Osseous Surgery (Including Flap Entry and Closure) – D4260

Name of the Procedure:

• Common Names: Osseous Surgery, Pocket Reduction Surgery
• Technical/Medical Term: Osseous Surgery (Including Flap Entry and Closure) for Four or More Contiguous Teeth or Tooth Bounded Spaces Per Quadrant (D4260)

Summary

Osseous surgery is a dental procedure designed to treat gum disease by reshaping the bone that supports your teeth. It involves lifting the gums, removing diseased tissue, and smoothing the bone to eliminate deep pockets that harbor bacteria. This helps in maintaining dental health by preventing further damage caused by periodontal disease.

Purpose

• Medical Conditions Addressed:
  • Periodontal Disease
  • Deep periodontal pockets
• Goals/Expected Outcomes:
  • Reduce pocket depth
  • Eliminate bacterial habitats
  • Promote healthier gum attachment
  • Prevent further bone loss

Indications

• Symptoms such as bleeding, swollen gums, and deep periodontal pockets
• Diagnosed with moderate to severe periodontitis
• Ineffectiveness of non-surgical treatments like scaling and root planing

Preparation

• Pre-procedure instructions may include:
  • Maintaining good oral hygiene
  • Potential fasting if sedation is used
  • Adjustments to certain medications, as advised by your dentist
• Diagnostic Tests/Assessments:
  • Dental X-rays
  • Comprehensive periodontal examination

Procedure Description

1. Anesthesia: Local anesthesia is administered to numb the area.
2. Incisions: Small incisions are made in the gums to create a flap.
3. Flap Entry: The gums are lifted to expose the bone and root surfaces.
4. Tissue Removal: Diseased tissue and bacteria are removed.
5. Bone Reshaping: Irregularities in the bone are smoothed out.
6. Closure: The gum flap is repositioned and sutured back in place.
   • Tools and Equipment: Scalers, curettes, dental lasers (optional), sutures.
   • Anesthesia: Local anesthesia; sedation may be used in some cases.

Duration

Typically, the procedure takes about 1-2 hours, though this can vary depending on the extent of the disease and number of quadrants treated.

Setting

• Performed in a dental office, outpatient clinic, or surgical center.

Personnel

• Periodontist or Oral Surgeon
• Dental Assistants and/or Hygienists
• Anesthesiologist (if sedation is used)

Risks and Complications

• Common risks: Bleeding, swelling, discomfort
• Rare complications: Infection, prolonged numbness, recession of gums
• Management: Anti-inflammatory medications, antibiotics, follow-up visits

Benefits

• Dramatic reduction in pocket depth
• Reduced risk of tooth loss
• Improved oral hygiene and overall dental health
• Benefits may be noticed in a few weeks as healing progresses

Recovery

• Post-procedure care: Maintain good oral hygiene, avoid certain foods, take prescribed medications
• Limit physical activities as directed
• Expected Recovery Time: Generally 1-2 weeks
• Follow-up: Scheduled with the periodontist to monitor healing

Alternatives

• Non-surgical options: Scaling and root planing, antibiotic treatments
• Other surgical options: Guided tissue regeneration, bone grafting
• Pros and Cons: Non-surgical methods may not be sufficient for severe cases; other surgical methods may offer different benefits or suit specific cases better.

Patient Experience

• During the procedure: Minimal pain due to local anesthesia; possible discomfort if sedation is not used
• After the procedure: Mild to moderate pain managed with pain relievers, possible swelling, restricted diet for a few days
• Comfort measures: Cold compresses, prescribed medications for pain management

This detailed overview aims to provide a comprehensive understanding of osseous surgery, ensuring the patient feels informed and prepared for the procedure.