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Osseous Surgery

Periodontal Flap Surgery and Root Coverage

Flap surgery is, by far, the most common surgery used in periodontal therapy. More advanced cases of periodontal disease involve gum pockets that are too deep to clean without reflecting back the gum tissue for access. The disease will progress because deep calculus and plaque can’t be removed from the root without this access. Open flap curettage is this surgical cleaning procedure.

  • Deep pocket with calculus

    Deep pocket with calculus

  • Flap reflected to access calculus

    Flap reflected to access calculus

A cleaned pocket may return the gum to its original level. Still, the deepened pocket remains present. Even practicing good oral hygiene and coming in for scheduled cleanings may not stop the bacteria from causing the pocket to be infected. The surgeon may choose to suture the gum down to where the bone has resorbed, reducing the depth of space. Once the space is reduced to 3 millimeters or less, the patient can then reach it with daily brushing and flossing, thereby eliminating the disease.

  • Gum sutured back to normal height, leaving a deepened space

    Gum sutured back to normal height, leaving a deepened space

  • Gum sutured down to bone to reduce residual space

    Gum sutured down to bone to reduce residual space

Usually, we find that the bacteria have caused the bone to resorb and become pitted. Flap surgery can then give access not only for root cleansing, but promotes recontouring of the bone itself. That’s why performing osseous surgery is a good way to eliminate moderate pockets.

  • Bone recontoured after<br /> flap reflected.

    Bone recontoured after
    flap reflected.

  • Tissue sutured down to smooth<br /> bone to eliminate pocket.

    Tissue sutured down to smooth
    bone to eliminate pocket.

If regeneration procedures are to be performed, flap surgery is also needed. The pictures below show a great representation of this.

  • Flap reflected to allow<br /> bone implant

    Flap reflected to allow
    bone implant

  • Flap resutured over<br /> bone implant

    Flap resutured over
    bone implant

  • Flap reflected to insert membrane

    Flap reflected to insert membrane

  • Flap resutured over membrane

    Flap resutured over membrane

Not only is flap surgery effective, but it’s also pretty painless, as patients only experience a minimal amount of postoperative discomfort.