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Gum disease surgery is necessary to be performed in patients suffering from moderate to advanced gum disease. We deal with the basics of gum surgery, the use of bone grafts, and the possibility of regenerative procedures in this article.

Gum disease is extremely prevalent around the world [1] but it continues to be poorly understood. Gum health, in fact, is the single most important determinant of the teeth’s longevity. A large percentage of the teeth lost in old age can be attributed to slow progressing gum disease.

Most people find out that they have gum disease when they walk into a dentist’s office seeking bleeding gums treatment. If by that time gum disease has progressed sufficiently enough then they will need to learn about gum surgery very quickly as well.

Gum disease surgery

Gum surgery is performed to gain access to the infected root surface of the tooth, eliminate pockets around the gingival which harbor harmful bacteria, and to place bone grafts in an attempt to regenerate bone [2].

The kind of gum surgery that is performed for these purposes is called as flap surgery.

How is flap surgery performed?

Flap surgery is performed under local anesthesia in a regular dental setup. A periodontist (a dentist who has specialized in gum treatment) will most likely be the person to perform this surgery. The extent of the surgery depends on the number of teeth which are infected [3].

The doctor will ask you to get an X-ray of the entire mouth done and supplement it with some x-rays taken in the dental clinic itself. These X-rays, along with probing for pocket depths around each tooth, are the only ways to determine which teeth need gum surgery and which do not [4].

Gum surgery can be performed with the help of a regular scalpel or with the help of lasers. Studies suggest that there is no difference in the outcome irrespective of the method used [5].

What exactly is gum surgery trying to achieve?

The whole idea of performing gum surgery is to leave patients with an easy to maintain dentition. Gum disease over the period of years leads to the development of pockets, bone loss, and maybe even tooth loss. During gum surgery, all such areas which cannot be kept clean by the patients themselves will be eliminated [6].

If the patients are regular with their maintenance treatment appointments and continue to follow good oral hygiene practices at home then they should be able to extend the lifespan of their teeth by years [7].

In an age where hasty extraction and replacement of teeth has become the norm, gum surgery is a procedure aimed at preserving the natural dentition for as long as possible.

Where are bone and soft tissue grafts used?

If during the pre-operative clinical examination or during the evaluation of the x-rays, areas appear where there is an opportunity for bone regeneration to be carried out then bone grafts will be used during the surgical procedure.

The bone grafts can be of different kinds depending upon the need of the surgeon [8]. They may be harvested from a different part of the jaw bone, be clinically formulated in a lab, or be derived from different animal sources. The last is the more commonly used option since it does not involve a second surgical site and also has a better success rate than the completely artificially formulated bone grafts.

The soft tissue grafts are used in areas where gum disease has caused the gums to recede [9]. If this happens in the front teeth, it may end up causing an esthetic problem that is difficult to take care of.

One of the reasons how recession of the gums can be treated is by using a soft tissue graft from another area in the mouth to try and cover up the teeth. Unlike bone grafts, the options for external soft tissue grafts are extremely slim and only applicable in a very narrow set of cases.

Can bone around the teeth grow back with gum surgery?

Regeneration of bone and other surrounding structures of the teeth is the ultimate goal of dentistry. It is, however, far from our reach right now and we can only aim for regeneration in some specific cases [10]. If the pattern of bone loss around the tooth is favorable then some additional bone graft can be placed to try and improve the stability of the tooth.

Artificial membranes may also be used in the procedure to try and give the bone cells the best chance to repopulate the area. Regeneration of tissues around the teeth and even of the complete tooth itself is an area of research which is being investigated fervently by researchers around the world.

For current patients, prevention of the loss of structures is a much better strategy to follow than to hope for regenerative procedures later on.

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