Daily brushing and flossing, along with regular visits to the dentist, will help keep your teeth healthy and strong. But good oral hygiene isn’t just for your teeth-it also keeps your gums healthy. Regular oral exams give your dentist the chance to detect gum disease in its early stages and treat it before it progresses.
When you skip your dental visits for too long, untreated gum disease can leave you with infected and damaged gums that require surgery. If you have been advised by your dentist in Amirad Family Dentistry to have gum surgery, here is what you need to know.
Gingivitis, a mild form of gum disease, can usually be treated by a dentist. Periodontal disease begins with bacteria present in the mouth attaching to the teeth. The bacteria collect and multiply, forming a biofilm called dental plaque.
If this plaque is left on the teeth, the adjacent gingival tissues can become inflamed, resulting in the development of gingivitis, an early form of gum disease.
Daily flossing and twice-daily brushing with a tooth paste that fights bacteria can help prevent gingivitis. Plaque and food debris are removed by oral hygiene practices and thus clean the surface of the teeth and eliminate bacterial plaque at the gum line of the teeth. [It needs to be clear from this section that gingivitis is an early form of gum disease that can lead to periodontitis, a serious form gum disease, if left untreated]
However, if plaque and food debris are not removed and oral hygiene practices are not maintained, then gingivitis will get worse and the gum tissue can become more inflamed, bleeding can occur, the area between the tooth and gum tissue can become deepened to form a periodontal pocket and periodontal disease can develop.
A periodontal pocket develops as the plaque bacteria from the biofilm continues to accumulate and moves below the gum line. At this point, home care is not very effective in removing the dental plaque. If it is left untreated by the dentist or dental hygienist, the biofilm will continue to spread below the gum line and infect the inside of the pocket. The bacteria in the plaque produce by products that cause the adjacent soft and hard tissue to degrade, forming a deeper pocket in the process. This type of advanced periodontal disease can affect the roots of the teeth and they can become infected, too. The teeth may become loose or uncomfortable and the patient will require Gum Surgery.
The patient would be required to have initial therapy to treat diseased periodontal pockets through scaling and root planning. The dental hygienist would utilize an ultrasonic scaling device to remove plaque, Tartar and food debris below the gum line and would hand scale the tooth and root surface to make it smooth and disease free.
Scaling and root planning can be completed in two or four sessions depending on how much oral disease the patient may have. Thorough oral hygiene procedures would be reviewed with the patient to improve oral care cleaning techniques at home.
After improving gum health, the next step is periodontal surgery.
Periodontal surgery can regrow damaged bones and tissues, prevent tooth loss, reduce gum gaps between the teeth, and reshape the jawbone to eliminate bacterial growth.
However, gum disease is not the only reason for gum surgery. Some patients opt for cosmetic gum surgery. Such as when their gums cover too much of their teeth, a condition known as a “gummy smile”.
The type of gum surgery you need depends on the severity of your gum disease and the specific damage it has done, or the type of cosmetic results you desire.
Types of gum surgery include:
-Periodontal plastic surgery procedure
-Pocket reduction procedures (flap surgery)
-Dental crown lengthening
-Soft tissue grafts
-Guided tissue regeneration (GTR)
At Amirad Family Dentistry, all of the above operations are performed in full, with more information each being described in detail.
Gingivectomy is a Time-honored procedure for removal of gingiva. The indications range from access to esthetics. The Gingivectomy can be used when supra bony pockets are present and access to osseous structures is not necessarily important. The procedure assists in decreasing gingival tissue in cases of enlargement and in altering fibrotic gingiva.
Figure A – Excision versus incision. The excisional gingivectomy incision is created on an external bevel (small arrow). If the bevel cannot be created owing to difficulties with access, the incision can be blended into the apical gingiva using the laser tip. The internal incision (large arrow) also can be created for purposes of the flap procedure.
Gingivectomy is the oldest surgical approach in periodontal therapy and is usually done for improvement of aesthetics or prognosis of teeth.
By removing the pocket wall, gingivectomy provides visibility and accessibility for complete calculus removal and thorough smoothing of the roots, creating a favourable environment for gingival healing and restoration of a physiologic gingival contour.
The procedure may also be carried out so that access to sub-gingival caries or crown margins is allowed. A common aesthetic reason for gingivectomy is a gummy smile due to gingival over growth.
1-Elimination of supra bony fibrous and firm pockets
Gingivectomy is the primary treatment method available in reducing the pocket depths of patients with periodontitis and supra bony pockets. In a retrospective comparison between different treatment approach to periodontitis management based on the initial and final gingival health, conventional gingivectomy was proven to be more successful in reducing pocket depths and inflammation compared to non-surgical treatments in pockets measured 3mm or more.
Removal of supra bony deep pockets will allow better visibility and access for the removal of calculus. As a result, this provides a suitable environment for the healing of the gingiva and the physiological contour of the gingiva to be restored.
2-Elimination of gingival enlargement
In cases of gingival enlargement induced by drugs, surgical treatment through a gingivectomy proved to be effective with most patients showing no clinical sign of recurrence after one year. Even though it is the most frequent method of treatment, it is only indicated when overgrowth is severe.
Another cause of gingival enlargement would be a hereditary
condition known as gingival fibromatosis. The extensive overgrowth of gingival tissue is usually treated with a gingivectomy, as it produces good aesthetic results.
3. Increase clinical crown height
• Sub-gingival margins
A gingivectomy can also be done to increase the clinical crown height of teeth. This is suitable in treatment planning for teeth with inadequate tissue for retention of prosthetic restorations as a result of sub gingival carious lesions or coronal fractures.
• Gummy smiles
Up to 3mm of gingival display when smiling is described to be cosmetically acceptable.
Gummy smiles are often used to describe smiles where there is more than 3mm of gingival tissue seen clinically and is usually deemed unaesthetic to the individual.
Similar to sub gingival crevices margins, gingivectomy to increase the crown height can be performed to provide better aesthetics and normal gingival architecture.
1- Need for bone surgery
2- When bottom of the pocket is apical to the mucogingival junction
3- Aesthetic considerations, particularly in anterior region of maxilla
Dental/ gingival morphologic characteristics and peri-oral variables influence patient’s smile frame. They are essential in achieving a predictable successful rehabilitation of patient’s smile.
In males and females, the mean vertical height of the maxillary central incisors averages 10.6 mm and 4.8 mm respectively.
With the lip line at the rest, the mean maxillary incisors display is 1.91 mm for men and 3.40 mm for women.
• Techniques and post-operative
Gingivectomy can be performed by various techniques:
1. Surgical gingivectomy
It is performed by scalpel. To reduce post-operative pain for the patient, the surgery should be as atraumatic as the surgeon can make it.
If the procedure has been carried out carefully, the patient’s post-operative pain is minimized.
2. Gingivectomy by electro surgery
Electro surgery is defined as the international passage of high-frequency ware forms or currents, through the tissues of the body to achieve a controllable surgical effect. It has been used in dentistry for more than 60 years.
The basic types of electrosurgical techniques are coagulation, desiccation, fulguration and electro section (cutting).
There are two main types of electro surgical units, mono polar and bi polar.
The results of studies which have looked at healing of electrosurgical wounds compared to scalpel wounds vary widely but it has been found that electro surgical equipment minimizes bleeding and most patients experience very little post-operative pain after the procedure. There may be more inflammatory response than the scalpel technique.
3. Laser gingivectomy
The laser types include:
• Nd: YAG
• Diode laser
It has been suggested that lasers can give a substantial reduction in bacteria such as Actinobacillus actinomycetemcomitans (Aa) which will reduce inflammation and facilitate the healing process.
It has been suggested that laser treatment result in minimal or no post-operative swelling, bleeding, scar tissue formation or pain. A part from ablating and coagulating the laser also sterilizes the tissues and eliminates the need for a post-surgical dressing.
Recurrence was minimal or eliminated when comparing laser gingivectomy to scalpel gingivectomy.