Learn About - California Periodontal Specialists

Dental Procedure, Pocket Depth Reduction

As the bacteria that cause periodontal disease release toxic substances, they trigger the breakdown of gum and bone. The gum then separates from the teeth, forming gaps that are called periodontal pockets. Bacteria settle in these pockets and because they cannot be removed by the patient's daily oral hygiene, they continue to accumulate and reproduce. Without proper treatment, the bacteria will continue to populate these pockets, creating further gum and bone destruction.

The first step in the treatment of periodontal disease involves the removal of the bacteria that inhabit the periodontal pockets in the form of plaque and tartar. The removal of the pocket irritants, scaling and root planing is combined with oral hygiene instructions that are aimed at improving the patient's ability to control plaque and avoid bacteria from re-infecting the periodontal pockets. Several weeks after completion of scaling and root planing, a periodontal re-evaluation should be completed to assess the healing response. If the periodontal pockets do not reduce to below 4 mm and the gums are still unhealthy, surgical treatment may be indicated.

Pocket depth reduction is a term used for a series of different surgical procedures (gingivectomy, flap surgery, osseous surgery). The purpose of these procedures is to gain access to the root surface to effectively remove calculus and to reduce the size of the pockets to help prevent bacteria from settling in.

What to Expect

Pocket depth reduction is done in the dentist's office with local anesthesia (lidocaine). After lifting the gum back, the bacterial plaque and tartar are removed from the root surfaces. It also may be necessary to remove the infected gum tissue and to smooth the bone surface. Stitches (sutures) are placed to aid in healing. The stitches are usually removed five to ten days after the surgery. Follow-up appointments are scheduled as necessary to evaluate healing and plaque control.

Post-surgical discomfort may last a few days and is usually minimal. It can be easily managed with commonly available over-the-counter medications such as aspirin, acetaminophen, or ibuprofen. Patients can expect to follow their normal routine the day after surgery. A dentist will provide special instructions related to diet, exercise, and medications.

After pocket depth reduction, patients may experience heightened tooth sensitivity. This is temporary and usually resolves within a few weeks. There are chemical aids available that help reduce sensitivity.

Some people also may experience looser teeth after periodontal surgery. This also is a transient finding that occurs as part of the normal healing process. With proper plaque control and bite adjustment, the teeth usually tighten up in a few weeks.

Another concern after pocket depth reduction is that the teeth may appear longer and that there are spaces in between the teeth. Actually, longer teeth are the result of periodontal disease, not of periodontal surgery. As periodontal disease infects and destroys the bone that encases the roots, the root surfaces become exposed. They do not appear exposed because they are covered by the inflamed, swollen gums that form the periodontal pocket. Without proper treatment, the periodontal pockets continue to deepen, giving way to more infection, bone loss, and eventually tooth loss and systemic complications.

There are treatments that can help improve esthetics after periodontal treatment. In addition to periodontal plastic surgery procedures, orthodontic tooth movement (braces) or restorative treatment (crown and bridges) can help create a more pleasing smile line.

Benefits

If periodontal pockets do not resolve after scaling and root planing, a dentist may recommend pocket depth reduction. Whether a dentist performs a gingivectomy, periodontal flap surgery, or osseous surgery, the patient will benefit from the reduction in pocket depth and the reattachment of the gums to the root surface. Pocket depth reduction, when followed by supportive periodontal treatment, is a predictable procedure that can help keep teeth healthy and reduce the risk of serious health problems related to periodontal disease. If a general dentist does not frequently do surgeries, he or she may refer the individual to a periodontist that specializes in this technique.

By Laura Minsk, DMD

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Increasing Gum Around a Tooth with Soft Tissue Grafts

If an individual has gum recession as a result of periodontal disease, or has thin gums that need to be augmented before dental procedures, their dentist may recommend a soft tissue (gum) graft. The purpose of the gum graft is to cover exposed root surfaces and to increase the amount of gum around a tooth. It can be done to improve the esthetics of the gum line, prevent further recession, as preparation for other dental procedures (restorations or orthodontics), or to protect the tooth from root sensitivity and cavities.

A graft is the transplantation of living tissue from one part of the body to another. In the case of a gum graft, the tissue is usually taken from the roof of the mouth and placed on the exposed root surface. In some instances, it may be possible to move gum tissue from a site right next to the root surface or to use tissue donated from a different source. One or several teeth can be treated simultaneously.

Gum grafts have been done since the 1960's with exceptional success. The techniques have changed since then, making the procedures even more predictable, comfortable, and esthetic. Today it is possible to match the texture and color of the gum tissue with minimal scarring.

What to Expect from Periodontal Gum Grafts

Soft tissue (gum) grafts are done in the dentist's office with local anesthesia (lidocaine). After obtaining the donor tissue, it is secured on the recipient site with stitches (sutures) or tissue glue. The donor site (usually the roof of the mouth) may also require stitching, bandages, or tissue glue. Post-surgical discomfort is usually minimal and can be easily managed with commonly available over-the-counter medications such as aspirin, acetaminophen, or ibuprofen. Patients can expect to follow their normal routine the day after oral surgery. The dentist will provide special instructions related to diet, exercise, and medications.

The stitches are usually removed five to ten days after the surgery. Follow-up appointments are scheduled as necessary to evaluate healing and plaque control.

Benefits of Gum Grafts

Soft tissue (gum) grafts are beneficial to help reduce further gum recession and bone loss as well as to help protect the root surface from decay and sensitivity. In addition, a dentist should be consulted about gum grafting procedures if individuals have exposed root surfaces or long-looking teeth that create a cosmetic problem. If a general dentist does not frequently perform soft tissue grafts, he or she may refer the patient to a periodontist who specializes in this technique.

By Laura Minsk, DMD