If you’ve had scaling and root planing (a deep cleaning) to try and eliminate the bacteria in the deep pockets causing your periodontal disease and the resulting therapy did not sufficiently reduce the pocket depths in your mouth, most likely you will need osseous or pocket reduction surgery in order to adequately treat and control the disease.
Why do I need Osseous (Pocket Reduction) Surgery?
This recommendation is normally based on the periodontal probing depths and/or clinical attachment levels measured following a re-evaluation of initial therapy. The critical probing depth to keep in mind is 4mm. Studies have shown that even though 4mm pockets are not good they can be maintained with a good periodontal maintenance program. However, when periodontal pockets are greater than 4mm, i.e., ≥5mm, we as dental professionals, with specialty instruments in our hands, are unable to effectively remove all of the bacteria in these pockets. If we are unable to effectively clean these areas there is no way you as a patient will be able to do so with regular brushing and flossing. Remember, our ultimate goal is to control and treat the disease in a way that will facilitate shallow pockets that you can keep clean at home and the hygienist can keep clean through regular maintenance visits.
How is Pocket Reduction Surgery Done?
In pocket reduction surgery we remove some of the excess gum tissue around your teeth, and reshape the diseased bone which often has craters in it due to the destruction that has occurred. This helps restore more of the natural contours that existed when your gums and bone were healthy. This reshaping will allow for the gums, which will be moved or positioned down (apically) toward the roots, to lay down in more intimate contact with the bone and form a tight biologic seal around the teeth. In this way, 5-8mm pockets can be reduced back into 3-4mm pockets which are something that you can keep clean at home. Another advantage to this type of surgery is that it allows complete access to the base of the pockets and entire root surface so we can clean the areas that were not able to be reached during your initial scaling and root planing appointments. This surgery is most often done a half mouth or one quadrant at a time and usually under IV sedation and local anesthetic in the office; However, more or less can be accomplished, depending on your individual situation and circumstances.
What are the drawbacks (side effects) associated with Pocket Reduction Surgery?
Every surgical procedure has risks or side effects associated with it and periodontal surgery is no exception. When we reduce the pockets, the tissue will rest lower on the tooth exposing more tooth structure including part of the roots which can lead to increased thermal (hot and cold) sensitivity. This sensitivity usually gets better with time for most patients but this is not always the case. Also, the areas between the teeth (embrasures) will now be more open and allow you to clean better. The caveat is that it can also make it easier for food to get caught in these areas. To aid you in both cleaning the area and removing potentially trapped food, we will give you additional cleaning aids (proxy brush) which are even better than floss, to get into these areas. Patients who keep these areas clean and follow a strict periodontal maintenance recall will have a highly successful outcome while those who do not will once again begin to break down. Remember, this is an investment in yourself to keep your teeth for years to come.