Gum surgery is the general term for any procedure involving the gums and the underlying structures that support the teeth, formally known as periodontal surgery. This dental work is typically performed by a periodontist, a dentist with advanced training in treating diseases and conditions of the soft tissues and bone around the teeth. The purpose of these interventions is either to treat advanced periodontal disease that non-surgical methods cannot resolve or to correct aesthetic and functional issues like gum recession.
The need for gum surgery often arises when the deep pockets created by gum disease become too difficult to clean, allowing infection to persist and threaten the stability of the teeth. These surgical methods provide the necessary access and correction to restore the health and appearance of the oral foundation.
The Primary Categories of Gum Surgery
Periodontal surgery can be broadly classified into two main categories: resective and regenerative/plastic procedures. Resective surgery focuses on removing or reshaping diseased or excess tissue to create a more maintainable environment by reducing the depth of periodontal pockets. Examples include a gingivectomy (removing gum tissue) and a gingivoplasty (reshaping gum tissue for better contour).
The second category, regenerative and plastic surgery, aims to add or rebuild lost tissue structure, often to cover exposed roots or restore bone support. This includes grafting techniques, where tissue or synthetic materials are used to replace what has been lost. The flap procedure, which involves temporarily lifting the gum tissue to gain access to the roots and bone underneath, is utilized in both resective and regenerative contexts.
Procedures for Treating Periodontal Disease
Surgical interventions for advanced periodontal disease eliminate deep infection, reduce pocket depth, and stabilize the supportive bone structure. The most common of these is osseous surgery, frequently performed in conjunction with a flap procedure. The periodontist lifts the gum tissue to expose the tooth root surfaces and underlying bone, allowing for thorough scaling and root planing to remove calculus and bacteria.
After cleaning, the damaged or uneven bone is often reshaped (osteoplasty) to create a smooth surface that eliminates bony defects where bacteria thrive. The gum tissue is then repositioned and sutured back down, resulting in a shallower pocket depth that the patient can effectively clean. This reduction in pocket depth is essential for long-term control of periodontitis.
In cases where significant bone structure has been lost, regenerative procedures are employed alongside the flap procedure to rebuild the lost tissue. This involves placing bone grafting material into the bony defects. Sometimes, a barrier membrane is placed over the graft to prevent faster-growing soft tissue from occupying the space, a technique called Guided Tissue Regeneration (GTR). The goal is to encourage the growth of new periodontal ligament, cementum, and alveolar bone, regenerating the tooth’s natural support system.
Procedures for Correcting Gum Recession and Aesthetics
A separate set of procedures focuses on correcting structural defects like gum recession and improving the appearance of the gum line. Gum grafting is the method of choice for treating recession, where the soft tissue margin has pulled away from the tooth, exposing the root surface. This recession can lead to sensitivity and further tissue loss if left unaddressed.
The most common technique is the connective tissue graft, where tissue is harvested from beneath the palate and transplanted to cover the exposed root. Other techniques include the free gingival graft (using a direct piece of tissue) and the pedicle graft (moving adjacent gum tissue while maintaining blood supply). These grafts not only cover the exposed root but also build up the thickness of the gum tissue, helping to prevent future recession.
For patients concerned with a “gummy smile,” where excess gum tissue makes teeth appear short, gingivoplasty or crown lengthening is performed. Crown lengthening involves removing or reshaping soft tissue and sometimes underlying bone to expose more of the natural tooth structure. This procedure can be done for aesthetic reasons to create a more balanced smile, or to prepare a tooth for a crown when decay extends below the gum line.
Recovery and Post-Operative Care
Proper post-operative care is essential for minimizing discomfort and ensuring the success of gum surgery. Patients should manage swelling by applying an ice pack to the cheek area for the first 24 to 48 hours. Pain medication, including over-the-counter or prescription drugs, should be taken as directed to control discomfort as the local anesthetic wears off.
A soft diet is necessary for the first few days, avoiding hard, crunchy, or hot foods that could damage the surgical site. Patients must avoid brushing or flossing the surgical area directly, instead using a prescribed antimicrobial rinse to keep the site clean and prevent infection. Strenuous physical activity is discouraged for several days, as it can increase bleeding and swelling.
Patients must also avoid using straws or spitting forcefully, as the suction can dislodge the blood clot or graft and impair healing. A follow-up appointment is scheduled within one to two weeks to remove any non-dissolvable sutures and monitor the initial healing process.