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Pocket Depth Reduction

 

As the bacteria that cause periodontal disease release toxic substances, they trigger the breakdown of gum and bone.  The gum then separates from the teeth, forming a gap that is called a periodontal pocket.  Bacteria settle in these pockets and because they cannot be removed by the patient’s daily oral hygiene, they continue to accumulate and reproduce. Without proper treatment, the bacteria will continue to populate these pockets, creating further gum and bone destruction.

 

The first step in the treatment of periodontal disease involves the removal of the bacteria that inhabit the periodontal pockets in the form of plaque and tartar. The removal of the pocket irritants, scaling and root planing, is combined with oral hygiene instructions that are aimed at improving the patient’s ability to control plaque and avoid bacteria from re-infecting the periodontal pockets.  Several weeks after completion of scaling and root planing, a periodontal re-evaluation should be completed to assess the healing response.  If the periodontal pockets don’t reduce to below 4mm and the gums are still unhealthy, surgical treatment may be indicated.

 

Pocket depth reduction is a term used for a series of different surgical procedures (gingivectomy, flap surgery, osseous surgery). The purpose of these procedures is to gain access to the root surface to effectively remove calculus and to reduce the size of the pockets to help prevent bacteria from settling in.

 

What to expect:

Pocket depth reduction is done in the dentist’s office with local anesthesia (lidocaine).  After lifting the gum back, the bacterial plaque and tartar are removed from the root surfaces.  It may also be necessary to remove the infected gum tissue and to smooth the bone surface. Stitches (sutures) are placed to aid in healing.  The stitches are usually removed five to ten days after the surgery.  Follow-up appointments are scheduled as necessary to evaluate healing and plaque control.

 

Post-surgical discomfort can last a few days and is usually minimal. It can be easily managed with commonly available over the counter medications such as aspirin, acetaminophen, or ibuprofen.  Patients can expect to follow their normal routine the day after surgery.  Your dental care provider will give you special instructions related to diet, exercise and medications.

 

After pocket depth reduction, you may experience heightened tooth sensitivity.  This is temporary and usually resolves within a few weeks.  There are chemical aids available that help reduce sensitivity.

Some people may also experience looser teeth after periodontal surgery.  This is also a transient finding that occurs as part of the normal healing process.  With proper plaque control and bite adjustment, the teeth usually tighten up in a few weeks.

Another concern after pocket depth reduction is that the teeth may appear longer and that there are spaces in between the teeth.  Actually, longer teeth are the result of periodontal disease, not of periodontal surgery.  As periodontal disease infects and destroys the bone that encase the roots, the root surfaces become exposed.  They don’t 'appear' exposed because they are covered by the inflamed, swollen gums that form the periodontal pocket. Without proper treatment the periodontal pockets continue to deepen, giving way to more infection, bone loss, and eventually tooth loss and systemic complications.

 

There are treatments that can help improve esthetics after periodontal treatment.  In addition to periodontal plastic surgery procedures, orthodontic tooth movement (braces) or restorative treatment (crown & bridges) can help create a more pleasing smile line.

Benefits:

If you have periodontal pockets that don’t resolve after scaling and root planing, your dentist may recommend pocket depth reduction. Whether your dentist does a gingivectomy, a periodontal flap surgery, or osseous surgery, you will benefit from the reduction in pocket depth and the reattachment of the gums to the root surface. Pocket depth reduction is a predictable procedure, that followed by periodontal maintenance and efficient daily oral hygiene can help keep your teeth and reduce the risk of serious health problems related to periodontal disease. If your general dentist doesn’t frequently do surgeries, he or she may refer you to a periodontist that specializes in this technique.

 

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