What is Gingivectomy procedure?

While it may sound unappealing, reduction of pathological pocketing through the procedure known as gingivectomy is an effective means of treating a condition commonly encountered when you are diagnosed with periodontal disease.  Often, when you do suffer from periodontal disease, you will exhibit some loss of jawbone around your teeth.  This loss of jawbone will leave empty spaces beneath your gums.  These spaces below your gums are called pockets.  If your pockets become too deep to clean out with a toothbrush and floss, they are referred to as being pathological or indicative of disease.

           Pathological pockets, because they can not be efficiently cleansed when you brush and floss, trap food inside them that the bacteria in your mouth which cause periodontal disease feed on.  Anyone who has any of their natural teeth has a vast number and variety of bacteria in their mouths.  Your body defends itself against these bacteria by means of inflammation.   Unfortunately, many patients’ bodies respond with so much inflammation that their own jawbone is destroyed in the process.  When you develop this stage of periodontal disease, it is called periodontitis.  To treat periodontitis successfully, it is essential to reduce the depth of your pathological pocketing.  Otherwise the causative bacteria will continue to have a place to flourish in your mouth and your body’s inflammatory response against them will persist in diminishing the jawbone around your teeth.  If this loss of jawbone progresses unchecked, your teeth will eventually loosen and then be lost.

           One way of reducing these pocket depths is through deep cleanings (technically known as quadrant scaling and root planing) done with Novocain to remove all build-up under your gums.  This phase of treatment, however, has only a limited potential to lessen deep pocketing.  Any pockets that remain pathological after quadrant scaling and root planing has been completed for you will need to be further reduced to a level that you can reasonably be expected to keep clean by brushing and flossing.  Gingivectomy is a simple way of accomplishing this needed further reduction.

           Gingivectomy is basically the process whereby excess gum tissue over your pathological pockets is trimmed away to decrease the extent of those pockets.  Our Periodontist accomplishes this using a scalpel or electrosurgery unit after first profoundly numbing the gum tissue to be removed.  He will measure your pocket depths before and after the procedure with a periodontal probe to confirm that sufficient tissue has been removed to ensure clean ability with a brush and floss.  Often times some of your tooth’s root surface will be exposed during this process.  Because newly exposed root surface can be quite temperature sensitive and also has an increased risk of tooth decay, a fluoride treatment will be perf ormed for you after the gingivectomy to lower the chances of these complications occurring.  Regrettably, some instances of pathological pocketing cannot be remedied using gingivectomy alone when the degree of damage to the underlying bone is too extensive.  In these cases, call our periodontist (gum specialist) for more comprehensive surgical care in those circumstances.

Is it just cutting off of the excess gum tissue?

No. This procedure is different from the simple “cutting off” (gingivectomy) of the excess gum that can be achieved by a: Laser, b: Radio-surgery or c: Surgical knife. The “cutting off” of the gum edge, while having some useful indications, is very limited in what it can achieve. When the very limited biological restrictions are violated, the gum will either re-grow or a permanent state of gingivitis will develop. For a stable and permanent improvement the underlying bone must be also reduced proportionately.

Is the procedure painful?

The actual procedure that takes about 2 to 3 hours to complete is done under local anesthesia, the same way most other dental procedures are done. While local anesthesia is sufficient to perform the Gum Lift completely painlessly, our Periodontist has found that most patients do better and are more comfortable when some degree of sedation is used. You can discuss the suitable technique of sedation for your case with our Periodontist.

Gum Lift is a minor surgery and there will be a wound that carries the same discomforts, limitations and delicacies of any other wound in the body. Post-operatively, you will be given two types of pain medications that you can use as you see fit.

However, interestingly, most patients report a degree of “numbness” on the gum at the operated site rather than “pain”. Apparently, the nerve fibers that are supposed to carry the pain signals from the gums are cut-off and there is “no sensation” from the gum! Most of the discomfort of the procedure comes from the swelling of the area rather than the wound itself.

How long is the Recovery?

For fastest and most comfortable recovery, our Periodontist’s recommendations are as follows:

For the day of the procedure: Bed rest. Do not plan on any activity after you leave the office. If you have had any type of sedation, you must arrange for a ride home/to your hotel. You must arrange for the medications and few days of suitable food in advance of the procedure.

For days 2 and 3: You must minimize your physical activity. This is a great time to catch up with books, internet and TV. If you have traveled from out of town, it is better if you do not travel back until the 4th day. Physical activity during this period increases the post operative swelling which is the primary cause of post-operative discomfort.

Days 4 thru 9: You can resume all normal activity from the 4th day on except work outs.

10th day on: No special consideration for the procedure needed.

How many visits does it take?

The procedure is done in one visit. Our periodontist would like to see the patient one more time in the days following the procedure to make sure the tissues are holding up well. For out of town patients, the pre-operative work up can be done through photographs and telephone conversations.

Will there be stitches?

Yes. If you are local, the remaining stitches are removed after 6 days. If you are traveling, resorbable stitches are used that do not require professional removal.

What are the possible complications?

Basically NONE. If patients follow the instructions in taking the prescribed antibiotics, resting and proper dieting following the procedure, there is nothing that can go “wrong”. Our periodontist has performed close to a thousand of these procedures and has had no complication so far. However, there can be some consequences to this procedure that the patient must be aware of:

·         Some teeth sensitivity will occur that usually disappears few months later.

·         The gum numbness that was earlier mentioned can take up to a year to completely go away.

·         “Spaces” between the teeth take 10 to 14 months to fill up by gum if gums are kept healthy during this period.

Will I later need Veneers or Crowns on my teeth?

It depends. This is a very important question that must be discussed BEFORE the procedure is done with Periodontist. Whether you would need further restorative work on your teeth after the gum lift or not, depends on the preexisting condition of your teeth and gums and how much gum lift you want done.

Periodontist can walk you through the published pictures of his cases at the web site so that you can see how much gum lift you need and can expect from gum lift without any further work on the teeth. Many of the more drastic improvements have been accomplished by a combination of gum lift and restorative procedures.

You must discuss this including all the expenses of it with Periodontist before the procedure because the gum lift procedure varies in technique depending on whether a restorative procedure is going to follow or not.

Are there any Guarantees?

Yes. Our Natick Periodontist guarantees that the final results will be similar to the preoperative computer imaging of your case. Of course, natural tissues heal and move differently from computer images and exact replication is not possible. Slight asymmetries can happen due to differences in root prominence of the teeth. After complete healing, if necessary, Periodontist will trim the gum edges (as part of the main procedure) to correct these irregularities.