Periodontal Surgery

Periodontal surgery, also known as gum surgery or periodontal therapy, encompasses a range of surgical procedures aimed at treating advanced gum disease (periodontitis) and addressing structural issues affecting the gums and supporting tissues of the teeth. Periodontal surgery may be recommended when non-surgical treatments, such as scaling and root planing (deep cleaning), are not sufficient to control gum disease or restore periodontal health. Here's an overview of periodontal surgery and its various treatment options:

1. Gingival Flap Surgery:

• Gingival flap surgery is a common type of periodontal surgery used to access and clean deep pockets of infection and inflammation that have formed between the gums and teeth. During the procedure, the gums are gently lifted (flapped) back to expose the underlying tooth roots and surrounding bone. The dentist or periodontist then removes tartar deposits, eliminates diseased tissue, and smooths irregular surfaces on the tooth roots to promote gum reattachment and reduce pocket depth. Once the cleaning is complete, the gums are repositioned and sutured back into place.

1. Gingivectomy:

• Gingivectomy is a surgical procedure used to remove and reshape excess gum tissue (gingiva) that has overgrown and encroached upon the tooth surfaces, creating a "gummy" smile or making it difficult to keep the teeth clean. During the procedure, the dentist or periodontist carefully trims away the excess gum tissue using specialized surgical instruments, creating a more proportionate and aesthetically pleasing gum line.

1. Osseous Surgery (Bone Surgery):

• Osseous surgery is performed to address bone loss and irregularities in the alveolar bone (the bone that supports the teeth) caused by advanced periodontal disease. During the procedure, the dentist or periodontist accesses the diseased bone and removes or reshapes it to eliminate bacteria and create a smoother, more stable bone surface. Bone grafting or guided tissue regeneration techniques may also be used to regenerate lost bone tissue and promote bone growth in areas of significant bone loss.

1. Soft Tissue Grafting:

• Soft tissue grafting, also known as gum grafting, is a surgical procedure used to augment or replace lost or damaged gum tissue caused by gum recession or periodontal disease. During the procedure, tissue grafts sourced from the patient's own palate (autografts), donor tissue (allografts), or synthetic materials are placed over exposed tooth roots or areas of deficient gum tissue to improve gum health, reduce tooth sensitivity, and enhance the appearance of the smile.

1. Periodontal Plastic Surgery:

• Periodontal plastic surgery encompasses a variety of surgical techniques aimed at improving the aesthetics and function of the gums. This may include procedures such as crown lengthening to expose more of the tooth structure, ridge augmentation to correct deformities in the jawbone, and frenectomy to remove abnormal frenulum attachments that restrict movement of the lips or tongue.

1. Guided Tissue Regeneration (GTR):

• Guided tissue regeneration is a regenerative periodontal therapy used to promote the regeneration of lost periodontal tissues, including bone, cementum, and periodontal ligaments, in areas affected by advanced gum disease. During the procedure, barrier membranes are placed over the exposed root surfaces to prevent soft tissue ingrowth and facilitate the growth of new bone and periodontal ligament attachment.

Periodontal surgery is typically performed under local anesthesia to ensure patient comfort during the procedure. Depending on the complexity of the case and the specific treatment goals, multiple surgical appointments may be required to achieve optimal results. Following periodontal surgery, patients are usually advised to follow a post-operative care regimen, including maintaining good oral hygiene, taking prescribed medications, and attending follow-up appointments to monitor healing and ensure the success of the treatment. By addressing underlying periodontal issues and restoring gum health, periodontal surgery can help prevent tooth loss, improve oral function, and enhance the overall health and appearance of the smile.

Odontogenic Keratocyst

An odontogenic keratocyst (OKC), also known as keratocystic odontogenic tumor (KCOT), is a benign but locally aggressive cystic lesion that originates from the dental lamina or remnants of the dental lamina. It is one of the most common types of cysts that affect the jaws and is often associated with developmental anomalies such as nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome).

Here are some key points about odontogenic keratocysts:

1. Origin: Odontogenic keratocysts arise from the remnants of the dental lamina, which is an embryonic structure involved in tooth development. They most commonly occur in the posterior mandible (lower jaw), particularly around the angle and ramus areas, but can also affect the maxilla (upper jaw) and other regions of the jaws. These cysts typically present as well-defined radiolucent lesions on dental radiographs.
2. Clinical Presentation: Odontogenic keratocysts are often asymptomatic and may be discovered incidentally on routine dental radiographs. However, they can grow to large sizes and cause swelling, expansion of the jawbone, displacement of adjacent teeth, and paresthesia (numbness) of the lower lip or chin if they impinge on the inferior alveolar nerve. In some cases, odontogenic keratocysts may cause pain or discomfort if they become infected or associated with other pathologic conditions.
3. Histopathology: Microscopically, odontogenic keratocysts are characterized by a thin, stratified epithelial lining with a distinct basal layer and a parakeratinized or orthokeratinized surface. The epithelial lining exhibits a high mitotic index and a tendency for proliferation and invagination into the surrounding connective tissue, leading to the formation of daughter cysts or satellite cysts. The presence of a characteristic palisading or corrugated basal cell layer is a hallmark feature of odontogenic keratocysts.
4. Treatment: The management of odontogenic keratocysts typically involves surgical intervention to remove the cystic lesion and prevent recurrence. This may include enucleation (complete removal of the cystic lining) with or without curettage (scraping) of the surrounding bone, marsupialization (creation of a surgical window to decompress the cyst), or resection of the affected jaw segment in cases of extensive or aggressive lesions. Adjunctive measures such as chemical cauterization with Carnoy's solution or cryotherapy may be employed to reduce the risk of recurrence by destroying residual epithelial remnants.
5. Recurrence: Odontogenic keratocysts have a high recurrence rate compared to other types of jaw cysts, with reported recurrence rates ranging from 10% to 62% following surgical treatment. Recurrence is thought to be attributed to the presence of satellite cysts, daughter cysts, or residual epithelial rests that are not completely removed during surgery. Close long-term follow-up with clinical and radiographic examinations is essential for monitoring postoperative healing and detecting early signs of recurrence.

In summary, odontogenic keratocyst is a benign but locally aggressive cystic lesion that originates from the remnants of the dental lamina. It commonly affects the jaws and may present with swelling, expansion, or displacement of adjacent structures. Surgical removal is the mainstay of treatment, but recurrence rates are relatively high, necessitating long-term follow-up and surveillance.