Gum Flap Surgery for Gum Disease: How Does It Work?

What Is Gum Flap Surgery?

Gum flap surgery is a dental procedure designed to reduce periodontal pockets. These are areas of breakdown and subsequent disconnection between your gums and your teeth leading to an increase in bacteria collection and potential infection. Periodontal pockets harbor pathogens and microorganisms that promote the progression of periodontal disease.

If it progresses, the disease turns into periodontitis, leading to tooth and bone loss. In such instances, doctors will treat the condition using surgical procedures such as periodontal/gum flap surgery.

Issues Treated

In early stages, periodontal diseases cause gingivitis, which leads to inflammation, reddening and swelling of the gums. 

Periodontal flap surgery treats gum diseases, but it can also treat other issues. Among them are: 

• Deep craters: Necrotizing Gingivitis causes gum tissues death, causing depressions to form on your gums.
• Inflammation: Swellings that form and persist in the areas around the periodontal pockets.
• Irregular bone contours: The procedure can treat jawbone defects.

The Procedure

A dentist or periodontist usually performs gum flap surgery three to four weeks after a non-surgical therapy. The therapy precedes the surgery so that gum tissues mature and build up, making the surgery less complex.

The step-by-step of gum flap surgery is:

Anesthesia Administration

The dentist will administer local anesthesia before starting the surgical procedure to reduce the discomfort via injection onto the gums, preventing pain receptors from sending information to the brain. 

Tissue Incision

The dentist will then make small incisions or cuts on your gum tissues, approximately 0.5 to 1 mm from the gum margin. After the incisions separate your affected gums from your teeth, they will lift the flap to access the bone tissues.

Tissue Removal

The dentist will then perform an interdental incision, which is an incision made on the gums found in between your teeth, and remove the infected gum tissue, known as granulation tissue. Before moving to the next step, they might perform root-planing and scale the exposed root surfaces.

Closing Up

This is the last aspect of the surgery once the affected gum tissues are removed. Dentists typically close the flaps and incisions using sutures, but research shows sutures are associated with inflammation of the gums. Now, many dental surgeons opt for fibrin glue.

Recovery

You should expect a full recovery two to three weeks after the surgery. You can hasten the recovery period by:

• Using drinking straws and avoiding smoking
• Eating soft foods that won’t cause pressure on your gums and teeth
• Elevate your head with a pillow when sleeping

It is common to experience some pain following gum flap surgery. Some people also get anxiety issues about their perception of pain after the surgery. 

To help reduce both conditions, dentists can prescribe some pain medications for the recovery period.

Potential Complications

Some side effects associated with gum flap surgery include bleeding, infection and paresthesia.

Bleeding

It is normal to get gum bleeds after the periodontal flap surgery for one to two days. If it goes beyond that, it could indicate a surgery complication. To stop the bleeding, do the following:

• Remove excess blood clots using gauze.
• Put a clean gauze over the area with excessive bleeding.
• Apply pressure on that area for 20 minutes.
• Inform your dentist about the persistent bleeding if it doesn’t stop.

Infections

A common infection is an alveolitis, also known as dry socket. It causes the inflammation of the jaw bone holding your teeth in place (alveolar bone). Thankfully, there are home remedies:

• Use the prescribed pain medications
• Rinse your mouth using warm water
• Don’t use carbonated drinks until you heal

Paresthesia

In rare cases, you could experience paresthesia, a tingling and burning sensation in your mouth after the surgery. This is primarily cause by anesthesia. 

The uncomfortable feeling should resolve with the weakening of the anesthesia.

Candidates for Gum Flap Surgery

About two in five adult Americans have a gum disease. That does not mean you need a periodontal flap surgery each time you have the disease. 

You may require gum flap surgery if your gum disease has progressed to a more severe form called severe chronic periodontitis. Other reasons that make you a perfect candidate for the gum flap surgery include:

• The condition is not responding to non-surgical therapeutic procedures.
• Your periodontal pockets have gotten excessively deeper.
• Gummy smile – your smile shows a significant amount of your gum line.
• Inflamed gums that are bleeding excessively.
• If you have tooth mobility, highly displacing your teeth beyond their usual boundaries.

References

Periodontal Diseases in Adults. (August 2021). National Institute of Dental and Craniofacial Research. 

What is gum recession, and how do gum grafts work to remedy it? (March 2021). TuftsNow. 

Periodontitis. (Feb 2020). MayoClinic.

Infectious postoperative complications in oral surgery. (January 2020). Journal of Clinical and Experimental Dentistry.

Incidence and severity of postoperative complications following oral, periodontal, and implant surgeries: A retrospective study. (November 2019). National Library of Medicine. 

Association of Anxiety with Pain Perception following Periodontal Flap Surgery. (February 2018). Journal of International Society of Preventive & Community Dentistry.

Necrotizing Ulcerative Gingivitis. (July 2017). Contemporary Clinical Dentistry.

Dry socket. (January 2017). Mayo Clinic.

Periodontal therapy for severe chronic periodontitis with periodontal regeneration and different types of prosthesis. (August 2014). The Bulletin of Tokyo Dental College.

Periodontal Disease? (July 2013). Centers for Disease Control and Prevention. 

Infected periodontal granulation tissue contains cells expressing embryonic stem cell markers. A pilot study. (2013). Swiss Monthly Journal for Medicine. 

New anesthetic technique in periodontal procedures. (August 2012). Journal of Indian Society of Periodontology.

Use of fibrin glue in periodontal flap surgery. (January 2008). Journal of Indian Society of Periodontology.

The Modified Widman Flap. (August 1974). Northwestern University Dental School.

After Your Oral Surgery. Washington University, School of Dentistry.