Periodontal Surgery—Open Flap
(Pocket Depth Reduction)
Periodontal disease refers to bacterial plaque and infections around the gum and tooth root. It can happen around one or several teeth. In its more advanced stages, surgery may be needed to fix damaged gums.
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Reasons for Procedure
This surgery is needed when:
- Deep infected pockets have formed and it is too hard to keep them clean
- Gums around the teeth are damaged and cannot be fixed with nonsurgical techniques, like deep cleaning and medications
This surgery slows the progression of periodontal disease by reducing deep pockets and bacterial growth. Periodontal disease can cause other health problems if not treated.
Problems from the procedure are rare, but all procedures have some risk. Your dentist will review potential problems, like:
- Changes in gum appearance
- Gum swelling
- Reaction to the sedation
Before your procedure, talk to your dentist about ways to manage factors that may increase your risk of complications such as:
What to Expect
Prior to Procedure
- Tell your dentist of any recent changes to your health, medications, allergies, or supplements.
- Take your prescription medications, unless your dentist says otherwise.
- Talk to your dentist or pharmacist if you are taking more than 1 drug. Some drugs can be dangerous when mixed. This includes over-the-counter medications and herb or dietary supplements.
- You may be asked to take an antibiotic before surgery.
- Arrange for a ride if you are having sedation.
Sometimes, sedative medications are used to make you more relaxed during surgery. If you are undergoing conscious sedation, you will be asked to not eat for at least 6 hours before surgery. Otherwise, you can follow a normal diet.
A local anesthetic will be used near the gum disease.
Your dentist may recommend conscious sedation. You will be awake, but will not have anxiety during the surgery.
Description of Procedure
This surgery is usually done in an outpatient setting. You do not need to stay overnight. If you are undergoing sedation, you will have it through an IV. Your heart rate, blood pressure, and breathing will be monitored during and after the surgery.
The periodontist or dentist will numb the affected area using a local anesthetic delivered through a needle. They will make a small cut in the gum line near the tooth root. The gum flap will be pulled back, and the infected area will be cleaned and scraped. The gum flap will be repositioned to minimize the deep pocket size that formed. The gum will be stitched back into place. A dressing will be applied.
How Long Will It Take?
The time it takes to complete the procedure depends on the extend of the damage and how many gum areas are affected.
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
At the Dentist Office
During your stay, the dental staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chance of infection such as:
- Washing your hands often and reminding your healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incision
When you return home:
- Do not exercise for a few days as directed.
- Follow your doctor's instructions.
Call Your Dentist
It is important for you to monitor your recovery. Alert your dentist to any problems right away. If any of the following occur, call your dentist:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excess bleeding, or any unusual discharge
- Pain and swelling that is not controlled with medication or home care
- Dressing or stitches have come loose or are uncomfortable
- Loose tissue
- Continued swelling after 48 hours
- New or unexpected symptoms
If you think you have an emergency, call for emergency medical services right away.
Academy of Periodontology
National Institute of Dental and Craniofacial Research
Canadian Dental Association
Dental Hygiene Canada
Gingivectomy. Encyclopedia of Surgery website. Available at: http://www.surgeryencyclopedia.com/Fi-La/Gingivectomy.html. Accessed September 13, 2017.
Gum graft surgery: Indications, successe rate and possible complications. Net Wellness website. Available at: http://www.netwellness.org/healthtopics/gumdisease/gumgraftsurgery.cfm. Accessed September 13, 2017.
Periodontal (gum) disease: Causes, symptoms, and treatments. National Institute of Dental and Craniofacial Research website. Available at: https://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm. Updated September 2013. Accessed September 13, 2017.
pocket reduction procedures. American Academy of Periodontology website. Available at:
https://www.perio.org/consumer/pocket-reduction-procedures.htm. Accessed September 13, 2017.
6/2/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T905141/Treatment-for-tobacco-use: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.
- Reviewer: EBSCO Medical Review Board
Michael Woods, MD
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