If the management of periodontitis is failing with the conventional treatment methods, deep scaling and polishing and use of antibiotics, a dentist may elect to perform minor oral surgery instead. Only qualified dentists and periodontal specialists are allowed to carry this surgical procedure. This surgery is usually carried out under local anaesthetic and normally takes place if;
- True pockets are too deep to effectively remove calculus with deep sub-gingival scaling
- If the furcation of teeth (the area between roots on a multi-rooted tooth) is involved
- If bone loss has occurred in such a way that remaining bone is unusually shaped or is particularly uneven
The aim of this treatment is to effectively remove all calculus from areas that are inaccessible through conventional treatment, and to try to illuminate particularly complex areas e.g. uneven alveolar bone, where calculus can accumulate but not be removed.
Standard procedure for periodontal surgery
- Local anaesthetic is administered
- The patient rinses their mouth out with a chlorhexidine based mouthwash for 30 seconds to 1 minute
- A flap of gum (gingival flap) is incised with a scalpel and blade
- The flap is prised away from the bone using a periosteal elevator and the calculus, tooth roots and bone are exposed
- A retractor is used to hold the gingival flap aside, e.g. tissue retractor
- Any uneven or complex shaped bone is removed using a combination of a surgical handpiece and surgical burs and various hand instruments such as a bone file, this leaves a smooth even bone surface behind
- Sub-gingival calculus and plaque are removed using scalers (either ultrasonic scalers or hand scalers or both)
- Any granulation tissue that is present is also removed using for example a Volkmann’s spoon
- Antibiotic can be applied locally e.g. Periochip
- The gingival flap is replaced and sutured back into place
The patient will often be prescribed painkillers and sometimes antibiotics following minor oral surgery, they will also be given oral hygiene instructions to follow until they return in 7 – 10 days to have the sutures removed and their condition reviewed.
If the surgery is successful periodontitis will be easier to manage for both patient and dental care professional, they will however, continue to need regular scaling and polishing and maintain good oral hygiene at home.
