Pocket reduction surgery, also known as flap surgery or osseous surgery, is a common periodontal procedure designed to treat advanced gum disease. The primary objective is to reduce the depth of periodontal pockets that form between the teeth and gums, eliminating deep areas where harmful bacteria accumulate. By accessing the tooth roots and underlying bone, the procedure allows for thorough cleaning and the reshaping of tissue. This permits the gum to reattach more snugly to the tooth surface, making the area easier to clean and maintain, thus halting the progression of periodontitis.
Why Deep Pockets Require Intervention
Periodontal pockets develop when bacterial plaque and tartar build up along the gumline. This irritates the gum tissue, leading to gingivitis. If left untreated, the inflammation advances, causing the gum tissue to detach and pull away from the tooth root surface.
This detachment creates an abnormal space where bacteria thrive and multiply. In a healthy mouth, the space between the gum and tooth, called the sulcus, measures 1 to 3 millimeters (mm) deep. Pockets measuring 5mm or more are considered moderate to severe, indicating significant disease progression.
Deep pockets are problematic because standard oral hygiene tools cannot reach the bottom to remove the bacteria and calculus. Unchecked bacterial colonization below the gumline destroys the tissue and the underlying bone that supports the teeth. This progressive bone loss compromises the stability of the teeth, leading to potential loosening and, eventually, tooth extraction.
How the Surgery is Performed
The procedure begins with the administration of a local anesthetic. Once the area is numb, the periodontist makes precise incisions along the gumline to gently separate the gum tissue from the underlying tooth and bone. This creates a soft tissue flap, which the surgeon folds back to fully expose the root surfaces and the infected area.
With the roots fully visible, the dental professional performs meticulous cleaning, a process known as scaling and root planing. This involves thoroughly removing all accumulated plaque, tartar, and infected granulation tissue from the root surfaces and bone defects.
Osseous Surgery
Osseous surgery is often required, where the periodontist carefully reshapes or smooths any irregular or damaged bone surfaces. This recontouring creates a more favorable shape for the gum tissue to lie against. By reducing these irregularities and shallowing the bony architecture, the final pocket depth is reduced.
Finally, the gum flap is repositioned back against the tooth and secured in place with fine sutures, which may be dissolvable or require removal at a follow-up appointment. The gum tissue lies snugly against the newly cleaned and smoothed root and bone structure. This reduces the original pocket depth and makes the area maintainable with daily brushing and flossing.
What to Expect During Recovery
Immediately following the procedure, patients will experience soreness, swelling, and bleeding at the surgical site. Discomfort is managed using over-the-counter pain medication or a prescribed regimen. Ice packs applied to the outside of the face in 20-minute intervals help minimize swelling, particularly during the first 24 to 48 hours.
Patients must adhere to a soft-food diet for the initial days of recovery, avoiding anything hard, crunchy, or hot that could irritate the surgical area. Oral hygiene requires special care; patients are instructed to avoid brushing the treated area directly. Instead, they should rinse gently with a prescribed antimicrobial mouthwash or warm salt water after the first 24 hours.
Activities that create suction, such as using a straw or smoking, must be avoided as they can dislodge the blood clot and interfere with healing. Most patients can resume light daily activities within a day or two, though heavy exercise should be avoided for the first few days. A follow-up appointment is typically scheduled within seven to ten days to check healing progress and remove any non-dissolvable sutures. Full initial recovery generally takes between two and four weeks.