Reduction Surgery

Osseous surgery, sometimes referred to as pocket reduction surgery or gingivectomy, refers to a number of different surgeries aimed at gaining access to the tooth roots to remove tartar and disease-causing bacteria.

GOALS OF OSSEOUS SURGERY

Osseous surgery is used to reshape deformities and remove pockets in the alveolar bone surrounding the teeth. It is a common necessity in effective treatment of more advanced periodontal diseases. The ultimate goal of osseous surgery is to reduce or eliminate the periodontal pockets that cause periodontal disease. Despite the word “surgery” the procedure is reported to feel more like a thorough cleaning.

The specific goals of osseous surgery include:

• Reducing Bacterial Spread:
  Bacteria from the mouth can spread throughout the body and cause other life-threatening conditions such as heart disease and respiratory disease. Removing deep tartar and thereby bacteria can help reduce the risk of bacteria spreading.
• Preventing Bone Loss:
  The immune system’s inflammatory response prompted by periodontal bacteria can lead to bone loss in the jaw region, and cause teeth to fall out. Osseous surgery seeks to stop periodontal disease before it progresses to this level.
• Enhancing the Smile:
  Mouths plagued with periodontal disease are often unsightly. Brown gums, rotting teeth, and ridge indentations can leave a person feeling depressed and too self-conscious to smile. Fortunately, osseous surgery can help reduce bacteria and disease and thereby restore your mouth to its former radiance, while restoring confidence at the same time.
• Facilitating Home Care:
  As the gum pocket deepens, it can become nearly impossible to brush and floss adequately. Osseous surgery reduces pocket size, making it easier to brush and floss, and thereby prevent further periodontal disease.

WHAT DOES OSSEOUS SURGERY ENTAIL?

A local anesthetic will be used to numb the area prior to surgery. First, Dr. Kaindl will cut around each tooth of the affected area to release the gum tissue from the bone. This allows access to the bone and roots of the teeth. After the roots have been thoroughly cleaned through scaling, a drill and hand tools will be used to reshape the bone around the teeth. Bone is removed in some areas to restore the normal rise and fall of the bone, but at a lower level. Bone grafting may also be necessary to fill in large defects.

Next, the gums will be placed back over the remaining bone and suture in place. The site will also be covered with a bandage (periodontal pack) or dressing. Pain medicine and mouth rinses containing chlorhexidine are generally prescribed following the surgery.

Do not be alarmed if bleeding and swelling occur after the surgery. This can be controlled easily by placing an ice pack on the outside of the affected area. In cases where the bleeding and swelling is in excess, it is advised that you call to notify our office. Several follow-up visits may be necessary and you must fulfill a meticulous maintenance program, especially during the initial phases of healing to avoid post-operative infection.

The gum tissue can be very thick and large covering the tooth surface making the teeth look short. This can happen because of medications, bone that extends too close to the surface of the teeth, or inflammation due to gum disease.

A gingivectomy is a periodontal procedure that eliminates excess gum tissue. The term “gingivectomy” is derived from Latin:

• “gingiva” means gum tissue,
• “-ectomy” means to remove.

The following are some reasons a gingivectomy might be needed:

Cosmetics: To make the teeth look normal in size when the gum is covering too much of it, making the teeth look longer and more proportional.

Functional/Esthetics: To remove excess gum tissue (gingival overgrowth) that has formed as a result of certain drugs such as anti-seizure and organ-transplant medications, and certain high blood pressure medications.

Bone and gum health around the teeth: To shrink deep gum pockets. This procedure might require some bone work as well.

THE GINGIVECTOMY PROCEDURE

Dr. Kaindl first will anesthetize the area(s) to be treated. The excess of gum tissue is removed either with a scalpel blade and sometimes some rotary instruments or a laser. In most cases no sutures (stitches) are required. The surgical sites will be sore for 24-48 hours, and medication will be provided to alleviate any discomfort experienced. A weekly follow-up appointment is usually needed to ensure proper healing.

A frenum is a naturally occurring muscle attachment, normally seen between the front teeth (either upper or lower). It connects the inner aspect of the lip with the gum. A lack of attached gingiva, in conjunction with a high (closer to the biting surface) frenum attachment, which exaggerates the pull on the gum margin, can result in recession. Additionally, an excessively large frenum can prevent the teeth from coming together resulting in a gap between the front teeth. If pulling is seen or the frenum is too large to allow the teeth to come together, the frenum is surgically released from the gum with a frenectomy. A frenectomy is simply the surgical removal of a frenum.

When Orthodontic treatment is planned or initiated, the removal of an abnormal frenum, with or without a gingival graft, can increase stability and improve the success of the final orthodontic result.