Best Periodontal Flap Surgery in Delhi, India

When oral health is neglected, the gums are the first to be affected. Untreated gum disease weakens the structure that holds the tooth in place, a condition called periodontitis. Periodontal flap surgery is indicated if periodontitis does not respond to non-surgical treatment options such as scaling (teeth cleaning) and root planing.  

Periodontal flap surgery is the best treatment of choice for periodontal pockets. These pockets are formed when the gums detach from the adjacent teeth, exposing the tooth's root surface and sometimes bone. If left untreated, the resulting area can host food particles, bacteria and infections.

The gums may show signs of inflammation such as redness, swelling, bleeding on probing, and sensitivity to hot and cold. 

Flap surgery is not a cure for periodontal disease, but it removes plaque from uncleanable zones, treats receded gums, and restores aesthetics. Additionally, it creates an environment that makes it easier for the patient to maintain periodontal health. Appropriate professional treatment and regular care at home can help keep the teeth and gums healthy for as long as possible.

When is Periodontal Flap Surgery Needed?

Periodontal flap surgery is indicated in patients with severe gum disease or periodontitis. This surgery would accompany antibiotic coverage, and scaling and root planing. It is carried out in cases where aesthetics is a major concern. For instance, if a patient has a low gum line, the gums can be cut and re-shaped to enhance aesthetic appeal. 

In cases of the receded gum line where the tooth can be salvaged, gums can be repositioned to achieve aesthetic and functional results.  

Diagnosis for Periodontal Disease 

Most patients are asymptomatic at the beginning of gum disease. However, as the disease progresses, the gums begin to swell, become inflamed, and cause bleeding when brushing or even touching them. More advanced periodontitis affects oral as well as systemic health. 

A dentist would visually inspect the gums for swelling, redness, gaps between teeth, bad breath, a receded gum line, and tooth root surface exposure. On probing, periodontitis can be confirmed if there is bleeding from the gums and an evident pocket has been formed. The tooth may also be mobile and sensitive.

Treatment for Periodontal Disease

Flap surgery is typically performed under local anaesthesia, sometimes accompanied by oral anti-anxiety medications. Alternatively, it may be performed under conscious sedation in patients with extreme anxiety. After anaesthesia has taken effect, a small cut is made to create space between the gums and teeth. The outer gum tissue is folded back to access the roots, periodontal ligament and bone.

Then the inflamed gum tissue is removed and the tooth roots are cleaned. The area is sometimes treated with antibiotics or other medications if needed. Bone defects are repaired with bone grafting material (autogenous bone or artificial bone), and proper regeneration of the periodontal ligament is allowed using barrier membranes and chemical growth factors. At last, the incision is closed with stitches, and a periodontal pack is placed.

Who are the Best Candidates for Periodontal Flap Surgery?

A flap procedure is advised for patients with moderate to severe gum disease who have not responded to non-surgical treatment options such as scaling and root planing. Patients with advanced periodontitis can be treated with gum flap surgery. Symptoms include:

• Inflammation and bleeding of the gums
• Tooth sensitivity
• Tooth mobility
• Severe gum recession
• Tooth loss
• Persistent halitosis

During a consultation with the dentist, signs of periodontal disease are inspected, and the pockets around the teeth are measured. Non-surgical treatments may suffice for mild to moderate periodontal disease. However, cases of advanced gum disease may likely need periodontal flap surgery.

This treatment helps remove built-up plaque around the roots and restore the health of gums. Sometimes, bone grafting may be done to improve bone and tooth health. The dentist can determine whether the gum flap surgery is suitable for a patient by examining the oral and overall health during an initial consultation.

Who Should Not Consider Periodontal Flap Surgery?

Patients with hopelessly loose teeth and only a few remaining in the mouth are not ideal candidates for periodontal flap surgery. 

How to Prepare for Periodontal Flap Surgery?

Periodontitis may recur if proper care is not taken. Hence, before the surgical procedure, the following points should be kept in mind:

• Tell the dentist of recent changes in medical history - medications, allergies, or supplements.
• Take the prophylactic prescription medications on time.
• Talk to the dentist if more than one drug is being taken at once to prevent drug interactions.
• Eat well before the surgery.
• Clean the mouth thoroughly with 2% Chlorhexidine mouthwash for 30 seconds before surgery. Do not eat or drink after rinsing.

Possible Complications of Periodontal Flap Surgery

Periodontal surgery is a safe procedure but carries certain risks. These risks may be:

• The roots of teeth may become sensitive for a few days. A desensitising paste can alleviate sensitivity.
• The gum disease may relapse if appropriate care is not taken and oral hygiene is not maintained as advised by the dentist.
• The shape of the gums may appear different, and a black triangle between teeth may form after complete healing.
• Gum surgery risks introducing harmful bacteria into the bloodstream and may lead to systemic infection if medicines are not taken as advised.
• Gum tissue may also get infected.
• Aesthetics may be compromised in some cases.

Care After  Periodontal Flap Surgery

Healing of gums after the surgery takes a week. Following post-operative care instructions given by the dentist is essential. General instructions given by dentists for a speedy recovery are as follows:

• Taking medicines as instructed is important to avoid inflammation and pain. 
• After the first 24 hours, gently rinse the mouth with warm salt water 5-6 times a day. This helps reduce swelling and relieve pain.
• Change the periodontal pack if it becomes soaked with blood.
• Make sure to get adequate rest after surgery. Strenuous physical activity may increase bleeding from the surgical site.
• Eat soft food such as pudding, rice and soup, and gradually move to a solid diet as the wound heals. 
• Avoid eating from the same side as the surgery. 
• Keep the head elevated to prevent excessive bleeding.
• Continue to brush your teeth and tongue.
• Applying a cold pack to the cheek of the operated side helps alleviate pain and reduces swelling.
• Do not suck, such as when using a straw for drinking.
• Do not smoke.

Dentists remove the stitches after 7-8 days of surgery.

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