When routine scaling and root planing does not help to restore periodontal health periodontal surgery may be advised. Most common surgical procedures are:
Pocket Reduction Procedures
When with routine scaling and root planning deep periodontal pockets cannot be cleaned we may recommend pocket reduction procedures. During this procedure, the gum tissue is folded back and the disease-causing plaque and tartar is removed. In some cases, irregular surfaces of the damaged bone are smoothened. This allows the gum tissue to better reattach to healthy bone. The gum tissue is then secured at its new position with sutures.
Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult to clean, so it's important to reduce them. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth – and decrease the chance of serious health problems associated with periodontal disease.
Bone Graft and Guided tissue Regeneration
If there is a defect in the bone, often times a bone graft can be placed to stimulate new bone formation. A combination of natural or synthetic bone can be used for regeneration. Sometimes specialised membranes may be used during this procedure to prevent the gum tissue from creeping in between the tooth and the bone. This helps allow a regeneration of new bone and periodontal ligament.
This procedure involves the removal of gum tissue (gingiva), bone or both to expose more of a tooth's structure.
What it's Used for
Crown lengthening is done when a tooth needs to be restored, but not enough tooth is present to support a crown or a filling.
This can happen when a tooth breaks off at the gum line, or a crown or filling falls out of a tooth that has extensive decay underneath. If the tooth requires a crown or a large filling, we need to expose more of the tooth by removing some soft tissue and/or bone.
In some cases, a condition called gummy smile —in which an unusually large amount of gum tissue shows around the upper teeth —can be treated using crown lengthening.
This procedure is usually done under local anesthesia. Incisions are made to reflect the gum away from the teeth. This provides access to the roots of the teeth and the bone that surrounds them. In some cases, by simply removing a little gum tissue when the incisions are made, enough tooth structure will be exposed for a crown of filling to be placed. However, in most situations it will also be necessary to remove some bone from around the roots of the teeth. The bone is removed using a combination of hand instruments (resembling chisels) and rotary instruments (similar to the drill and burs used to treat cavities).
Then the gum tissue is secured with sutures.
Soft tissue Grafts
Soft tissue grafts are used for treating gum recession, and/or to improve the esthetics of your gum line.
Gum Recession could be due to a variety of reasons including aggressive tooth brushing, periodontal disease or clenching of teeth.
Exposed tooth roots are the result of gum recession. Since the roots are exposed your teeth will be sensitive to cold liquids and foods. Soft tissue grafts can easily eliminate this problem.
Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. During this procedure, gum tissue is taken from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth. A soft tissue graft can reduce further recession and bone loss. It also protects the root from decay and reduces sensitivity.