|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".
Dont 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 its 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?
- 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.
- 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.
- 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.
Its difficult to explain, but by doing this, the pockets will be reduced or
- 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:
- 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 cant get back here
within a week we place
a different type of suture that wont irritate or attach to your gums; it must
still be removed, but
you can wait as long as a month.
- 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 dont have to
worry about getting food stuck in between your teeth.
- 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