Gingival (periodontal) flap surgery describes a state of-the-art surgical technique commonly used to treat and repair periodontal pockets, a frequent consequence of periodontal (gum) disease, the end result of inflammation and infection that causes gum tissue to become detached from the teeth.

When there is advanced periodontal disease, the stability of the teeth becomes compromised by infection, affecting ligament and bone.  To correct it, a gingival (periodontal) flap surgery (gingivectomy) will be needed, but only after antibiotics have failed to stop it, and a non-surgical treatment called scaling and root planning has been done to eliminate the infection.

There are three stages of gum disease — a progression that can affect the bone that surrounds and supports your teeth:  gingivitis, periodontitis, and advanced periodontitis.  It can be painless, so it is very important to be aware of the symptoms, which can include:

  • Swollen, red, tender or bleeding gums
  • Gums that recede or move away from the tooth
  • Persistent bad breath or bad taste in mouth
  • Loose teeth
  • Visible pus surrounding the teeth and gums

In a gingivectomy, an oral surgery performed under local anesthetic, the periodontist will use a scalpel to open the gum with vertical incisions on both sides of the tooth or teeth to be treated, and separate the gum from the bone, lifting or folding back the gum tissue like the flap of an envelope, exposing the root to allow calculus (hardened plaque) buildup to be removed.  Any inflamed or necrotic tissue between the teeth or in the bone will be removed.  Scaling and root planing to clean plaque and tartar is then performed, and any bone damage will be repaired.  This procedure to smooth the edges of the bone to limit places for plaque to grow is called osseous recontouring.  If there is bone loss, a bone graft may be used to help restore the bone.

Finally, the flap of gum tissue will be positioned back against the teeth and stitched in place, either with stitches that dissolve on their own or the type that will need to be removed a week to 10 days later.  Sometimes a bandage called a periodontal pack or dressing may be used cover the surgical site.

Following the surgery there may be some mild to moderate discomfort that can usually be handled with an over-the-counter pain reliever.  You will need to take good care of the surgical site:

  • Gentle brushing (teeth and tongue) and flossing, but avoiding the surgical site.
  • Use an antimicrobial mouthwash recommended by your periodontist, or warm salt water.
  • Avoid vigorous swishing of mouthwash or water, or sucking such as using a straw.
  • Apply ice to the face, with a thin covering between skin and ice, to reduce any swelling.
  • Avoid strenuous physical activity — it might increase bleeding.
  • Eat cold foods, liquid or soft, for a day or two: applesauce, chocolate pudding, ice cream…
  • Take any prescribed antibiotics and/or pain medications as directed.
  • Keep your head elevated, recliner or two pillows.
  • No smoking is allowed. It inhibits healing and jeopardizes the surgery.
  • See your periodontist in 7 to 10 days to check on healing progress.

The beauty and essence of the flap approach is that it maintains and preserves the existing healthy outer layers of gingival tissue while allowing access to remove diseased tissue and regenerate new tissue within.  Only when free of contaminants can new tissues grow and reattach to root surfaces.  When the inside of the flap and roots are freshly cleaned, “growth factors” can be used to stimulate and enhance healing.

The long-term goal of periodontal surgery is to help increase the life expectancy of the teeth, by controlling the basic cause — the bacterial biofilm, i.e., plaque.  Technically speaking, it is not a cure, but rather creates an environment that makes it easier to maintain health.  Vigilance in home care and regular periodontal recall cleanings and monitoring are necessary to ensure long-term success.

If you are interested in gingival flap procedure in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.