Around 4-6 weeks after your first scaling and root planing, your re-evaluation exam will determine the outcome of initial treatment. If there are still pathological (deep) pockets that need further treatment, local surgery can remove any remaining infection and decrease pocket depths to reduce your risk for disease in the future.
Flap surgery – Pocket Depth Reduction
This is advised when a gum pocket is too deep to clean with daily oral hygiene and professional care routine. The gum tissue is folded back and allows for visible and instrumental access to the root for removal of calculus, plaque, diseased tissue and smoothing of irregular damaged bone. The gum is then secured back into place. Reduced pockets increase your chances of keeping you natural teeth and avoiding disease progression.
The gum tissue is folded back and allows for visible and instrumental access to the root for removal of calculus, plaque, diseased tissue and smoothing of irregular damaged bone.
Bone regeneration – Bone grafting – guided tissue regeneration
Examples of tooth and jaw bone defects are: defects from periodontal disease, abscesses, tooth extraction, trauma, cysts and bone loss around implants.
There are bone grafts (from your own mouth, from deceased human organ donors, from bovine or synthetic polymers or calcium), membranes (porcine or synthetic) and growth factors, chemically similar to your body, which stimulate your bone to grow back. Over time your own newly formed bone will replace much of the graft material. This procedure will give your teeth better support.
Bone graft is similar to your human bone and is accepted by our defense mechanism and not rejected. It acts as a framework so your bone forming cells, blood vessels migrate into it and form your own new bone and the defect is repaired. Bone graft is safe. The bone is highly controlled in processing and sterilization which removes all impurities. It is highly purified with no allergic reactions or infections observed. The new bone begins to form within the first few weeks after grafting but will take 3-12 months (depending on size) to achieve the quantity and density of bone needed for further dental or surgical procedures to be performed.
Membranes can be used over tooth surfaces to guide bone to heal along the tooth. Membranes can also be used over bone grafts to hold them in place, protect in case of gum tissue opening during healing and prevent the growth of gum tissue into the surgical area. Membranes are either made of non-resorbable GoreTex material or made of a thin resorbable (melts away) natural fiber material (porcine collagen or synthetic). Porcine derived collagen is also used for many artificial heart valves. This product is not indicated for patients with a known history of allergic response to collagen or porcine derived products. Depending on the chosen resorbable membrane, it resorbs in 1-4 months and does not need to be removed by your dentist.
Bone Grafting Procedure
The first step is to remove the periodontal disease and stop the bone loss during the initial deep cleaning phase previously mentioned. During surgery Dr. Hoffmeyer gives you a local anesthetic, gently opens the area, filling in the missing section with bone grafting material. The following 1-2 years all follow-up of periodontal care with cleanings (not dental exams) will be with Dr. Hoffmeyer who observes the healing results. It is very important that the grafted areas are not probed with any instruments as this may destroy the healing process and result.