Osseous Surgery

 Don't worry, osseous surgery is a pretty straight forward procedure that isn't overly invasive.  It is the final step in treating periodontal disease and is performed by Periodontist, a dental specialist in gums.  The surgery is a procedure done when you have a pocket around a tooth (or teeth) that has not responded to other treatments, such as Scaling and Root Planing and a maintenance program.  
 
   If you have periodontitis then you have probably already gone in for your exam, your deep cleaning, and then a reevaluation exam that checks the pocket depths after your SRP to see if there is a reduction in depth and in bleeding around the gums.  If your pocket depths have not improved enough or gotten worse, then your doctor may recommend osseous surgery.  It is a procedure used to smooth and reshape the affected bone and create a shallow pocket that makes it more difficult for more aggressive bacteria to survive.  The surgery includes a thorough cleaning of the root surface and smoothing the surface of uneven bone caused by the periodontitis.  The goal of the surgery is to eliminate the existing bacteria and infection and stop the decaying process and prevent further damage caused by the progression of periodontal disease.  This in turn will help you maintain a healthy mouth, healthy body and healthy smile!
 
    What happens in osseous surgery, you may be wondering.  Is it painful?  How long does it take?  Am I awake?  What can I expect afterwards?  Can I eat?  Will it work?  All valid questions that I hope to answer for you.  The procedure itself takes about an hour to hour and a half per quadrant of your mouth worked on (upper right, upper left, lower right, lower left).  So the length of the surgery depends on how big of a section needs to be cleaned, it also depends on whether you need bone grafting or guided tissue regeneration (which I will explain in a minute).  You will be awake for the procedure.  The doctor will numb the area being worked on and you won't feel a thing.  Think of osseous surgery like an EXTRA, EXTRA deep cleaning.  After you are numb the doctor will open up the gum tissue around the area to be treated, lifting it away from the teeth and underlying bone.  This allows her/him access and direct vision of the bone and tooth root surface.  Then your doctor will use hand instruments and powered handpieces to clean and smooth the root surface and bone surrounding the root.  The surface of the bone that is uneven, because of destruction caused by the body's response to the bacterial attack, is smoothed to make a better surface for repair and development of a healthy attachment system.  After the roots have been cleaned and the bone has been reshaped, the gum tissue is trimmed to match the new underlying structure and stitched in place.  In some cases you may need bone grafting with or without guided tissue regeneration membrane (which is placed over bone grafting to act as a barrier to prevent the gum from growing down into the pocket and affecting the regeneration process).  As we've discussed before, periodontitis causes bone loss, so if your disease has eaten away bone causing deep pockets, bone grafting may be done to help regenerate some of the bone you have lost.  Bone grafting may sound scary, but it's not.  It is basically bone particle (synthetic, bovine, or human) that looks like sand, and is mixed with antibiotics and placed into the area where you've lost bone.  Your body thinks that you've broken bone and starts to heal the area, thereby incorporating your own bone and regenerating some of the bone density you have lost.  So after the cleaning, smoothing, tissue trimming and possible grafting are done, your doctor will stitch everything back into place and you're done!
 
    Your doctor will prescribe pain medications for you to use during the post-surgical healing phase, along with antibiotics and an antibacterial mouthwash.  The stitches will either fall out on their own or be removed 7-21 days after your surgery.  Your periodontal office will need to check the surgical site with a few regular visits to check on the healing of the site, usually for a couple weeks after and again three to six months post-surgery to ensure the healing is complete.  You may or may not need your pain medications, everyone heals different and feels pain different, but for most people you'll be up and about the next day.  You may find that a tooth or a few teeth appear longer in your mouth, this is due to the bone loss and removal of small amount of tissue.  It can occasionally result in some root sensitivity or food impaction, it depends on the severity of the disease.  If the sensitivity is a problem it can be treated with applications of fluoride or using a sensitivity gel or toothpaste. Your office will give you home care instructions that will include how to keep the area clean and what you can and cannot eat.  But yes, you can eat!  Just try to keep it cold to room temp for the first couple days, avoiding hot, spicy, acidic and crunchy foods.  My personal preferences for after surgery are eggs, oatmeal (cooled down), yogurt, pasta (again, cooled down), or milkshakes!  Just avoid the straw, just like when you got your wisdom teeth out, no smoking, no spitting, no using straws for about 5 days.
 
    As long as you keep up with your periodontal maintenance program and brush and floss well at home, the surgery should get your pockets and disease under control!  

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