Osseous surgery is a common procedure used to manage advanced gum disease by reshaping the bone supporting the teeth. Patients often worry about the appearance of their gums afterward, specifically whether lost gum tissue will return. This article clarifies the biological response of gum tissue following osseous surgery and examines clinical options for restoring gum aesthetics and function.
Understanding Osseous Surgery and Expected Tissue Response
The primary goal of osseous surgery is to eliminate deep periodontal pockets where bacteria thrive, making the area accessible for routine cleaning. This is achieved by removing diseased or irregular bone (ostectomy) and smoothing the remaining bone structure (osteoplasty). The procedure creates a shallow, maintainable pocket depth, typically aiming for 1 to 3 millimeters, which is necessary for long-term periodontal health.
To achieve this stable environment, the supporting bone is intentionally recontoured to a lower, uniform level. The soft gum tissue (gingiva) is then surgically repositioned to match this new bone contour, a process known as apical positioning. This step preserves the proper biological width—the necessary space for gum attachment above the bone.
This remodeling results in a predictable and necessary amount of gingival recession. This recession is a functional outcome, not a complication, of the procedure. The new position of the gum margin is directly dictated by the reduced height of the alveolar bone, ensuring a healthy biological relationship between the bone and soft tissue.
Why Gum Tissue Does Not Naturally Regenerate
Following osseous surgery, the healing process is characterized by repair rather than true biological regeneration. Wound healing involves the rapid proliferation of epithelial cells from the gums. These cells quickly migrate down the root surface during recovery to cover and seal the exposed wound area.
This rapid migration forms a long junctional epithelium (LJE), which is a scar-like connection to the tooth, not the original robust attachment. The LJE lacks the complex structures of a healthy periodontium, such as reformed connective tissue fibers, cementum, and the periodontal ligament (PDL). The swift growth of the epithelium outpaces slower-growing connective tissue cells, preventing the reformation of the original attachment.
True regeneration requires the regrowth of all these lost components to their original levels, which the body does not spontaneously achieve after conventional resective surgery. Therefore, the gum tissue that receded as an intentional part of the procedure will not migrate back up or regrow on its own. The resultant gum line is a permanent outcome of the surgical healing process.
Addressing Recession: Clinical Options for Gum Restoration
Since gum tissue does not naturally revert to its former position, clinical interventions are available for patients concerned about aesthetics or increased root sensitivity. The most common solution involves soft tissue grafting procedures designed to cover exposed root surfaces and increase the zone of attached gingiva. These procedures are typically performed after the initial osseous surgery site has fully healed.
Connective Tissue Graft (CTG)
A connective tissue graft (CTG) is a frequently utilized technique. Tissue is harvested from beneath the surface layer of the palate and placed over the exposed root. This subepithelial tissue provides a good blood supply and structure for the receiving site to integrate the new tissue, often yielding excellent aesthetic results and superior root coverage.
Free Gingival Graft (FGG) and Guided Tissue Regeneration (GTR)
Alternatively, a free gingival graft (FGG) involves taking a small, full-thickness piece of tissue from the roof of the mouth and transplanting it directly to the recession site. While FGGs are effective at thickening the tissue and stopping further recession, CTGs are preferred when the primary goal is maximizing root coverage and achieving a natural gum contour. For instances requiring the regrowth of bone and ligament, a more advanced technique called Guided Tissue Regeneration (GTR) may be considered, which uses barrier membranes to direct the healing process toward true periodontal structure formation.