Pocket Reduction
Pocket reduction surgery (also known as osseous surgery) is a collective term for several different surgeries aimed at gaining access to the roots of the teeth in order to remove bacteria and tartar (calculus).
The bacteria found in plaque (the sticky substance on teeth) produces acids that lead to demineralization of the tooth surface and ultimately contributes to periodontal disease.
Periodontal infections cause a chronic inflammatory response in the body that destroys bone and gum tissues once they invade the subgingival area (below the gum line). Deep pockets form between the gums and teeth as the tissue continues to be destroyed.
Periodontal disease is a progressive condition which, if left untreated, causes aggressive bacteria to colonize the pockets around teeth that can lead to loss of bone and eventual loss of a tooth or teeth. Pocket reduction surgery is an attempt to alleviate this destructive cycle by decreasing the depths of these bacteria-harboring pockets.
Reasons for the pocket reduction surgery
Pocket reduction surgery is a common periodontal procedure which has been proven effective at eliminating bacteria, reducing inflammation and saving teeth. The goals of pocket reduction surgery are:
Reducing bacteria - Oral bacteria has been connected to many other serious conditions such as diabetes, heart disease, rheumatoid arthritis, Alzheimer’s, and stroke. Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize there. It is important to decrease these more aggressive bacterial types in the mouth to reduce the risk of secondary infection.
Halting bone loss - The chronic inflammatory response induced by aggressive oral bacteria in deep pockets may cause the body to destroy bone. As the jawbone becomes affected by periodontal disease, the teeth lose their rigid anchor. When the teeth become too loose, they may require extraction.
Facilitate home care - As the gum pockets become progressively deeper, they are incredibly difficult to clean by the patient. A toothbrush and dental floss cannot reach the bottom of the pockets, increasing the risk of further periodontal infections. Surgically decreasing these pockets allows for improved oral hygiene.
Enhancing the smile - Smiles may be marred by inflamed gums, decaying teeth and ridge indentations. Pocket reduction surgery halts the progression of gum disease and improves aesthetics of the smile.
What does pocket reduction surgery involve?
Before recommending treatment or performing any procedure, your periodontist will perform a thorough visual and x-ray examination in order to assess the condition of the teeth, gums and underlying bone. Pocket reduction surgery (osseous surgery) is used to repair mild to moderate bone damage caused by periodontitis. The purpose of this surgical procedure is to contour the bony structure around the tooth and place the gums as close to the bone line as possible. During this procedure, the surgeon reshapes the bone to rid the damaged and uneven areas. This reduction surgery will be performed under local anesthetic and sedation if the patient requests.
The gums are gently pulled back from the teeth to allow elimination of bacteria and calculus (tartar). Scaling of the surface will generally be required to fully remove the tartar from the surface of the tooth root. If the root is not completely smooth, a root planing procedure will be performed to ensure that when the gums do heal, they will not reattach to rough or uneven surfaces. The gum is then sutured and left in place for 5-10 days.
Though the gums will be more temperature sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums. For most people, the root sensitivity gradually improves over time.
The area treated will then heal for four to six months. After this healing period, your periodontist will evaluate your healing and decide an appropriate periodontal maintenance interval with the dental hygienist.