Reviewed by Dr Izbel Aksit.
Gum disease affects millions around the globe even though it’s preventable. Unfortunately, 45% of the people in the UK alone have periodontitis, also known as gum disease. Two in three adults in the UK also have visible plaque. And if this plaque is not taken care of in time, it can harden into tartar (calculus).
Ultimately, the presence of this tartar is what sometimes necessitates a gingival flap surgery. This gum flap surgery can be done on its own or in combination with a bone grafting procedure, especially if the patient has suffered significant bone loss and intends to get dental implants.
When Is There A Need for Gingival Flap Surgery?
To understand the surgery itself, you need to first know why it becomes necessary in some instances. The problem starts if a person doesn’t have good oral hygiene or suffers from some other health condition.
In that case, first, the gums get inflamed. This condition is known as gingivitis and can go away on its own if you improve your dental care. However, if that doesn’t happen, gingivitis progresses to periodontitis, a very severe gum disease.
The inflamed gum tissue separates from the tooth itself, and periodontal pockets develop containing tartar that now extends deep below the gum line. These pockets also give way to the entrapment of further microorganisms, which release the toxins that damage the underlying bone structure and the periodontal ligament. Left untreated, not only does it permanently damage the underlying bone, but can also result in tooth loss.
Earlier interventions to clean plaque and tartar involve scaling and root planing. However, when the pockets are too deep (at least 5mm), the dentist cannot access those areas to clean them. So, even if the teeth above the gum line are clean, the harmful bacteria trapped underneath continue to produce toxins and damage the ligaments and bone tissue.
In that case, periodontal flap surgery is needed. This gum surgery aims to clean the deeper structure of the tooth and, if needed, repair bone tissue affected by the bacteria by combining it with a bone graft. These gum surgeries can help restore your periodontal health.
Ideal Candidates For Gingival Flap Surgery
Many people wonder whether they need a surgical or non-surgical intervention to treat the problem at hand. You’re a good candidate for periodontal flap surgery, if:
- You have chronic periodontal disease and have developed deep periodontal pockets that cannot be treated with scaling and root planing.
- You are experiencing tooth loss because of damage to the underlying bone tissue.
- You’re going to get dental implants but cannot support them with your existing bone tissue.
- You intend on relieving periodontal disease and its accompanying symptoms, such as pain, bleeding, bad breath, shifting teeth, and receding gums.
A delay in getting treatment can worsen the problem, which is why it’s important to speak to your dentist immediately.
The Procedure of Gingival Flap Surgery
Once you arrive at the clinic, the dentist will do a pre-surgical dental evaluation. S/he will assess if non-surgical treatments can resolve the issue. However, in the case of advanced gum disease, they may have to opt for surgical alternatives, which, in this case, is flap surgery.
A gingival flap surgery takes place under local anaesthesia, but sedation can also be used. It is administered to ensure that the patient doesn’t experience any pain during the surgery. The anaesthetic kicks in after a few minutes, and that’s when the dentist proceeds with the surgery.
First, the surgeon makes incisions on the side of the surgical site, extending downward from the teeth. This way, they cut out a flap of the skin and curve it back to expose the underlying tooth structure. Now that they have a clear visual of the tooth-supporting bone structure (tooth roots, ligaments and bone), they go ahead with cleaning it first. Here, the dentist may also remove inflamed tissue.
This may be the only surgery that you end up needing. However, depending on your case, you may also end up needing additional surgery like bone grafting. For instance, if the patient desires to get dental implants but doesn’t have enough bone tissue to support the implants, they need to undergo this surgery.
While performing flap surgery, a dentist can also repair any bone defects that may have arisen directly as a result of the periodontal disease. This is known as bone grafting, in which bone tissue is added to the existing, damaged jawbone.
After the flap surgery and bone grafting, the dentist rolls back the skin flap to its original place and places dissolvable stitches on the outer gum tissue. Keep in mind the implants won’t be fitted right after this.
Usually, patients need to wait for at least a month before coming in for implants. Also, for the placement of the implant, the dentist will have to perform another flap surgery, although the size of the surgical area will be smaller.
Side Effects of Surgery
It’s common to experience some side effects after gingival flap surgery. These may be as follows:
Pain: It’s normal to feel pain for at least 2-3 days after the surgery. Make sure to follow the aftercare instructions and take your medicines for better pain management.
Swelling: This is another common side effect of periodontal surgery. You may experience it for one week or so following the treatment.
Bleeding: This only happens for a few hours following the surgery. If the bleeding persists and worsens in the day(s) following the surgery, make sure to reach out for immediate help.
Tooth Sensitivity: This is another common side effect of gum flap surgery and can last for a few days to weeks.
To relieve these side effects, make sure to follow all the instructions of your surgeon.
Recovery & Results of Gingival Flap Surgery
Soon after the surgery, it’s best to rest for at least 1-2 days. Your dentist will prescribe painkillers and antibiotics to you, so you should make sure to take them.
24 hours after the gingival flap surgery, you can use a warm salt water rinse for the swelling. However, do not swish it around or spit it. You should not put any sort of pressure on the surgical site. For the same reason and to avoid bleeding, do not brush and floss the surgical site for at least 7 days.
This surgery yields permanent results. However, if you do not take care of your teeth, gum disease can return. That’ll mean a resumption of bone loss and inflammation of the surrounding tissue.
Aftercare Instructions for Gingival Flap Surgery
Your surgeon will provide aftercare instructions to you, and you need to follow these to maintain the results of the surgery.
Soon after the surgery, avoid chewing anything from the side of the mouth where you had the gingival flap surgery. Eating hard foods that are difficult to break is definitely not a good idea.
It’s best if you stick to soft foods for a few days. Here, it’s also important not to eat any foods that are too hot or cold as your teeth might be sensitive. Also, do not try sucking in any liquid using a straw. And lastly, make sure to eat healthy, wholesome foods.
Have Good Oral Hygiene
You need to make sure that your dental hygiene is top-notch. That means brushing twice a day and flossing and using an antibacterial mouthwash. In addition, you should get regular dental cleanings every 3 or 6 months.
Lie At An Angle & Use Cold Compress
Soon after the surgery, it’s best if you lie down at an angle after some time, as it’ll help with swelling. To further help with swelling, you can also apply cold compresses around the surgical area on the skin outside.
Avoid Physical Activity
You should also avoid any physical activity for a few days as it can make you bleed. If you play contact sports, you should ask the dentist when you can start practising/playing again.
Do Not Smoke
And lastly, you need to avoid smoking for at least a week after the surgery takes place. Your dentist may also advise you to stop smoking even before the surgery takes place.
The reason for it is that it constricts the blood vessels. That means less oxygen and nutrients for the tissue that needs these two to heal. So, make sure to avoid smoking or consuming any tobacco products.
Risks & Complications of Gum Flap Surgery
One complication that can result from gingival flap surgery is infection. It can happen because of different reasons, such as poor oral health or smoking. To avoid it, you must take your prescribed antibiotics for as long as instructed by the dentist.
Summing It Up
Periodontitis or gum disease can lead to the formation of pockets with tartar around the teeth. This not only damages the surrounding tissue but also results in bone loss.
If it isn’t as severe and the tartar isn’t deeply lodged below the gum line, a simple dental cleaning can do the trick. However, if the bacteria are present deep down, removing them becomes essential because otherwise, they’ll continue to cause damage. For this, gingival flap surgery is performed.
It is not only helpful in repairing periodontal pockets, cleaning the bacteria and removing the diseased tissue but also allows the dentist to perform a bone graft surgery on the patient if it’s needed.
The latter is needed when the patient needs to get dental implants but doesn’t have enough bone tissue to support them. So, the dentist performs a combination of these surgeries. And the results from them are permanent if the patient continues to maintain good oral health.