There are situations where non-surgical treatment may not resolve more advanced levels of periodontitis including: advanced bone loss, deep vertical bone defects, complex root anatomy and root furcations (where the roots divide in back teeth) and where the gum tissue is of a thick and fibrous nature. Periodontal surgery can facilitate access to remove plaque and calculus (tartar) that is located deep under the gum and also provides the opportunity to reshape the gum in order to minimise or eliminate pocketing. Periodontal surgery is usually delayed until after non-surgical treatment has been provided and can be directed at those sites where it may be beneficial.
Where bone loss associated with periodontal disease is vertical in nature, creating gutters of bone loss, there may be an opportunity to regenerate both the lost bone and periodontal attachment. Regenerative techniques most often employ surgical placement of membranes or bone graft materials, or use enamel matrix proteins in the form of Emdogain gel. Although, regenerative techniques require careful site selection, the results can be dramatic.
Advanced periodontal surgical procedures
As well as the management of chronic and aggressive periodontitis, we can also help in a variety of pre-prosthetic, aesthetic, mucogingival and periodontal plastic surgery procedures.
Mucogingival and periodontal plastic surgery
Periodontal plastic surgery refers to a number of procedures that are aimed at restoring or adjusting the nature and position of the gingival (gum) tissue such as in the treatment of gingival recession. The simplest form of treatment is the free gingival graft, where a section of mucosa(the skin covering the palate) from the roof of the mouth is removed and used as a gum graft to an area that is deficient. The free gingival graft is often used to treat the recession that can occur next to the lower central incisors (lower ffront teeth).
Another technique grafts a section of connective tissue (deeper tissue) from the palate to a tunnel created in the soft tissue adjacent to the recession.
Connective tissue grafts are particularly effective when aesthetics are the key concern and are often combined with a procedure that moves adjacent healthy gum over the recession.
Advances in the application of microsurgical techniques to all these procedures have led to improved success, less post-operative discomfort and reduced healing times.