Periodontal surgery is a surgical procedure done for severe periodontitis. Read this article to know more.
Periodontal surgery is used for chronic periodontitis and aesthetic purposes. The surgery that is performed for esthetic purposes is known as plastic surgery. Severe gingival inflammation can also be treated by periodontal surgery. Some patients will have a small crown part of the tooth. The length of the crown can be clinically improved by crown lengthening procedure. The main reason for the condition of periodontitis is the calculus deposition for a prolonged period. The procedure that is used for removing the calculus is known as scaling. If the removal of calculus and other infected tissues is aimed at the root surfaces, then the procedure is termed root planing. Before we go for different periodontal surgeries, it will be useful to understand the terms pocket depth, gingival abscess, and periodontal abscess.
Your gingival tissue and the bone should be intact. When there is any periodontal problem, the gingival tissue begins to sag and will result in a pocket formation. This deepening in the position of the gingiva or the displacement of the gingival tissue will result in the pocket depth. A periodontal probe is used to measure the pocket depth. Normal pocket depth is 1-3 millimeters. In mild periodontitis, the pocket depth will be increased to 4 millimeters. In moderate periodontitis, the pocket depth would be 5-7 millimeters. If the pocket depth is more than 9 millimeters, it is an indication of advanced periodontitis. The pocket depth can be identified both clinically and in dental X-rays.
A gingival abscess occurs only in the gingival tissues. It does not affect the teeth. The periodontal abscess occurs deep in the periodontal pockets. It results in the spreading of the infection to the bones and other tissues.
Gingival curettage is a procedure that involves removing the tissue that is inflamed for a longer duration. Bacteria and calculus deposits will accompany this inflamed tissue. If the curettage process is performed after scaling and root planing, then the treatment will be more successful. The reason for the positive outcome is due to the elimination of the cause of periodontitis. The procedure of gingival curettage can also be performed along with ultrasonic devices. The usage of ultrasonic instruments can be effective in reducing the damage to the gingival tissues. There are many instruments for the curettage procedure, and each one has a specific usage.
Gingivectomy is a procedure that involves the removal of a part of the gingiva. It helps in the reduction of pocket depth. It can also be used for the reduction or elimination of the periodontal abscess. Instruments like tissue nippers are used for this purpose. The following methods can perform gingivectomy:
Electrosurgery. The advantage of this method is that it reduces bleeding during surgery. But, it causes pain when the point of electrosurgery touches the bone. The treatment procedure also causes bad smell. Before going for this surgery, the patient has to undergo a medical examination. This procedure is not advisable for patients who have cardiac pacemakers.
Chemosurgery. Chemicals such as paraformaldehyde and potassium hydroxide are used for chemosurgery. It is one of the oldest periodontal procedures and is not used in many clinical practices.
Laser. The lasers of wavelength 910 and 1064 nm are used for periodontal surgeries. An injury to the nearby tissues is a significant disadvantage of this procedure.
Gingivoplasty is a procedure that is used to reshape the gingival tissue. The contours can also be altered in this procedure. Instruments like periodontal knives and electrodes are used.
It is the most common surgery done in clinics. It can be performed in conditions where there is bleeding of the gums, defects in the bones of the teeth, pocket formation in the molar teeth, etc.,
The main aim of flap surgery is to remove the inflamed tissues and achieve the gingiva's ideal morphology. The sensitive part of the surgery lies in not removing the essential structures of the periodontium.
This surgical procedure is not chosen when there is any medical illness in patients. If the surgery prognosis is poor, then it is better to go for extraction procedures if there is tooth mobility. Poor oral hygiene will contribute to the recurrence of periodontal problems.
The different flap surgeries are:
The flap surgery for pocket therapy.
Apically displaced flap.
Flaps for reconstructive surgery.
Distal molar surgery.
Periodontal diseases can result in bony defects in patients. The defects occurring in the bone are not in a uniform manner. The loss in the bone can happen either vertically or horizontally. Osseous surgery is a procedure that can help repair the osseous (bony) defects. Osseous surgery can be additive or subtractive. When the additive osseous surgery is not suitable, then resective osseous surgery can be used. All these procedures are aimed at forming an ideal level and shape of the alveolar bone. An improper treatment might result in spicules that are sharp.
The notable advantage of resective osseous surgery are:
Reduction in pocket depth.
Proper contouring of the alveolar bone and gingiva.
It helps in providing an ideal environment for maintaining oral hygiene.
The procedures of periodontal surgery require a few tips to be followed after the surgery.
If the surgery involves any suturing procedures, then the patient should have a follow-up for the removal of the suture. The patient is advised to brush in super soft bristle toothbrushes. To avoid infections, there is a necessity to maintain proper oral hygiene. The doctor will prescribe mouthwashes like chlorhexidine. It should be mixed with water and gargled twice a day. If the suture is causing any discomfort or pain, the patient can go for a soft diet and liquid items.
The disadvantages of periodontal surgery are:
The supporting alveolar bone will be lost.
A mobile tooth.
Recession in the gingiva.
For further details, get help from icliniq.com.
Last reviewed at:
10 Nov 2021 - 4 min read
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