grafting).: (See below for more details).
To improve appearance (gum grafting or gingival sculpting).: A "toothy" smile caused by gum recession often can be corrected by soft tissue grafting techniques. Likewise, teeth can be made to look longer for a patient with a "gummy" smile. (See Cosmetic Surgery page).

Will it hurt?

Only local anesthetic ("novocaine") is necessary to perform periodontal surgeries. During the visit you should feel nothing once the area has been numbed. When the "novocaine" wears off, there will be mild to moderate discomfort. Medication will be prescribed to control any discomfort you might experience.

Antibiotics or antibacterial rinses also may be prescribed. If you take your medicine as directed and follow your periodontist's instructions, you probably will experience only minor discomfort. Most patients resume their normal routines a few days after surgery.

Nervous or fearful patients could benefit from use of Nitrous Oxide (laughing gas) or from oral sedation using Valium or Halcion. We want you to be as comfortable as possible throughout your treatment.

Will I be able to speak and eat normally after surgery?

You should be able to speak normally after the anesthetic has worn off. It is important to eat a well-balanced, nutritious diet after surgery. You will need to avoid chewing in the surgical area for at least one week. Following some types of periodontal surgery, the teeth may be more sensitive to hot and cold. This will diminish considerably during the first few weeks after surgery, and may be treated with a simple in-office procedure, and home-use products.

When will I need to return to my periodontist?

Usually patients return in one week to remove any stitches and to cleanse the surgical area. Additional follow-up appointments will be required to evaluate your healing response and to review proper oral hygiene procedures.

Will I ever need surgery again?

Proper oral hygiene procedures at home and regular professional care are key factors in achieving a successful long-term result. Periodontal diseases are chronic diseases that require constant and careful attention.

Crown Lengthening:

Before Surgery

After Surgery

After Restoration

When a tooth is fractured or decay extends below the gumline, this area must be uncovered before it can be restored, for several reasons:

In order for the gum to heal against the tooth in a healthy manner, there must be 3 millimeters of healthy tooth between the margin of a filling or crown (cap) and the crest of the bone which supports the tooth. This is called biologic width.
A tooth that is broken or decayed below the gumline is difficult, if not impossible, for your dentist to restore correctly since access and visibility are compromised.
Inadequate retention form means there is not enough tooth structure left above the gumline to firmly hold a crown.
In addition, even the best filling or crown will trap bacteria where it meets the tooth. If this area is below the gumline where you cannot properly clean it, the bacterial accumulation can result in both periodontal problems and new decay.

A crown lengthening procedure reshapes the gum and bone to solve these problems.

Gingival Grafting:

Free Gingival Graft Before

Free Gingival Graft After

Connective Tissue Graft Before

Connective Tissue Graft After

A tooth is surrounded by two types of tissue. The first is gingiva (gum), which is pink, thick and dense. It is also called keratinized tissue. Gingiva forms a tight seal around the tooth which serves as a barrier against the penetration of bacteria to the underlying bone. The gingiva also helps to withstand trauma from brushing, eating, etc. The other type of tissue, mucosa, found directly below the gingiva, is red, thin and loose or elastic. It does not seal tightly around the tooth, nor does it withstand trauma well (as shown by how easily you can "scratch" the floor of the mouth).

When gum recession occurs, the body loses a natural defense against both bacterial penetration and trauma. When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than gentle oral hygiene is necessary. Recession can be caused by genetically thin bone and gum, overscrubbing or toothbrush bristles that are too stiff, or by clenching and grinding habits.

When recession reaches the mucosa, the first line of defense against bacterial penetration is lost. No matter how meticulously the patient tries to control the bacteria, there is a greater chance of it penetrating and affecting the underlying supporting bone. In addition, gum recession may result in root sensitivity as well as an unsightly appearance to the gum and tooth.

Some people genetically have extremely thin gingiva and require grafting to prevent recession before it starts. This is quite common when orthodontic tooth movement is planned.

A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth, or moved over from adjacent areas, to provide a stable band of dense gingiva around the tooth. There is also a new skin graft product that eliminates taking gum from the roof of the mouth.

A connective tissue graft is a newer technique used to help cover the exposed portion of the root. It offers more predictable root coverage and better color matching but is a more technically difficult procedure. It is the preferred technique for upper teeth and for severe recession.

Dr. Layport makes a stent, which looks like the older-style orthodontic retainer, to protect the roof of the mouth during healing greatly reducing soreness and complications after surgery.

The visit to perform a gingival graft is about 60 minutes long. The stitches are removed approximately one week later in a 5-10 minute visit. A 5 minute check-up verifies the final result 6 weeks later.

Gingival graft procedures are quite predictable. The color of the graft and the amount of root coverage is more variable.