Osseous Surgery

Our bone and gum tissue should fit snugly around our teeth, the same as when we wear a turtleneck sweater around our necks. When periodontal disease is advanced, however, this supporting tissue and bone is destroyed, resulting in loosening of the gum and bone attachment, and the formation of deep pockets. Periodontal disease is the most common cause of tooth loss in adults.

A periodontal pocket reduction procedure may sometimes be recommended if your pockets are too deep to clean with daily home oral hygiene and a professional hygiene maintenance care (Figure 1). During this procedure the gum tissue is folded back, and deeply trapped plaque and calculus containing disease-causing bacteria are removed (Figure 2). The irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone (Figure 3). The gum tissue is then secured into place (Figure 4).

Osseous surgery may be indicated for those affected by severe periodontal disease. The specific goals of this treatment are:

1. To reduce of eliminate the pockets that cause periodontal disease
2. To reduce bacterial spread – bacteria from the mouth have the potential to spread throughout the body and cause other life-threatening conditions such as cardiovascular disease and lung cancer. (See The Mouth-Body Relationship)
3. To prevent bone loss – the recontouring of damaged bone helps to prevent the bone loss around teeth from progressing
4. To facilitate home care – as the pocket deepens, it becomes nearly impossible to effectively clean with brushing and flossing, and even with professional dental cleanings. Osseous surgery will reduce the pocket, making it easier to maintain, thereby preventing further disease

A pocket reduction procedure takes approximately one hour. It may be done with local anaesthetic alone, or in combination with sedation (see Sedation). Most patients are back at work one day after having had pocket reduction. The majority of healing takes place during the first week, and patients may then resume most of their normal eating and oral hygiene practices (see Post-Operative Instructions). The tissue underneath continues to mature however, and full healing of the gums takes 4-6 weeks. You will be seen for a 1-week and 6-week post-operative check.

Patients who receive osseous surgery to help keep their teeth may notice the following:

Teeth may look and feel longer

There may be more spaces (embrasures) between teeth, underneath the contact area (Figures 5-6)

Teeth may be sensitive for a period of about 1-month. Sensitivity fades over time, and can be managed with desensitizing toothpastes such as Sensodyne© ProNamel© (https://www.pronamel.ca)

Teeth may feel slightly loose (mobile) for a period of about 1-month. This is temporary, as they firm up again during the healing process

Reduced pockets and a combination of daily home oral hygiene as well as professional hygiene maintenance care will help those affected by severe disease to keep their natural teeth.