Periodontal Disease

Periodontal disease is an infection of the gums and/or bone that surrounds the tooth. Generally the disease is painless, and most patients are not aware they have a problem until examined by a dentist.

Performing Surgical Treatment

Initial Preparation generally produces shrinkage of the inflamed gum, and thus a reduction of the pocket depth. Often, if the patient has excellent oral hygiene habits and keeps regular maintenance appointments, this is enough to stabilize a case. However, with pockets that continue to bleed when probed, or with pockets deeper than 5mm, there is a high probability the disease process will continue. In those cases elimination of the remaining pockets is the best treatment. If it is obvious during the examination that surgery is needed to obtain the best result, parts of the Initial Preparation may be abbreviated or by-passed completely. Scaling and root planing may be done during surgery, when access is the most ideal. This approach avoids repeating steps of Initial Preparation that would be performed during surgery, saving time and reducing costs.

There are three primary surgical procedures that may be used to reduce or eliminate pockets that remain after Initial Preparation (Click any heading for a more detailed discussion and clinical examples).

• Gingivectomy - Trimming excess tissue when the bone contour has not been altered.
• Flap Surgery - The most common surgical procedure, giving the periodontist access to the jawbone. In most advanced periodontal cases, the bone has been altered by infection and smoothing irregularities is needed.
• Regeneration Surgery - Ideally, periodontal therapy would regenerate bone and tissue back to its original form. While this is not always possible, new techniques are allowing for more predictable regeneration of tissues.

The goal of periodontal surgery is to give the periodontist access for treatment, and to reduce pocket depth. The ideal surgical result is pocket elimination, giving the patient the ability to remove plaque from the sulcus daily. In some cases the pockets are so deep that complete elimination is not possible, and some depth remains even after surgery. Some of these teeth may be considered questionable, and their long-term prognosis guarded. However, as long as these teeth do not jeopardize surrounding dentition, are functional, and do not cause discomfort, they are maintained. Many questionable teeth are kept for years, if the patient is able to perform a high level of oral hygiene and stay on a good maintenance program.