Why do I need pocket reduction surgery?
Your Periodontist may have recommended you undergo pocket reduction surgery or osseous surgery. This recommendation is based on your periodontal probing depths. The critical probing depth to keep in mind is 5mm. When periodontal pockets get above 5mm we as dental professionals, with specialty instruments in our hands, are unable to get all of the bacteria deep down in the pockets. If we are unable to get these deep pockets clean there is no way a patient will be able to keep these pockets clean. The end goal of treatment is to give you a mouth that you can keep clean at home and one you can easily maintain on your own.
What is pocket reduction?
Imagine if a person were standing at the base of a cliff and shot a gun. The bullet would not make a 90º turn when it reached the edge of the cliff, but rather it would arc over the top. The same is true of the bone in your mouth. If your bone has sharp irregular areas, the gums cannot follow those contours and will simply arc over the top. With pocket reduction surgery, we remove some of the excess tissue and reshape the bone to restore more natural contours like it did in health. This will allow for the gums to lay down more intimately with the bone and form a tight biologic seal around the teeth. In this way we can turn 6, 7, and 8mm pockets back into 3-4mm which are something that you can keep clean at home.
What are the drawbacks of pocket reduction?
When we reduce the pockets, the tissue will rest lower on the tooth. This can expose some root structure leading to hot/cold sensitivity. Also, the areas between the teeth (embrasures) will now be more open. This will create areas of plaque and food traps. But…it will also give you greater access to get your cleaning aids (proxy brush, rubber tip stimulator) into these areas. Patients who keep these areas clean will have a highly successful outcome. Patients who do not keep these areas clean will break down faster than if we had never worked on them. This is why your home care is so critical.
What causes deep pocket depths?
These deep pockets are a factor of either advanced periodontal disease (in which case scaling and root planning will never solve your problem), or they are a factor of anatomic considerations.
- If your deep pockets are a factor of advanced periodontal disease, the problem is access to the bottom of the pocket. With pocket reduction we have 100% visual access all the way to the bottom of the defect to thoroughly clean the teeth. It is this open access which permits us to clean the teeth in a way that could never be done in a closed environment.
- If your deep pockets are a factor of anatomic defects then scaling and root planning will never solve the problem. If there are sharp, vertical defects or craters in the bone, the only way to address these are to reshape the bone back to how it looked in a state of health.