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Osseous Surgery, Periodontal Surgery, Gum Surgery
What Is It?
Osseous Surgery is a type of periodontal (gum) surgery that involves the removal and/or reshaping of the jawbone under the gum. The phrase 'gum disease' is not a technically accurate description because most of the damage occurs not in the gum but in the underlying bone; osseous means bone. Dr Antonious performs this procedure, but occasionally Dr Antonious will refer you to a periodontist who specializes in periodontal surgery.
A simple analogy with carpeting may be used to describe the process of osseous surgery; the overlying gum is the carpet and the underlying floor is the bone. Bone is frequently irregularly destroyed by the infection associated with gum disease. This irregular bone will, like a bump in the floor under a carpet, prevent the gum, or carpet, from laying down flat. Reshaping the bone with osseous surgery by your dentist will allow the gum to lay down flat in the areas between the teeth.
Osseous Surgery is designed to modify and reshape deformities in the alveolar bone surrounding the teeth. It is a common requirement in effective treatment of more involved periodontal diseases. In some instances, the bony support of the tooth assumes an unusual configuration as a result of uneven progression of the disease. When this occurs, modification of the altered bone support may be indicated.
Why do You Need Periodontal/Osseous Surgery?
This surgical procedure is used by your dentist to smooth, correct defects and irregularities in the bone surrounding the diseased teeth with the ultimate goal of reducing or eliminating the periodontal/gum pockets. Of course the areas to be treated are anesthetized with local anesthesia. Don’t let the word "surgery" scare you. Except in the most complex cases, it feels like a thorough cleaning. If you must worry about something, you can worry about possible post-surgical discomfort; I must say though I give less pain medication now than I ever have- perhaps it’s the experience!
The average surgical procedure takes about 2 hours, including the time to get numb. We use an average of 3 anesthetic cartridges per quadrant. We use a combination of two types of local anesthetic: 1. Carbocaine and 2.Xylocaine with epinephrine; the "epi" is used to control bleeding and to make the anesthetic last longer. If you have problems getting numb, please tell your dentist at the beginning of the procedure, as Dr. Antonious can usually give it in a different location to make it work better and perhaps faster. Also, some patients have problems staying numb; in these cases Dr. Antonious will take the necessary steps to ensure that you stay numb during the entire surgery.
What do we do exactly during surgery?
1. First, after getting the area "numb" we FLAP the gum back so that your dentist can visualize the amount and type of bone loss. Your dentist can also visualize tartar that may be attached to the roots.
2. Your dentist will then remove the tartar and clean out what we call granulation tissue from the bone defects or craters. This granulation tissue is basically infected/inflamed gum tissue that creeps into the craters and defects as the bone resorbs or disappears.
3. Next, your dentist will use hand instruments or a special diamond bur on a high speed handpiece to smooth and recontour the bone so that the craters are reduced or eliminated. It’s difficult to explain, but by doing this, the pockets will be reduced or eliminated.
4. At this time, in some cases where the craters or "holes" in the bone are too deep your dentist will then use a bone graft to fill them in. As advances in periodontology have been made, additionally we now use a special membrane (Guided Tissue Regeneration procedure) to cover over the bone graft so that the gum does not grow down into the crater and "sabotage" the bone regeneration procedure.
There are 2 types of membranes currently being used:
A. Resorbable
B. Non-resorbable
5. After the bone is reshaped or augmented with bone graft, we then replace the original gum flap back over the bone and place sutures (stitches). The stitches are usually nylon and must be removed in about ten days. Sometimes, however, if you can’t get back here within ten days we place a different type of suture that won’t irritate or attach to your gums; it must still be removed, but you can wait as long as a month.
6. Lastly, we then may place putty-like packing over the area. Unlike many patients think, it is NOT important for healing. It is placed merely so that you don’t have to worry about getting food stuck in between your teeth.
7. Post-Op instructions are then given to you to show you how to take care of the area so that as little possible discomfort will take place. Often a prescription is given for any discomfort.
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