dental instruments and oral health

What Is Periodontal Flap Surgery?

Periodontal disease (PD), which is the advanced form of gum disease, permanently destroys your gums, ligaments, and surrounding bone tissue. If the disease is left untreated, tooth loss may also occur. Although, if your periodontist catches PD early on, he or she can control the disease with non-surgical treatments. This includes scaling and root planing (deep cleaning), which is a non-invasive procedure that removes tartar below your gum line. In addition, periodontal flap surgery may also be necessary, depending on the severity of the disease.

Periodontal flap surgery, or gingival flap surgery, is a popular procedure that treats and repairs periodontal pockets. For reference, periodontal pockets are areas below your gum line that form when gum tissue detaches from your teeth. As a result, deep spaces form. Unfortunately, these pockets cannot be cleaned at home with a toothbrush, which creates a perfect environment for harmful bacteria to grow quickly.

Treatment Stages & Steps for Flap Surgery

Gum disease commonly forms if bacteria and tartar collect below your gum line. To counteract the damaging effects of PD, periodontists typically perform scaling and root planing first. Then, if this procedure isn’t completely effective, they may recommend flap surgery to control the disease. Flap surgery is not a cure for PD. Although, it helps reduce the harmful effects of the disease by improving your periodontal health.

There are four main steps in a flap surgery procedure, including:

Step 1: Local Anesthesia Administration

Local anesthesia is typically administered before periodontal flap surgery. The drug is injected into your mouth, numbs the treated area, and causes a loss of nociception (pain receptor). In other words, patients remain awake during the entire procedure, but cannot feel anything. Local anesthesia also eliminates pain for up to four hours post-op. Depending on the patient’s needs, anti-anxiety medications or sedatives may also be necessary.

Step 2: Gum Tissue Incision

After local anesthesia is in full effect, a periodontist makes a small incision into the gums. This separates your gum tissue from your teeth. Then the dentist gently folds back the gum tissue, which allows for easy access to the roots, ligaments, and surrounding bone tissue.

Step 3: Gum Tissue Removal

Once the periodontist accesses the roots, ligaments, and bone tissue, they carefully remove the inflamed gum tissue. Then they clean the roots and remove any remaining debris. If there is significant bone loss, your periodontist may also recommend bone grafts to regenerate new, healthy bone tissue.

Step 4: Stitches

After the periodontist removes the infected gum tissue and cleans your teeth roots, they close the incision with stitches. In addition, they may recommend follow-up appointments to ensure your mouth is healing properly.

Aftercare Tips

After the procedure is complete, your periodontist typically prescribes pain medications and antibiotics to help reduce any discomfort. Although, flap surgery is relatively quick and you should only experience mild discomfort for a few days post-op. Other aftercare tips include:

  • Refrain from brushing or flossing the surgical site until it heals. Although, if your dentist places a periodontal dressing, you can gently remove the plaque from the healing teeth with a toothbrush. For reference, periodontal dressings are placed on the surgical site to protect the healing tissues from heavy forces, such as chewing or brushing.
  • You can continue brushing the rest of your teeth normally.
  • Rinse your mouth with an antimicrobial mouthwash that contains chlorhexidine to kill bacteria and encourage healing.
  • Normally, your periodontist schedules a follow-up appointment about a week after the procedure to ensure everything is healing properly.
  • Swelling and minor bleeding are normal. However, if the swelling lasts longer than a few days, you can use an ice pack to control the pain.

Possible Complications of Flap Surgery

If you experience bleeding for more than two days, you can develop an infection. Call your periodontist right away if this occurs. Other possible complications include:

two teeth with receding gums graphic

Gum Recession

Gum recession is when your gums begin to pull away from your teeth. As a result, the roots of your teeth become exposed, which typically causes sensitivity to hot and cold substances. This is because root surfaces do not have hard enamel covering them like the crowns of teeth do, which makes them more prone to sensitivity and decay. Receding gums also make your teeth appear longer than they are.

Root Decay

If you develop gum recession, your teeth roots are also more prone to decay. For example, when your gums recede far enough, the root surfaces of your teeth become visible. This allows bacteria to spread below the gum line, which ultimately leads to decay and possible bone loss.