Your bone and gum tissue should fit snugly around your teeth like a turtleneck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth. Over time, these pockets become deeper, providing a larger space for bacteria to thrive and wreak havoc.
As bacteria accumulate and advance under the gum tissue in these deep pockets, additional bone and tissue loss follows. Eventually, if too much bone is lost, the teeth will need to be extracted.
Flap surgery is sometimes performed to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for you or your dental professional to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again.
A pocket reduction procedure is recommended if daily at-home oral hygiene and a professional care routine cannot effectively reach these deep pockets.
In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.
In some cases, periodontal procedures help lay the groundwork for restorative and cosmetic dentistry and/or improve the esthetics of your gum line. If you have a "gummy" smile because your teeth appear short, it is possible that your teeth may be the right length, but are covered by excessive gum tissue. Crown lengthening corrects this condition.
Crown lengthening involves reshaping excess gum and bone tissue in order to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.
Crown lengthening often makes a restorative or cosmetic dental procedure possible. This is especially true if you have a tooth that is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.
Soft tissue grafts are sometimes performed to treat gum disease, or correct other abnormalities.
The procedure involves taking gum tissue from the palate or another donor source to cover an exposed root in order to even the gum line and reduce sensitivity.
Periodontal procedures are available to stop further dental problems and gum recession, and to improve the esthetics of your gum line. For example, an exposed tooth root resulting from gum recession may not be causing you pain or sensitivity, but is causing one or more of your teeth to look longer than the others. In other cases, an exposed tooth rooth causes sever pain because it is exposed to extremes in temperatures or different kinds of food and liquids.
Once contributing factors are controlled, a soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss.
Scaling and Root Planning
Some cases of acute periodontal (gum) disease that do not respond to more conventional treatment and self-care such as flossing may require a special kind of cleaning called scaling and root planing.
The procedure begins with administration of a local anesthetic to reduce any discomfort. Then, a small instrument called a "scaler," or an ultrasonic cleaner, is used to clean beneath your gum line to remove plaque and tartar.
The root surfaces on the tooth are then planed and smoothed. This lets the gum tissue heal and reattach itself to the tooth.
Osseous (Bone) Surgery
Osseous (meaning "bone") surgery involves removing and/or reshaping the jawbone under the gum. Such a procedure is called for not because of gum disease per se, but because of most of the damage that occurs in the underlying bone. Actually, gum disease and its attendant infection that spreads below the gum tissue can destroy the bone structure below. The bone becomes irregularly shaped, preventing the gum from laying down flat.