Surgical Periodontal Disease Treatments

Pocket Reduction Surgery

If non-surgical treatments can’t reduce pocket depth, surgery may be needed. Surgery on gum and bone can reduce pocket depth and save a tooth or teeth. It also allows the dentist to remove tartar deep below the gum line. In some cases, pocket reduction surgery is combined with regenerative procedures.

Reshaping Gum and Bone

Pocket reduction begins with flap surgery. The gum is separated from the tooth and later reattached in a new position. In most cases, osseous surgery is also performed. This involves reshaping and smoothing the bone. After treatment is complete, the gum line will most likely be lower, leaving more of the tooth exposed. If the root is exposed, ongoing treatment with fluoride or another material may be needed to reduce sensitivity.

Before Surgery

A deep pocket allows plaque and tartar to collect far below the gum line. Inflammation and infection have destroyed some supporting bone.

Opening the Gum

The gum is first lifted and rolled back, creating a “gum flap.” Tartar is then removed from the root. The surgeon also removes diseased gum tissue

Shaping the Bone

If needed, the bone is smoothed and reshaped. This reduces pits and rough areas where bacteria grow.

Helping Tissue Heal

A substance may be applied to the root to help the ligaments and gum reattach. Instruments may be used to cauterize (seal off) the area and reduce bleeding.

Closing Up

The gum flap is sewn shut in a position that reduces pocket depth. A dressing may be used to protect the area. This dressing is a bit like clay or putty. If used, it remains in place until removed by your dentist at a follow-up visit

After the Gum Heals

Once the gum is healed, the stitches dissolve or are removed. Your dentist also removes the dressing. The pocket is shallower. With a lower gum line, it is likely that more of the tooth will be visible.

Regenerative Procedures

Certain procedures can be used to stimulate growth of new bone. This increases the height of the bone around the tooth, giving it more support. Getting back even half the lost bone height extends the life of the tooth.

Bone Replacement Graft

A graft helps your body replace lost bone. The graft consists of your own bone, synthetic material, or bone from a tissue bank. A gel containing growth factors may also be used to stimulate tissues to grow.

Bone Graft -Placing the Graft
Placing the Graft

First, a gum flap is created. Growth factors may then be applied to the root. Graft material is packed into the area where bone was lost.

Bone Graft - Closing Up
Closing Up

The gum is closed and sewn together. The growth factors stimulate tissue to grow. The graft provides a platform for new bone to grow.

Bone Replacement - After the area HealsAfter the Area Heals

Stitches dissolve or are removed. Though the gum has healed, it takes a year or more for new bone growth to fill the space.

Guided Tissue Regeneration (GTR)

A special membrane is placed between gum and bone. This prevents gum tissue, which grows quickly, from filling the space where bone was lost. That way, new bone has time to grow where it’s needed.

Guided Tissue Regeneration - Surgery on Gum and BoneSurgery on Gum and Bone

The gum is opened. Then a membrane is placed over the damaged bone

 Guided Tissue Regeneration - Separating TissuesSeparating Tissues

Once in place between bone and gum, the membrane allows space for bone to heal.

diagram shoing new bone growth after the area has healed from the procedureAfter Healing

The stitches and membrane dissolve or are removed. In about a year, bone forms to support the tooth.

Gingival Grafting Surgery

When you look in the mirror, does the gum line look uneven? Or do you see too little gum? These are common effects of periodontal disease. Surgery on the gums can lower or even out the gum line. And if more of the tooth needs to be exposed, surgery can fix that too.

Soft Tissue Graft

When the gum isn’t supported by bone, the gum can start to pull away. A graft can be used to fill in an area where the gum has receded. The graft tissue may be taken from the roof of the mouth or from a tissue bank.

Soft Tissue Graft - Before SurgeryBefore Surgery

A gum line that has receded can expose the root. This can lead to tooth sensitivity and cavities in the root. The uneven gum line may also be visible when you smile.

Soft Tissue Graft - After SurgeryAfter Surgery

Graft tissue covers part or all of the exposed root. This protects the root and prevents the gum from receding further. It can also improve your appearance

Crown Lengthening – Surgery to include more of the crown includes:

Crown Lengthening - unctional Crown LengtheningFunctional Lengthening – In some cases, a restoration (artificial crown) is needed. Gum and bone are removed to expose enough tooth to anchor the new crown. This also helps prevent future damage to gum and bone near the restoration.

Functional Crown Lengthening – Gum and bone are removed. The remaining portion of the tooth can now support a replacement crown.

Crown Lengthening - Cosmetic LengtheningCosmetic Lengthening – This is done to remove an overgrowth of gum tissue that causes a “gummy” smile. It can improve appearance and may make teeth easier to keep clean.

Cosmetic Crown Lengthening – Removing gum creates a more attractive smile.

LANAP Laser Surgery

New Technology For Treating Periodontal Disease

Laser Assisted New Attachment Procedure (LANAP) is a laser based technique for treating periodontal disease without using a scalpel and sutures. This alternative is more comfortable for the patient than conventional gum surgery which can be very painful.

How Does It Work?

Tartar, associated with inflamed and bleeding gums, is removed from the root surface of the tooth using an ultrasonic scaler and small instruments.

Next, a small amount of light energy from a laser is directed through a tiny fiber, which is gently placed between the gum and tooth. This light energy removes a tiny amount of diseased tissue and aids in reducing the bacteria associated with periodontal disease. After the area is thoroughly cleaned the body can heal the area naturally.

LANAP Laser Surgery - Laser accesses the pocket.

Laser accesses the pocket.

ANAP Laser Surgery - laser removes diseased tissue

Laser removes diseased tissue, leaving important connective fibers in place.

ANAP Laser Surgery - ultrasonic scaler

Ultrasonic scaler removes root surface deposits.

ANAP Laser Surgery - laser finishes debriding

Laser finishes debriding the pocket.

LANAP Laser Surgery - tissue is compressed

The tissue is compressed against the root surface and a stable fibrin clot forms.

LANAP Laser Surgery - bite is adjusted

The bite is adjusted where needed to balance the forces on the teeth.

Laser Periodontal Therapy can be used on all stages of gum diseases; from Gingivitis through severe periodontal disease. The benefits of laser surgery are outstanding from simple treatments to the most complex.

Some of these benefits are:

  • No healthy tissue is removed, enhancing the chance for the gum tissue to reattach to the tooth surface without further exposure of the root
  • Less pain & less bleeding
  • Faster healing with little or no “down time”
  • Laser Therapy stimulates bone regeneration

FDA approved PerioLase® Laser

Port Charlotte Periodontist Dr. Carol Stevens uses the FDA approved PerioLase® Laser for treating periodontal disease. If you suffer from tender, red, swollen, or bleeding gums, call Dr. Carol Stevens for an appointment to evaluate your condition.