What is Periodontal Flap Surgery?

Gingival flap surgery is a type of gum procedure. The gums are separated from the teeth and folded back temporarily. This allows a dentist to reach the root of the tooth and the bone.

Effects of Periodontal Flap Surgery

The most important goal of this treatment is to improve access and visibility to clean off the plaque and calculus. In some cases, the pocket depths are reduced to help facilitate cleaning by both the patient and dental professional. Accomplishing these goals helps to assure that further bone loss will not take place, however proper preventive maintenance therapy is needed.

Candidates for Periodontal Flap Surgery

Gingival flap surgery is used to treat gum disease (periodontitis). It may be recommended for people with moderate or advanced periodontitis. Usually, a treatment that doesn’t involve surgery is done first. This is called scaling and root planing. If this treatment does not eliminate the gum infection, gingival flap surgery may be used. It also may be done along with another procedure known as osseous (bone) surgery.

Your Consultation

Your periodontist or your dental hygienist will first remove all plaque and tartar (calculus) from around your teeth. He or she will make sure that your oral hygiene is good. Your periodontist also will evaluate your health and the medicines you take. This is important to make sure that surgery is safe for you.

Procedure

First, you will get a shot to numb the area. Then the periodontist will use a scalpel to separate the gums from the teeth. They will be lifted or folded back in the form of a flap. This gives the periodontist direct access to the roots and bone supporting the teeth.

Inflamed tissue will be removed from between the teeth and from any holes (defects) in the bone. The periodontist then will do a procedure called scaling and root planing to clean plaque and tartar. If you have bone defects, your periodontist may eliminate them. This procedure is called osseous recontouring. It smoothes the edges of the bone using files or rotating burs.

After these procedures are completed, the gums will be placed back against the teeth and stitched in place. Some periodontists use stitches that dissolve on their own. Others use stitches that have to be removed a week to 10 days after the surgery. Your periodontist also may cover the surgical site with a bandage known as a periodontal pack or dressing.

Recovery

You will have mild to moderate discomfort after the procedure. Your periodontist can prescribe pain medicine to control it. Many people are comfortable with just an over-the-counter pain reliever.

It is very important for you to keep your mouth as clean as possible while the surgical site is healing. This means you should brush and floss the rest of your mouth normally. If the surgical site is not covered by a periodontal pack, you can use a toothbrush to gently remove plaque from the teeth. Antimicrobial mouth rinses containing chlorhexidine are often prescribed after gum surgery. These rinses do not remove plaque. However, they kill bacteria and help your mouth to heal.

You may have some swelling. This can be reduced if you apply an ice pack to the outside of your face in the treated area. In some situations, antibiotics may be prescribed to prevent an infection. Be sure to take them as instructed. Your periodontist will want to reexamine the area in 7 to 10 days.

Risks

If patients do not carry through with recommended treatment, then there may be an increased risk of:

  • Deepening of periodontal pockets
  • Periodontal infections
  • Loosening and/or shifting of teeth
  • Loss of teeth

Your gums in the area that was treated are more likely to recede over time. The teeth that were treated may become more sensitive to hot and cold. The teeth also are more likely to develop cavities in the roots.

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FAQs

What is periodontal disease?

Periodontal Disease, or Gum disease, is an infection of the gums caused by several kinds of bacteria, including Streptococcus Mutans. It is one of the most widespread diseases in the world. The American Academy of Periodontology (AAP) has estimated that more than 80% of the American population has some form of periodontal disease.

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Is it dangerous?

Yes, it can be. If left untreated, pockets of infection form between the gums and the roots of the teeth. Eventually, the tissue connecting the teeth and the gums begins to break down, causing the teeth to loosen. The underlying bone structure also may actually begin to deteriorate and diminish. Periodontal disease, not tooth decay, is the most common cause of adult tooth loss in most industrialized countries.

During the past decade, growing scientific evidence suggests that patients with periodontal disease are at greater risk for heart disease, lung disease and other systemic disorders. Studies have also linked periodontal disease to low birth weight and stroke. So in a real way, periodontal disease maybe life threatening.

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How can I tell if I have periodontal disease?

Unfortunately, periodontal disease offers very few warning signs. In fact, the symptoms are seldom apparent to the patient at all, or at least not before the disease has already caused a great deal of destruction. One sign is gums that are painful and puffy and bleed easily. Another is bad breath. But these symptoms can sometimes be very subtle.

The primary way that periodontal disease is diagnosed is by probing. This is done by a dental professional such as a periodontist (gum specialist),general dentist or, in most cases, by a hygienist. Some modern probing systems detect periodontal disease by measuring temperature or sulfide levels. However, most probing systems, even high-tech computerized probes, gauge periodontal disease by measuring the depth of the “periodontal pocket, that space between the teeth and the gums that has been opened up by periodontal infection. In a general sense, the deeper the pocket, the more serious the level of disease. More and more, dentists also take samples from the pocket and examine them under a microscope or perform a special test to check bacteria types and levels.

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What can I do to prevent periodontal disease?

Going to a dentist or periodontist who will probe your gums on a regular basis is essential. If you have never been probed, chances are your dentist has no idea whether you have periodontal disease or not.

One of the simplest ways to prevent periodontal disease (and tooth decay as well) is to practice good oral hygiene. That means brushing and flossing faithfully and thoroughly. New ultra gentle oral care systems such as the DHI Sensitive Care System have been developed specifically for diabetics and other medically compromised individuals who have sensitive gums. They are extremely comfortable and virtually eliminate bleeding while brushing. They even include an advanced flossing device for gently cleaning between the teeth.

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If I have periodontal disease, how will it be treated?

That usually depends on your dentist and the level of disease. One of the primary treatments is a series of additional, deeper cleanings known as scaling and root planing. Some general dentists and periodontists complement this treatment using antibacterial solutions. Still others use low-powered lasers to kill the bacteria inside the pocket. In fact, your treatment may include all of the above.

If your disease has been allowed to become more advanced, flap surgery may be necessary. In flap surgery, a scalpel is used to make an incision so that a portion of the gum (a “flap”) can be peeled away from the root surface, exposing the inside of the periodontal pocket.. Once the flap has been opened up, a metal instrument is used to scrape away the deposits of plaque and bacteria covering the root surface. After applying a local antibiotic, the flap is then closed up using stitches. The postoperative period can be extremely uncomfortable or painful, and it can sometimes take up to a week before you can eat solid food normally.

Obviously, the least painful and least costly alternative to these treatments is prevention. And thanks to breakthroughs such as the DHI Sensitive Care System , prevention has never been easier and more comfortable. Remember, good oral hygiene may not only spare you from periodontal treatment, it may even spare you from heart disease, lung disease and other dangers related to gum disease.

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