Dental surgery

Dental surgery is any of a number of medical procedures that involve artificially modifying dentition.

Pocket Reduction Surgery

Pocket reduction surgery (also known as gingivectomy, osseous surgery and flap surgery) is a collective term for a series of several different surgeries aimed at gaining access to the roots of the teeth in order to remove bacteria and tartar (calculus).

The human mouth contains dozens of different bacteria at any given time. The bacteria found in plaque (the sticky substance on teeth) produce acids that lead to demineralization of the tooth surface, and ultimately contribute to periodontal disease.

Periodontal infections cause a chronic inflammatory response in the body that literally destroys bone and gum tissues once they invade the subgingival area (below the gum line). Gum pockets form and deepen between the gums and teeth as the tissue continues to be destroyed.

Periodontal disease is a progressive condition which, if left untreated, causes massive bacteria colonization in gum pockets and can eventually cause teeth to fall out. Pocket reduction surgery is an attempt to alleviate this destructive cycle, and reduce the depth of the bacteria-harboring pockets.

Reasons for the pocket reduction surgery

Pocket reduction surgery is a common periodontal procedure which has been proven effective at eliminating bacteria, reducing inflammation and saving teeth. The goals of pocket reduction surgery are:


  • Reducing bacterial spread - Oral bacteria has been connected to many other serious conditions such as diabetes, heart disease and stroke. Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize. It is important to decrease bacteria in the mouth in order to reduce the risk of secondary infection.
  • Halting bone loss - The chronic inflammatory response induced by oral bacteria leads the body to destroy bone tissue. As the jawbone becomes affected by periodontal disease, the teeth lose their rigid anchor. When the teeth become too loose, they may require extraction.
  • Facilitate home care - As the gum pockets become progressively deeper, they become incredibly difficult for the patient to clean. The toothbrush and dental floss cannot reach the bottom of the pockets, increasing the risk of further periodontal infections.
  • Enhancing the smile - An oral cavity that is affected by periodontal disease is not attractive to the eye. In fact, smiles may be marred by brown gums, rotting teeth and ridge indentations. Pocket reduction surgery halts the progression of gum disease and improves the aesthetics of the smile.
What does pocket reduction surgery involve?

Before recommending treatment or performing any procedure, the dentist will perform thorough visual and X-ray examinations in order to assess the condition of the teeth, gums, and underlying bone. Pocket reduction surgery can be performed under local or general anesthetic depending on patient preferences.

The gums will be gently pulled back from the teeth and bacteria and calculus (tartar) will be eliminated. Scaling and root planing will generally be required to fully remove the ossification (tartar) from the surface of the tooth root. If the root is not completely smooth, a planing procedure will be performed to ensure that when the gums do heal, they will not reattach to rough or uneven surfaces.

The final part of the surgery is usually the administration of an antimicrobial liquid to eliminate any remaining bacteria and promote healing. The gum is then sutured with tiny stitches that are left in place for 5-10 days.

Though the gums will be more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums.

If you have any questions about pocket reduction surgery or treatment for periodontal disease, please contact our practice.

Ridge Modification

Ridge modification is an effective procedure for treating deformities in the upper and lower jaws. These deformities can occur as a result of periodontal disease, trauma, injury, wearing dentures, or developmental problems. Such defects can leave insufficient bone for the placement of dental implants and an additional unattractive indentation in the jaw line adjacent to the missing teeth.

During the ridge modification procedure, the gum is lifted away from the ridge to fully expose the defect in the bone. The bony defect can be filled with bone graft material that can help regenerate lost bone or a bone substitute. Finally, the incision is closed and several months of healing will be required. Depending on the case and type of implant and procedure, the dental implant might be placed during the ridge modification procedure or when healing is complete; this all depends on the condition of the bone. Ridge modification improves the cosmetic appearance, functionality of the mouth, and the chance of enjoying dental implants for many years.

Apicoectomy

The teeth are held  firmly in place  by srtong roots that extend into the jawbone,  Molars and premolars tend to have several roots, whereas the front incisors only have a single roots.  The end or tip of each root is temed the apex.  The apex is where the nerves and blood vessels enter the tooth ans aids in the delivery of blood to the crown (the part of the tooth you can see in your mouth).

A root canal treatment refers to the cleaning of the canals and the removal of infected and inflames tissue within the root.  When the inflammation or infection persists after the root canal treatment, an apicoetomy may be required.  An apicoectomy is essentially the removal of the apex (or root tip) followed by a filling procedure to seal the root from further infection.  When left untreated, roots can damage other teeth, spread infection, and cause regression of th jawbone.

Reasons for an apicoetomy

Infected and inflamed soft tissue around the root of a tooth can be exceptionally painful and debilitating.  The purpose of an apicoectomy  is to eliminate the infection in the tissue and to ultimately preserve  the function of the tooth and save it from extraction.  An apicoectomy will rarely be considered by the surgeon unless a prior root canal treatment has failed.

They are several reasons why an apicoectomy may be necessary:

  • Small adjoining root branches -  Roots are extremely complex and can contain many tiny branches cannot be cleaned and sealed when the root canal treatment is performed, inflammation can persist.
  • Blocked root canal - In some cases, the surgeon is unable to effectively clean a root canal because it is blocked by a fractured file left behind from prior root canal treatment.  Infection and débris can quickly affect adjacent teeth.