Advanced Periodontal Procedures & Gingival Surgery

Most periodontal (“around the tooth”) problems in pets are the result of chronic periodontal disease (chronic infection) or injury.  Sometimes teeth with significant periodontal attachment loss (gingival recession/bone loss) and where the potential for controlling further tissue loss is reasonably good, advanced dental procedures can be performed to save these teeth.  Advanced periodontal surgery techniques can help avoid extraction and be utilized to help make teeth more stable, functional and therefore resistant to infection.

Whether these procedures are necessary or even feasible for an individual patient can only be determined with the pet under anesthesia and after completion of a thorough oral exam that includes intraoral X-Rays.  If advanced periodontal surgical procedures are elected and undertaken, it is essential that the pet owners understand the following:  1) Post-surgical follow-up assessments (under general anesthesia) will be needed.  2) High levels of oral hygiene will need to be maintained at home.  3) As for any procedure, there is some risk of treatment failure.

Advanced periodontal procedures available at Animal Dentistry & Oral Surgery and include:

Bone grafting

    • These procedures are needed when the infection of periodontal disease results in significant supportive bone loss around the tooth roots.
    • Replacing the bone, with grafting techniques, improves the health and stability of the tooth.  Regeneration of bone will also provide an environment that promotes reattachment of the gingiva (gum tissue) at a more normal location on the tooth.  Resistance to ongoing infection will be enhanced.
    • Bone loss that results in a defect or periodontal pocket around a tooth root can be replaced using bone grafting procedures.  It is difficult to impossible to replace bone loss that involves the furcational area (area between roots) or bone loss that extends across more than one root.  In these circumstances, infection just can’t be controlled and tooth extraction may be the best option. This one of the reasons why preventing periodontal disease is so important.
    • There are different sources for the bone actually utilized for the graft. Often these procedures are accomplished using bone obtained from osteoallografts (bone from the same species, but not from the same individual).  There are companies that specialize in the engineering of graft products and provide these freeze dried, sterilized and packaged materials directly to the specialists.
    • In some circumstances, it is advantageous for bone graft material to be harvested from the patient’s own oral tissues (autogenous graft).
    • Following advanced periodontal procedures involving bone grafting,  reevaluations under general anesthesia are usually necessary within 3 to 6 months to monitor healing at the surgical site.  Along with visual inspection, gentle probing and intra-oral radiographs will be needed to assess the health of the new bone at the site and to determine if the grafting procedure was successful in integrating new bone around the tooth roots.

Guided tissue regeneration (GTR):

    • These procedures are often done in-concert with bone grafting procedure and require incorporation of a special membrane over the graft.  The GTR membrane will help protect the graft site and may improve the likelihood of new bone forming and healthy periodontal structures re-attaching to the tooth in anatomically appropriate locations.
    • As a result of GTR, undesired elements are kept out and normal periodontal tissues are “guided” into the appropriate location.  A variety of absorbable membrane types are available and just like those used for human GTR procedures, a disadvantage is that they can be expensive.
    • The membrane is surgically placed below the gingiva (gum line) and secured into place with one or more sutures.
    • Whenever advanced periodontal procedures involving guided tissue regeneration are performed, reevaluations (under general anesthesia) are usually necessary within 3 to 6 months.  As for bone grafting, gentle probing and intra-oral radiographs will also be utilized to assess the regeneration of bone and periodontal ligament tissues health at the site.

Gingival transposition surgery:

    • These procedures are necessary when there has been a focal area of gingival loss or recession leaving the tooth root exposed and unprotected.
    • Gingiva (gum tissue) can be transposed (moved) from an adjacent area or even from other donor locations within the mouth (free transfer).  As this is a surgical procedure there will be absorbable sutures placed at the site.

MOST IMPORTANTLY: For the ongoing control of infection for all patient’s with  established periodontal disease, high levels (elevated levels) of oral hygiene care are required for the patient at home. This is especially essential for any patient undergoing advanced periodontal procedures.  Usually, this will include daily oral tooth brushing and oral antiseptic rinses.  Also, more frequent professional dental cleaning will be necessary.  Once a year professional cleaning may not be adequate.  Without maintenance of high levels of oral hygiene at home, professional dental care alone will not be enough and heroic procedures to save the teeth will not be successful.