Surgical Treatment

Pocket Elimination Surgery

After a non-surgical attempt has been made to arrest gum disease, any persistent pocketing should receive a small surgical procedure to fully correct the pocket to make it more manageable and prevent further progression of the disease.  This usually involves a small incision at the crest of the gum where it meets the tooth, followed by removal of the diseased gum tissue between the teeth. The surface of the root can be inspected for any residual calculus and cleaned if necessary. Occasionally, if the conditions are favorable, bone chips can be placed into the pocket to try and regain lost bone. Sutures are placed to hold the gum back in place while healing occurs.  A follow-up appointment may be needed a few weeks after to check healing.  Mild discomfort is expected, and a prescription analgesic is usually given along with written post-op care instructions.

Gingivectomy

Occasionally, excessive gum tissue exists around a tooth or teeth.  This can be from inadequate eruption of the tooth or teeth, producing a “gummy smile” with short appearing teeth, or it can be induced by certain medications, such as some heart medications or antiepileptics.  A minor surgical recontouring procedure called a Gingivectomy can remove excess soft tissue to enhance the appearance of a smile. Usually no suturing is involved, healing is straightforward, mild discomfort is expected, and a prescription analgesic is usually given along with written post-op care instructions.  A follow-up appointment may be needed a few weeks after to check healing.  

Soft tissue grafts

Occasionally, gum tissue covering the root of the tooth may be lost due to recession.  This can result from trauma from overly aggressive brushing with a hard or medium bristle brush, or could be due to malpositioned or orthodontically positioned teeth where thin or no bone coverage of the root has compromised the blood supply to the gum tissue.  A bacterial infection may or may not be present and/or contributory to the recession.

Treatment involves removing a piece of gum tissue where there is an excess, typically the palate (roof of the mouth), and transferring it to the defective area.  A small surgical preparation of the recession site is made to accept the donor graft.  The donor tissue is sutured in place and allowed to heal.  Occasionally, freeze-dried donor tissue from a tissue bank is used instead of using the palate as a donor.   A follow-up appointment may be needed a few weeks after to check healing.  Mild discomfort is expected, and a prescription analgesic is usually given along with written post-op care instructions.

Crown Lengthening

If there is decay or a tooth breaks below the gumline, it may be necessary to remove some gum tissue to expose the extent of the decay or fracture and restore the tooth properly.  For a restoration to be properly placed, 3 mm of exposed root is needed above the supporting bone for the gum to attach to the root and be healthy.  If there is not enough room for the gum to attach, it becomes irritated and uncomfortable. To correct this, a small surgical procedure called Crown Lengthening is done to create more exposed root surface for the gum to attach to.  A small incision is made around the tooth, and the gum reflected back to expose the root and bone (picture peeling back the skin of a banana or an orange).  The bone in the area of the decay or fracture is removed enough to allow the gum to reattach, and the reflected gum is reattached with sutures and allowed to heal. A follow-up appointment may be needed a few weeks after to check healing.  Mild discomfort is expected, and a prescription analgesic is usually given along with written post-op care instructions.  The tooth can then be restored properly in 4-6 weeks.