The goal of periodontal therapy is to stop the progression of gum and bone loss and get your mouth to a healthy state. The initial stage of treatment is typically scaling and root planing to remove bacteria and calculus from below the gum line. While this is an important step in the road to periodontal health, several studies have shown that it is virtually impossible to remove all the plaque and bacteria from pockets that are 5 mm and deeper. When deep pockets between teeth persist following this initial therapy, it is difficult for dental professionals and patients alike to keep these pockets bacteria and calculus free. Due to this, surgery is often necessary to restore periodontal health. Depending on the topography of the bone defects, either a resective therapy (osseous surgery) or regenerative therapy (guided tissue regeneration) will be recommended by the periodontist.
Resective Therapy (Osseous Surgery)
Resective therapy, termed osseous surgery, is often recommended when pockets are too deep to clean with daily home care and a professional care routine. Typically this is the case when pockets following scaling and root planning are still 5 mm in depth or greater. During this procedure, after administering anesthetic, the periodontist pushes back the gum tissue and removes disease causing bacteria and calculus. In most cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease causing bacteria can hide. This reshaping of the bone allows for the gum tissue to reattach to the tooth after healing at a lower level down the root surface, reducing the pocket depth and improving the health of the affected teeth. The gums are then placed back over the newly shaped bone and sutured in place. Typically no antibiotics are prescribed for this treatment and over-the-counter pain medication is sufficient for any post-operative discomfort.
Case Study 1
This 91 year-old gentleman presented on referral from his general dentist for “deep pocket depths that didn’t shrink after scaling and root planing.” Although osseous surgery was completed in all four quadrants of his mouth, we will focus on the upper right quadrant.
Photos and measurements taken at initial appointment with Dr Weiner
Osseous surgery was completed to reduce the 5-7 mm pockets and smooth out the defects, or holes, in the bone caused by periodontitis. The photos below were taken 2.5 months following osseous surgery. Notice the improved health of the gum tissue.
Photos taken one year post surgery (at periodontal maintenance appointment)
These photos, radiographs (“x-rays”), and periodontal charting were taken two years after surgery (at the patient’s periodontal maintenance appointment). Note that all pocket depths have remained less than 5 mm and the vastly improved gum health two years after osseous surgery.