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 the Periodontist to smooth/correct defects and irregularities in the bone surrounding the diseased teeth with the ultimate goal of reducing or eliminating the periodontal pockets. Of course the areas to be treated are anesthetized with local anesthesia (Lidocaine or "Novocaine". 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 1 hour, 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 Dr. Mao at the beginning of the procedure, as Dr. Mao 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. Mao must start the procedure immediately after the "shot" before it wears off. We aim to please!

  What do we do exactly during surgery?

  1. First, after getting the area "numb" we inspect the area and measure the depth of the pocket so that can determine the amount and type of bone loss. We can also visualize residual tartar that may be attached to the roots.
  2. Osseous Bone Defect

  3. We then FLAP back the gum and remove the tartar; we also clean out what we call granulation tissue from the bone defect. This granulation tissue is basically infected/inflamed gum tissue that creeps into the craters and defects as the bone resorbs or disappears.
  4. Gingival Flap and Clean

  5. Next, we use hand instruments or a special carbide 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.
  6. Osseous Contouring

  7. In some cases where there are deep craters or "holes" in the bone we may use a bone graft to fill them in. As advances in periodontology have been made, additionally we now use a special membrane (See: 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

  1. After the bone is reshaped or augmented (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 one week. Sometimes, however, if you can’t get back here within a week 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.

    osseous surgery sutures

  2. Lastly, we then place a 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.
  3. Post-Op instructions are then give to you to teach you how to take care of the area so that as little discomfort will take place as possible. Often a prescription is given for any discomfort.



Richard Mao, D.M.D.
Practice Limited to Periodontics
E-Mailwith Questions


402 Severn Bldg.
8600 La Salle Rd.
Towson, Md. 21286
Tel:(410) 321-9595
707 N.Hickory Ave.
Bel Air, Md. 21014
Tel:(410) 879-6969