Penam Periodontics - Evidence based Personalized Periodontics

Periodontal Surgery

Periodontal access surgery.

Periodontal surgery is a valid treatment in areas where the periodontist cannot gain access to the root surfaces of the teeth to remove the bacterial plaque and deposits. There may be defects in the tooth surface; the roots of the molar teeth may be close together; or the periodontal destruction has wrapped around the root of the tooth preventing complete access to the periodontal pocket site for cleaning. These events occur more frequently around molar teeth than other teeth. It is our practice aim to be as thorough as possible to reduce the frequency of the need to perform these procedures. One major drawback of surgery is that the actual surgical process results in loss of attachment of the tooth to the bone as it destroys a small amount of the tissue. There is no significant evidence of better outcomes with surgery compared with normal periodontal debridement for any degree of periodontal attachment loss. 

Osseous Surgery

Osseous surgery refers predominately to surgery aimed at altering the contours and deformities of the tissues to facilitate better plaque control and better home care. Whilst this procedure was popularized in the USA immediately following initial periodontal debridement, the scientific evidence suggests that a period of natural healing and remodelling should be allowed to occur prior to considering this treatment procedure. The remodelling period varies between 6 months for moderate disease cases up to 12 months for severe disease cases. We would perform this treatment where there is a persistent problem which prevents the patient from adequately cleaning the teeth.

Pocket Reduction Surgery

Pocket reduction surgery was also popularized in the USA and was based upon the concept that reducing the pocket depth resulted in reduced pocket bacterial counts. However the procedure does not alter the bacterial flora to any significant degree compared with the more conservative treatments. Evaluation of disease activity shows that progression is not restricted to deep pockets but can occur in pockets of any depth. If a pocket site continues to show evidence of bleeding this indicates the continued growth of bacteria within the pocket. In this case periodontal access surgery may be used. The pocket reduction surgery concept is no longer considered a valid procedure.

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