Periodontics (Gum & Bone Treatment)

Categories of gum surgery

The periodontist will generally assess the patient for surgical procedures to reduce the pockets to make it possible to maintain the hygiene himself. There are a few general categories of pocket elimination surgeries or esthetic procedures performed by periodontists, over and above scaling and root planing which also is always done during these surgeries.

1. Gingivectomy

Gingivectomy is used mostly in the treatment of Type II periodontal disease.  In this case, the level of the bone is ascertained, and the gingiva are simply cut off at that level.  By eliminating the top of the gingiva, the sulcus is reduced to manageable depth, and oral hygiene can resume at normal levels. 

2. Crown Lengthening

Crown lengthening can be done either for esthetic or functional purposes:

a. Esthetic Crown Lengthening:

When a disparity in the clinical crown length exists between contralateral teeth resluting in a left/right side height discrepancy, esthetic surgical correction can be provided to enhance the cosmetic result before restorative measures.

Esthetic crown lengthening may be carried out by performing gingivectomy and or osseous resection only on the facial aspect, for better esthetics. Root exposure is often a common complication and intentional root canal or post surgical treatment with veneers or crowns may be required.

b. Functional Crown Lengthening

This procedure is carried out in order to gain crown length for restorative purposes. The gingiva and bone follow a definite pattern interproximally, facially and palatally. Whenever the functional requirement needs more than 2mm of bone resection on the facial and palatal osseous crest a facial and palatal flap should be reflected and osseous resection is done all over including the interproximal region. This mantains the osseous contour of the tooth

 

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Before   After

Courtesy of Escalade Dental Team

3. Apically Repositioned Flap

In an Apically repositioned flap procedure, a pair of vertical incisions are made at either end of a scalloped incision around the necks of the teeth.  The gingiva are then retracted exposing the bone and roots underneath.  Once exposed, the bone is reshaped. and sometimes augmented with bone-graft material to eliminate bony pockets and to even out the gum line.  After the bone has been resculpted, the gingiva are replaced back into a position which is closer to the bone line.  This results in an even, and well scalloped gum line.  Because of the care taken in reshaping the underlying bone, this surgery technique produces much more esthetic results than gingivectomy and allows for the treatment of the bony defects seen in type III disease.

4. Functional and esthetic grafting techniques

The ability to replace bone and gum tissues lost to periodontal disease has made slow but steady progress over the last twenty years.  Where once the non supporting bone surrounding the "wells" of the infrabony pockets could only be shaved down to allow for better healed contours of soft tissue around the roots of teeth, now it has become possible to replace some of the missing bone with bone graft material.  The use of bone graft material generally requires the use of a collagen membrane to help hold it place.  The use of bone graft material and a collagen membrane is called guided tissue regeneration (GTR).

Sometimes, it is advantageous to use grafting procedures to improve the appearance of the teeth and gums.  This is frequently done by moving gum tissue from places where it can rebuild itself, such as from the roof of the mouth, to areas where it is needed for esthetic repair.  In fact, these repairs have functional value as well, and may make quite an improvement in the overall health of the teeth and gums.

 

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