“Gum surgery” is a broad term for dental procedures required to treat or correct issues affecting the gums and underlying bone structure. These interventions are officially grouped under the professional name “periodontal surgery.” A periodontist, a dental specialist, performs these procedures when non-surgical treatments like deep cleanings are insufficient to halt the progression of advanced gum disease (periodontitis). Goals include eliminating infection, reducing the space where bacteria can hide, stopping bone loss, and restoring both the function and appearance of the oral tissues.
Surgical Procedures for Pocket Reduction
Advanced periodontitis creates deep spaces, known as periodontal pockets, between the teeth and gums where destructive bacteria thrive, leading to the erosion of supporting bone. The most common therapeutic interventions are designed to clean these infected areas and reduce the pocket depth, making the area maintainable with daily brushing and flossing.
Gingival Flap Surgery
Gingival Flap Surgery involves lifting a section of the gum tissue away from the tooth and bone to gain direct visibility and access to the root surfaces. Once the flap is opened, the periodontist thoroughly removes all calculus (hardened plaque) and diseased tissue from the root and bone surface. The flap is then secured back around the tooth with sutures, repositioned to fit more snugly and minimize the pocket depth.
Osseous Surgery
Osseous Surgery is often performed concurrently with flap surgery and focuses on reshaping the bone itself. Bacterial infection can create irregular bone contours, craters, or deformities in the jawbone where bacteria accumulate. After the infection is cleaned, the surgeon smooths and recontours the affected bone structure to eliminate these defects. This reshaping prevents the recurrence of deep pockets and creates a smooth, clean surface that the gum tissue can reattach to.
Regenerative and Grafting Surgeries
When periodontal disease or trauma causes significant loss of gum tissue or supporting bone, grafting surgeries are performed to rebuild or replace the lost biological structures. These procedures focus on adding material to encourage the body’s natural healing and regeneration processes.
Soft Tissue Grafts
Soft Tissue Grafts are utilized to treat gum recession, where the gum margin pulls back and exposes the tooth root surface, leading to increased thermal sensitivity and decay. Common techniques involve harvesting tissue from a donor site, often the roof of the mouth (palate), and transplanting it to cover the exposed root area. The connective tissue graft, taken from beneath the outer layer of the palate, is the most common approach for covering large areas of exposed root.
Bone Grafts
Bone Grafts are performed to restore jawbone volume lost due to advanced periodontitis or to prepare a stable foundation for a dental implant. The material used for the graft acts as a scaffold, stimulating the body to grow new bone tissue. Graft materials are categorized by their source:
- Autografts use bone from the patient’s own body, offering the highest success rate.
- Allografts use processed, donated human bone.
- Xenografts use bone derived from an animal source, such as cows.
- Alloplasts are synthetic materials like calcium phosphate or bioactive glass.
Guided Tissue Regeneration (GTR)
Guided Tissue Regeneration (GTR) involves placing a specialized barrier membrane between the gum tissue and the bone defect. This membrane physically prevents faster-growing gum cells from migrating into the space, reserving the site for slower-growing bone and ligament cells. The goal is to encourage the predictable regrowth of the complex tissues that make up the tooth’s supporting apparatus.
Procedures for Gum Line Contouring
Some surgical procedures are performed not to treat deep infection, but to reshape the gum tissue for functional or aesthetic improvements, specifically focusing on the visible gum line and tooth exposure. These contouring procedures typically involve the removal or repositioning of healthy gum tissue.
Gingivectomy
Gingivectomy is a procedure that involves the removal of excess gum tissue. It is used to treat gingival enlargement caused by certain medications or to correct a “gummy smile” by exposing more of the natural tooth crown. By trimming away the excess tissue, the periodontist can improve the aesthetic proportion between the teeth and gums or reduce minor pocket depths.
Crown Lengthening
Crown Lengthening is a procedure used to expose additional tooth structure. It is frequently necessary for restorative purposes, such as when a tooth is fractured or decayed below the gum line, requiring exposure of healthy tooth for a crown or filling. The procedure involves the removal of soft tissue and often the reshaping of a small amount of the underlying bone. When performed for aesthetic reasons, it corrects a gummy smile by establishing a harmonious gum-to-tooth ratio.