When periodontitis, or advanced gum disease, progresses, it causes the gum tissue to pull away from the teeth, creating deep spaces called periodontal pockets. These pockets fill with bacterial plaque and hard calculus, which cannot be effectively removed with standard non-surgical treatments like scaling and root planing. Untreated severe infection destroys the supporting bone structure and can result in tooth loss. Periodontal flap surgery becomes a necessary intervention to halt the disease’s progression and restore the health of the supportive tissues.
Defining Periodontal Flap Surgery
Periodontal flap surgery is a specialized procedure designed to access and treat deep pockets, often measuring five millimeters or more in depth. The purpose is to gain visual access to the tooth root surface and underlying bone. Without this access, the thorough cleaning required to eliminate the infection below the gumline is not possible.
The term “flap” refers to a section of gum tissue that is carefully separated from the tooth and bone and gently lifted back. This temporary lifting allows the periodontist to perform a meticulous cleaning that targets bacteria and hardened deposits on the root surfaces. Once the area is cleaned and disinfected, the tissue is repositioned against the tooth at a level that reduces the depth of the pocket.
This procedure is reserved for patients whose gum disease has not responded to initial non-surgical therapies. Reducing the depth of the pockets makes it possible for patients to maintain the area with routine daily oral hygiene, preventing the recurrence of infection. The surgery also offers the opportunity to reshape minor bone irregularities or to place bone graft material to encourage the regeneration of lost support structure.
The Steps of the Surgical Procedure
The surgical process begins with the administration of a local anesthetic to ensure the treatment area is numb. The periodontist makes a precise incision around the necks of the affected teeth to separate the gum tissue from the underlying structures. This allows for the gentle elevation of the gum tissue, creating the flap that exposes the root surfaces and affected bone.
With the root surfaces visible, debridement is performed, involving meticulous scaling and root planing to remove all plaque, calculus, and diseased tissue. The root surfaces are smoothed to make it more difficult for bacteria to reattach. If bone loss has created defects, the surgeon may perform osseous surgery to reshape the bone or introduce bone grafting materials to support regeneration.
After cleaning and necessary bone work are complete, the exposed area is irrigated with a sterile solution to flush out remaining debris. The gum flap is then repositioned against the tooth root, often at a slightly lower level to eliminate the deep pocket. Finally, the tissue is secured using fine sutures, which hold the gum firmly in place during initial healing.
Post-Surgical Recovery and Care
Immediately following the procedure, patients should expect minor swelling and slight bleeding, which is normal for the first 24 hours. Swelling is managed by applying an ice pack to the outside of the cheek in the surgical area, using a cycle of ten minutes on and ten minutes off during the first day. Pain and discomfort are managed with prescribed or over-the-counter medications, taken as directed, often starting before the local anesthetic wears off.
For the first week, a soft diet is recommended, consisting of foods like mashed potatoes, scrambled eggs, and soup, while avoiding anything crunchy, spicy, or excessively hot. Avoid using a straw or forcefully spitting, as the suction created can dislodge the protective blood clot and interfere with healing. Patients must refrain from strenuous physical activity for the first few days to prevent increased bleeding caused by elevated blood pressure.
Oral hygiene requires modification; patients must avoid brushing or flossing the surgical site for approximately seven to ten days to protect the healing tissues and sutures. Instead, a prescription antimicrobial rinse, such as chlorhexidine, is used twice daily to control plaque and prevent infection. The sutures are removed by the periodontist during a follow-up appointment, generally scheduled one to two weeks after the surgery.