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In a healthy mouth, the bony tooth
sockets cup and support the teeth. Patients with periodontitis
develop defects (holes) in the bone around their teeth.
This is associated with the formation of periodontal
pockets and loosening of the teeth. Osseous defects can
be treated by either reshaping the existing bone
(osseous surgery) or regenerating the lost bone
(regenerative surgery). The decision to use one
procedure or the other is based on the distribution of
the bony defects. Osseous surgery is commonly used to
treat bone loss around multiple teeth while regenerative
surgery is done when the defect(s) is localized to a
single tooth.
What It
Involves
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Bone
Grafts (Regenerative Surgery)
The goal of regenerative surgery is to coax the body into rebuilding the structures that attach a tooth to the jaw, including bone. As with osseous surgery, regenerative surgery involves preparation of surgical flaps and thorough cleaning of the roots. However, rather than taking bone away, the holes in the bone are filled in with a graft material and covered with a physical barrier. Bone grafting materials commonly used include bits of a patient's own bone, cadaver bone, cow bone and synthetic glasses. The patient's own bone is preferable. The barriers, used to prevent soft tissue from growing into the bony defect, are made from human skin, cow skin or synthetic materials such as GoreTex TM . The gums are then repositioned over the treated site and secured in place with sutures. Over the course of the next six to nine months, your body fills in the periodontal defect with new hard and soft tissue, effectively reattaching the tooth to your jaw. Discomfort Factor These procedures are done with a local anesthetic. Pain medications may be prescribed to ease discomfort after surgery. Aftercare It is very important for you to keep your mouth as clean as possible while the surgical site is healing. This means you should brush and floss the rest of your mouth normally. If the surgical site is not covered by a periodontal pack, you can use a toothbrush to gently remove plaque from the teeth. Antimicrobial mouth rinses containing chlorhexidine are commonly prescribed following periodontal surgery. Although these rinses do not remove plaque from the teeth, they kill bacteria and help your mouth heal. You may also have some swelling after surgery. This can be minimized by applying an ice pack to the outside of your face in the treated area. In some situations, antibiotics may be prescribed to prevent a post-surgical infection and these should be taken as instructed. Your periodontist will want to reexamine the area in seven to 10 days. Side Effects Of Treatment Initially, there may be some bleeding, swelling and risk of infection. Long term, there is likely to be gum recession, sensitivity to hot and cold, and an increased risk of root cavities. |
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What It Involves Discomfort Factor Aftercare Side Effects Of Treatment
Gums can recede for a number of reasons, including periodontal disease, physical trauma (brushing too hard, too often or with a hard brush), tooth position and aging. If gum recession is severe, the root of the tooth will be exposed. This can make the tooth sensitive to hot or cold temperatures and more prone to root decay. In addition, this condition may be aesthetically displeasing. Soft-tissue grafts are used to cover the exposed root area to prevent further recession, stop the sensitivity and improve the appearance of the tooth. Some people's gums are naturally very thin, which increases the likelihood that recession will occur. In these cases, a soft-tissue graft may be done to prevent problems in the future. There are three different types of soft-tissue grafts: free gingival grafts, connective-tissue grafts and pedicle grafts. In a free gingival graft, a small strip of flesh is removed from the roof of the mouth. The "graft" is then sutured to the existing gum tissue in the area being treated. This is often used for people who naturally have minimal amounts of gum tissue around their teeth and need to have them enlarged. In a connective-tissue graft, a flap is cut in the roof of the mouth, forming a "trap door." The underlying tissue is removed leaving the outermost epithelial layer of skin still attached. Sutures are used to stitch the outer layer back in place. The tissue that was removed, known as subepithelial connective tissue, is then slipped under the gum tissue surrounding an exposed root surface and anchored in place with sutures. Currently, this is the most commonly used procedure for treating root exposure. In a pedicle graft, a flap of tissue from around an adjacent tooth is partially cut away with one edge still attached. The flap, also called a pedicle, is then slid sideways to cover the exposed root and stitched in place. A pedicle graft can be more successful than a free gingival graft because at least some of the blood vessels that feed the grafted section remain in place. However, a pedicle graft can only be done if an adjacent tooth has enough gum tissue to "share" with the tooth being treated. Regardless of the type of procedure, many periodontists will use periodontal packing to cover and protect the grafted tissue for the first week or two of healing. |
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| Discomfort Factor With free grafts and connective-tissue grafts, you will have two wounds, near the tooth and on the roof of your mouth, where the graft tissue was removed. The wound on the palate is often described as feeling like a significant pizza burn. Prescription pain medication can help control discomfort after surgery. | ||||||||
| Aftercare Keeping the mouth clean is important, so unaffected teeth will have to be brushed and flossed as usual. Chlorhexidine-containing mouth rinses usually are prescribed to assist in plaque control during the healing period. Antibiotics may be prescribed, but usually are not. | ||||||||
| Side Effects Of TreatmentTypically, there are no long-term side effects following soft tissue grafting. In some cases, the new gum tissue may need some reshaping via gingivoplasty to achieve an ideal aesthetic result. | ||||||||
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Gingivectomy refers to the surgical removal of gum tissue (gingiva). Gingivoplasty involves the surgical reshaping of gum tissue around teeth with healthy gums. Neither of these procedures involves removal of bone. They typically are performed by periodontists, dentists who specialize in treating gums and the other supporting structures of your teeth. The gingivectomy procedure originally was developed to treat periodontal disease. Today, gingivectomies are used less as a treatment for gum disease and more commonly as a cosmetic technique. Gum tissue may need to be removed for two reasons:
Gingivoplasty can help give the gums a more natural appearance. This procedure can be used to correct malformed or asymmetrical gums caused by genetics, disease or trauma, and might be done solely for cosmetic purposes. Gingivoplasty often is done alone, but can be done during or after a gingivectomy, which removes excess gum tissue, or a gum graft, which adds tissue to the gum line. Preparation--Prior to either procedure, your periodontist will talk to you about oral hygiene after the procedure and any other instructions you will need to follow. Before a gingivectomy or gingivoplasty, you should receive a thorough cleaning and, possibly, root planing, to remove tartar (calculus) from existing pockets. Gingivectomies and gingivoplasties usually are done with a scalpel, but also are done with electrosurgery units, lasers and/or diamond dental burs. Your periodontist also might use specialized instruments that were designed for gingivectomies, with angled blades to help them get around teeth. Before either procedure, you will receive a local anesthetic by injection to numb your gums. A gingivectomy can take a few minutes to several hours, depending on how much tissue is being removed. Gingivoplasties typically are done in a couple of minutes. After a gingivectomy or gingivoplasty, a periodontal dressing (a type of bandage) will be placed on your gums. This usually is left in place for a week to 10 days, during which you will need to follow a somewhat soft diet and avoid spicy and crunchy foods. Your dentist might give you prescriptions for pain medication and a chlorhexidine mouthwash. It is very important to keep your mouth clean during the healing period. Do not brush your teeth in the surgical area while the pack is in place. Brush and floss the rest of your mouth normally. When the pack comes off, you can brush and floss your teeth normally, but gently. It is not uncommon for the healing tissues to bleed when you floss or brush immediately after the dressing is removed. After seven to 10 days, you will return to your periodontist to have the pack removed. Your gums will begin to look normal in three to four weeks, but it can take two to three months for the tissue to heal completely. Risks There are no major risks to either procedure. Infection is very rare. Bleeding is a possibility, but also is rare. The affected area might ooze blood for the first 24 to 48 hours, but after that, it should not bleed much, if at all.
When To Call A
Professional
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