Pocket reduction surgery (also known as osseous surgery and flap surgery) is a collective term for a series of several different surgeries aimed at gaining access to the roots of the teeth in order to remove bacteria and tartar (calculus).
Periodontal infections cause a chronic inflammatory response in the body that literally destroys bone and gum tissues once they invade the subgingival area (below the gum line). Gum pockets form and deepen between the gums and teeth as the tissue continues to be destroyed.
Periodontal disease is a progressive condition which, if left untreated, causes massive bacterial colonization in gum pockets. This bacterial infection can eventually lead to the affected teeth falling out. Pocket reduction surgery is an attempt to alleviate this destructive cycle, and reduce the depth of the bacteria-harboring pockets.
Reasons for the pocket reduction surgery
Pocket reduction surgery is a common periodontal procedure which has been proven effective at eliminating bacteria, reducing inflammation and saving teeth. The goals of pocket reduction surgery are:
Reducing bacterial spread – Oral bacteria has been connected to many other serious conditions such as diabetes, heart disease and stroke. Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize. It is important to decrease bacteria in the mouth in order to reduce the risk of secondary infection.
Halting bone loss – The chronic inflammatory response induced by oral bacteria leads the body to destroy bone tissue. As the jawbone becomes affected by periodontal disease, the teeth lose their rigid anchor. When the teeth become too loose, they may require extraction.
Facilitate home care – As the gum pockets become progressively deeper, they become incredibly difficult to clean by the patient. The toothbrush and dental floss cannot reach to the bottom of the pockets, increasing the risk of further periodontal infections.
Enhancing the smile – An oral cavity that is affected by periodontal disease is not attractive to the eye. In fact, smiles may be marred by red, bleeding gums, misaligned teeth, gingival recession leading to long teeth, and spaces between the teeth. Pocket reduction surgery halts the progression of gum disease and improves the aesthetics of the smile.
What does pocket reduction surgery involve?
Before recommending treatment or performing any procedure, Dr. Marino will perform a thorough visual and x-ray examinations in order to assess the condition of the teeth, gums and underlying bone. Pocket reduction surgery may be performed under local anesthesia with optional oral sedation medication (sleep medicine).
Conventional pocket reduction surgery
The gums will be gently moved back from the teeth and bacteria and calculus (tartar) will be eliminated. Scaling and root planing will generally be required to fully remove the calculus (tartar) from the surface of the tooth root. If the root is not completely smooth, a planing procedure will be performed to ensure that when the gums do heal, they will not reattach to rough or uneven surfaces.
The final part of the surgery is usually the administration of an antimicrobial liquid to eliminate any remaining bacteria and promote healing. The gum is then sutured with tiny stitches that are left in place for 14 to 21 days. The gums and teeth may be more sensitive following treatment, however this is usually reversable. The patient may also notice larger, wider spaces between the teeth following treatment. Following treatment there should be a significant reduction in pocket depth, and a great deal of improvement in the condition of the teeth and gums.
Laser assisted pocket reduction surgery LANAP (laser assisted new attachment procedures)
The laser allows access to the root of the tooth with no cutting, no sutures, and with minimal bleeding and post operative pain. The tissues are anesthetized, the laser is used on a selected setting, scaling and root planning are performed, and a final pass of the laser is made. The occlusion (bite) is adjusted, and the patient is asked to follow a strict diet and to wear a mouth guard to prevent bruxing. The patient returns for post operative appointments which include polishing and periodontal cleaning. An antimicrobial liquid is administratrated to reduce the colonization of any remaining bacteria and promote healing.
Following LANAP therapy, the patient should be able to return to normal activity, with little or no discomfort. We expect a significant reduction in pocket depth and a great deal of improvement in the condition of the teeth and gums.
If you have any questions about pocket reduction surgery or treatment for periodontal disease, please ask Dr. Marino.