Osseous Surgery

Purpose

There exist absolute limits beyond which the ability to instrument (scaling, root planning and soft tissue curettage) the root surfaces of teeth below the gum line to completely remove all tartar (calculus) and disease causing bacteria is suspect, if not impossible. The rationale for periodontal surgery is to first definitively clean and thereafter, reduce the periodontal pockets. Dental plaque, the primary cause of periodontal disease if not thoroughly removed, continuously secretes bacterial toxins (poisons) into the pockets that infect the gums and destroy the bone that supports your teeth. As the gums and supporting bone are lost, pockets deepen. Periodontal infection (periodontitis) is the most common cause of tooth looseness (mobility) and loss in adults. Deep pockets cannot be predictably cleaned either personally or professionally. If periodontal infection is allowed to continue unabated, teeth that could and otherwise should be saved can eventually be lost.

Goals of Periodontal Osseous Surgery

Periodontal Osseous Surgery sometimes referred to as Pocket Reduction Surgery describes a surgical approach to first gain the access necessary to the infected tooth roots and jaw to enable the complete removal of all the tartar (calculus) and disease- causing bacteria located well below the gum line. Bacteria and your body’s inflammatory response to infection result in the destruction of your jawbone and overtime, cause craters to form in the bone. To return your gums to health and facilitate future Periodontal Supportive Maintenance, osseous surgery is directed towards reducing the craters in the jaw bone where disease causing bacteria reside. These craters would be smoothed down to promote healing and the reestablishment of a healthy and long term maintainable environment. Finally, the gums are precisely repositioned in close proximity to the jaw bone to reduce the pockets and in so doing, the ecological niche where disease causing bacteria would otherwise collect in future. Despite the word surgery, the procedure is reported to feel more like a thorough cleaning. The specific goals of periodontal osseous surgery include:

  • Reducing Systemic Bacterial Spread and Your Body’s Inflammatory Response:
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    Oral (mouth) bacteria can spread throughout the body and in so doing increase the risk of many potentially life-threatening conditions including heart and respiratory diseases. By removing calculus and disease causing oral bacteria, the risk of bacterial spread and the development of a systemic (body wide) inflammation are reduced.

  • Preventing Jaw Bone Loss:
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    The immune system’s inflammatory response activated by periodontal pathogenic (disease causing) bacteria causes a permanent and progressive loss of jaw (alveolar) bone support. If this condition is left untreated, teeth can eventually fall out. Periodontal osseous surgery seeks to stop periodontal disease before it progresses to this level.

  • Enhancing Your Smile:
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    Mouths plagued by periodontal disease are unsightly. Swollen bleeding gums and indentations in your jaw bone topography can contribute to a person feeling depressed and self-conscious about their smile. Fortunately, periodontal osseous surgery can help. By reducing oral bacteria and resultant infection, your mouth can often be restored to its former radiance thereby re-establishing your body image and confidence in your smile.

  • Facilitating Professional and Personal Oral Care:
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    As the gum (periodontal) pockets deepen, it becomes increasingly challenging to professionally clean (scaling and root planning) below the entire gum and along the tooth roots surfaces coated with bacterial plaque. Periodontal osseous surgery reduces pocket depth making the removal of plaque and tartar (calculus) from below the gum line predictable. Surgery has been shown to prevent the recurrence of periodontal disease.

What does the procedure entail?

The goal of all periodontal surgical procedures first and foremost is to gain the access necessary to those areas of infection that would otherwise remain unreachable (deep pockets and infection). A surgical approach provides the access and visibility needed to definitively remove infection located along the root surfaces of your teeth and surrounding jaw bone. What distinguishes osseous surgery from merely a definitive clean out (open curettage) procedure is the reshaping of areas of infection within the jaw bone (craters). This serves to eliminate sites where disease (pathogenic) causing bacteria can reside while recreating normal healthy bone architecture. Once this has been achieved, the gums are repositioned to reduce deep pockets and reestablish a maintainable environment conducive to long term heath. Dependent upon the specifics of your case and the degree of infection, periodontal osseous resective surgery represents the most predictable means to manage moderate to advanced periodontal disease and re-establish a lasting state of periodontal health.

A local anesthetic will be used to numb the area prior to surgery. Your health,safety and comfort remain paramount. Our Sedation Tab discusses various sedative options to improve your experience by reducing anxiety and establishing a state of calm.

Dr. Novack will begin by making an incision around each tooth to release the infected gum tissue from the bone. This creates the access and visibility necessary to definitively clean the root surfaces and remove all areas of infection (plaque and calculus). Removing the bacteria and the toxins they produce will minimize future bone loss from developing around the roots of your teeth. Irregular shaped craters represent areas where jaw bone loss has occurred. These craters will be smoothed down to limit these ecological niches where disease causing bacteria can reside thereby promoting healing and the re-establishment of health. Technology exists in appropriate instances to reconstruct the lost bone and the supporting structures that secure teeth to bone. This is defined as Guided Tissue Regeneration. Please refer to the Guided Tissue-Bone Regeneration Tab that explains how in the right instance, the hands of time can be turned back and teeth that would otherwise have been lost are saved. Finally, the gums will be repositioned in close proximity to surgically established healthy bone architecture. The goal is to keep your mouth healthy and free of disease for years to come.

Dependent upon your specific anatomy, the surgical site may be covered with a bandage (periodontal pack-dressing) to help hold – maintain the gum close to the bone to optimize your treatment results.

Our commitment to your comfort extends beyond your surgical appointment. You will be provided with an ice pack prior to leaving the office that will help control normal postoperative swelling following your surgery. Appropriate pain medication will be prescribed to ensure your comfort is maintained during the post operative healing course. An antiseptic mouth rise (Peridex®) is routinely prescribed to be used both prior and subsequent to your surgery to reduce bacterial levels and the potential for post operative infection. Slight bleeding, swelling and bruising are entirely normal after any surgery. Should any concerns arise, Dr. Novack is always reachable to assist. Contact information is listed on our answering service.

Dr. Novack’s philosophy is that each patient’s surgical treatment is considered complete only when the very best possible treatment result has been achieved. All your post operative care is included in Dr. Novack’s surgical fee. Your post operative care will continue as required to accomplish the objective’s you and Dr. Novack set when planning out your case. At these visits, attention to your twice daily personal home care will be evaluated. Dr. Novack ascribes to a collaborative approach to patient care. Meticulous oral hygiene represents a critical element in avoiding post-operative infection and optimizing your healing response.