Periodontics is a specialized field of dentistry focused on the supporting structures of the teeth: the gums and the underlying jawbone. These tissues form the foundation that keeps teeth healthy, stable, and functional. When bacterial infection progresses, periodontitis develops, which destroys gum tissue and bone. Advanced stages of this disease often require more intensive treatments than routine cleaning. Surgical periodontics offers solutions to repair and regenerate tissues damaged by the progressive effects of gum disease.
Defining Surgical Periodontics
Surgical periodontics utilizes surgical techniques to treat advanced gum disease and correct defects of the gums, bone, and alveolar mucosa. This approach is typically performed by a periodontist, a dentist who has completed several years of additional postgraduate training. The primary goal of these procedures is to create an oral environment that supports long-term health and stability. This involves eliminating chronic infection, reducing the depth of pockets between the gum and tooth root, and restoring lost soft and hard tissues. Surgery makes the affected areas more accessible for professional maintenance and daily oral hygiene.
When Surgical Intervention Is Necessary
The decision to proceed with surgery is made when non-surgical treatments, such as scaling and root planing (deep cleaning), have proven insufficient to control the disease. Non-surgical methods are effective for early-to-moderate periodontitis but struggle to reach and clean very deep pockets of infection. Pockets measuring 5 millimeters or more are often inaccessible to thorough instrumentation and harbor bacteria.
Surgery becomes necessary to gain direct visual access to the root surfaces and underlying bone for complete cleaning and debridement. Significant bone loss, known as osseous defects, may require surgical reshaping or regeneration to stabilize the tooth. Surgery is also indicated to correct severe gum recession that exposes the tooth root or to reshape tissue in preparation for restorative procedures, like placing a crown. The specific clinical presentation guides the periodontist’s choice of surgical procedure.
Key Procedures in Periodontal Surgery
Pocket Reduction Surgery
One of the most common surgical procedures is Pocket Reduction Surgery, often called flap surgery, which reduces the depth of the periodontal pockets. The periodontist makes small incisions to temporarily lift back the gum tissue, creating a flap that exposes the root and the damaged bone. This visual access allows for the complete removal of disease-causing bacteria, plaque, and tartar from the root surface. After cleaning, the gum tissue is repositioned and secured with sutures. In some cases, the underlying bone may also be reshaped, a procedure known as osseous surgery, to eliminate defects and create a smoother contour that encourages the gum to reattach more closely to the tooth.
Regenerative Procedures
Regenerative procedures focus on regrowing the bone, cementum, and periodontal ligament lost to disease. Techniques like Guided Tissue Regeneration (GTR) and Guided Bone Regeneration (GBR) utilize barrier membranes to selectively block faster-growing gum tissue cells from occupying the space. This allows slower-growing bone and ligament cells the necessary time to migrate and develop new attachment to the root surface. These procedures often incorporate bone graft materials, which can be sourced from the patient, a donor, or synthetic compounds, along with tissue-stimulating proteins to promote the formation of new supporting structures.
Soft Tissue Grafting
Soft Tissue Grafting is used primarily to treat gum recession or to thicken thin gum tissue. When gum tissue recedes, the tooth roots become exposed, leading to sensitivity and an increased risk of decay. A periodontist may harvest a small piece of tissue, most commonly from the palate or a donor source, and secure it over the exposed root surface. The connective tissue graft is the most frequently used technique for root coverage, providing a stable band of attached gum tissue that protects the underlying root and improves appearance.
Post-Surgical Care and Healing
Following periodontal surgery, post-operative care is necessary for successful healing. Patients should expect mild to moderate discomfort, swelling, and minor bleeding in the first 24 to 48 hours, manageable with prescribed pain medication and an ice pack applied to the cheek. Patients must avoid disturbing the surgical site; they should not vigorously rinse, spit, or use a straw, as these actions can dislodge the blood clot and interfere with initial healing.
For the first week, a soft diet is necessary to prevent trauma, and patients should avoid hard, crunchy, or excessively hot foods. Oral hygiene routines must be modified, typically involving a prescribed antimicrobial rinse to keep the area clean without mechanical brushing. Sutures, if not dissolvable, are usually removed one to two weeks after the procedure. Patients must attend all follow-up appointments so the periodontist can monitor the healing process. Complete soft tissue healing usually occurs within a few weeks, though bone regeneration can take several months.