Repair Phase (Surgical)

Once the patient has completed the Anti-infective Phase of therapy and it has been determined that deep pockets or bleeding pockets exist, the repair phase of periodontal therapy is recommended. Todays technology allows patients to see these problem areas, thus giving them an understanding of the need for further treatment.

The purpose of the Repair Phase of therapy is to reduce the pocket, thereby shrinking the available space the bacteria can live. In other words, this phase is designed to repair the damage caused by the original infection. If the pocket is not decreased to acceptable levels, the disease will return and initial treatments will need to be repeated. Furthermore, deep pockets left untreated can harbor bacteria and create areas of chronic low grade inflammation that research is showing can adversely affect your overall health. (see Health issues associated with periodontal disease)

Technology has greatly improved periodontal treatment associated with the repair phase. Today, people return to work immediately following a majority of our procedures. Artificial bone grafts, resorbable stitches, and post-op medications along with modern equipment and technology, make treatment manageable.

Over the years, many different treatments have been developed to treat advanced periodontal disease. As a periodontal specialist, Dr. Morris will guide you in deciding which of the following Repair Phase treatments is best for you.

Gingivectomy

This procedure involves the excision of the soft tissue wall of the periodontal pocket. An internal or external beveled incision can be used. A gingivectomy is performed to eliminate suprabony pockets after completion of the Anti-infective Phase of therapy.  This procedure can also be used to restore normal architecture when gingival enlargements exist.

Flap Debridement

Consists of lifting or reflecting a soft tissue flap so as to allow debridement of the root surface and removal of granulation tissue and infection. This procedure is performed in moderate to deep probing depths or when it is important to maintain esthetics.  Many types of this surgery exist and they include the following: Open Flap Curettage, Reverse Bevel Flap Surgery, Modified Kirkland Flap Procedure, Widman Surgery and Modified Widman Surgery. 

Apical Position Flap

Consists of lifting or reflecting soft tissue flaps and replacing them at a more apical level than where they were originally. This is done to preserve keratinized tissue.Unlike a gingivectomy the tissue is not removed.

Osseous (Bone) Surgery

This procedure is  performed by lifting or reflecting soft tissue flaps and reshaping the underlying bone to achieve a more physiologic form (shape). This procedure is performed in advanced periodontal disease and helps eliminate moderate to deep pockets

Laser Periodontal Therapy

Laser Periodontal Therapy involves the use of light energy to remove tissue in the periodontal pocket.  The use of sonic scalers should always be used as an adjunct to laser therapy to clean the root surface.  Once the root is scaled and diseased tissue is removed by the laser, the pocket will heal around the tooth.  Although this procedure is not expected to regenerate as other periodontal treatments, one benefit to the patient is that no incisions are made.  This is a plus in patients with dental fears.

Bone Grafting

Involves the lifting or reflectiing of soft tissue flaps, debridement (cleaning) of the root surface, preparation of the bone surface and the placement of bone grafting material into the defect around the tooth. This treatment is designed to stimulate periodontal regeneration when disease has altered the bone. Artificial grafts, cadavor grafts, animal grafts or the patient’s own bone may be utilzed. Today, most Repair Phase treatment includes the addition of bone grafts.

Guided Tissue Regeneration

Involves the lifting or reflectiing of soft tissue flaps, debridement (cleaning) of the root surface, preparation of the bone surface and the placement of bone grafting material into the defect around the tooth. A membrane is then place over the grafted defect. This resorbable membrane is placed to keep soft tissue from growing into the wound, thus allowing better bone regeneration.

Tissue Engineering

Involves the lifting or reflectiing of soft tissue flaps, debridement (cleaning) of the root surface, preparation of the bone surface and the placement of biologic materials into the defect and around the tooth. This is the future of periodontal therapy.

Today, signaling proteins and peptides can be added to the wound to augment tissue regeneration. These treatments require a greater investment by the patient and the cost/benefit ratio needs to be analysed for each situation.

 

X-ray showing tissue engineering.