Surgical Therapies

1. Gingivectomy

Gingivectomy is the surgical excision of overgrown gum tissue. This can be performed by using lasers or conventional surgery.

2. Flap surgery

This is for degranulation of the infected periodontal pockets which are generally deep(>5mm). Flap is a section of the gingiva and or mucosa surgically elevated to gain access to the underlying bone and root surfaces. Flap surgery is generally performed when the gum pockets do not resolve after scaling and root planing, or when there are some deformities in the bone which have to be corrected. Following debridement, the flap is sutured back in the previous position.

3. Regenerative surgeries for regenerating the lost support and bone

The use of bone graft materials synthetic, autogenous, allogenous), GTR(barrier membranes), growth factors, PRF, enamel matrix proteins. Periodontal disease leads to bone loss and the patterns of bone destruction are broadly divided into horizontal and vertical or angular. Horizontal bone loss can be seen as loss of bone in a straight line on the radiograph. Vertical bone loss can be seen as saucer-shaped or v- shaped defects and can be filled with bone graft powders. A successful regenerative therapy stops the progress of the disease, helps to fill up the bone defects over 3-6 months and restores the support of the tooth.

4. Orthodontic interrelationship

5. Endo-perio management

There exists a communication between the opening of the tooth root(apical foramen) and the periodontium (gingival crevice). When infection from the tooth communicates with the gums or vice-versa, it is called an endo-perio lesion. In either cases, a root canal therapy is needed prior to gum surgery. Both the conditions will heal together, thus leading to resolution of the lesion.

6. Abscess drainage

Abscess is a localized collection of pus. It generally appears as an ovoid , shiny, reddish bulge or swelling anywhere along the length of the tooth in the gums. It generally is caused due bacterial infection which finds the path of least resistance for drainage. An acute abscess is sudden in onset, mostly due to injury or trauma, is painful, pus discharge, tooth may be vital,associated with a periodontal pocket,and or decay and may cause fever, lymph node enlargement, tooth slightly elevated out of the socket. A chronic abscess is due to longstanding infections,and eventually establishes drainage through a fistula or sinus tract .Only in cases of spreading abscess with systemic involvement, antibiotics should be prescribed. If the tooth is also involved, emergency abscess drainage and root canal therapy is indicated.