From the Guidelines
Periodontal flap surgery should be considered a last resort, with a strong emphasis on minimal invasiveness and patient-centered care, focusing on reducing surgical and procedure chair time, patients' intra- and postoperative discomfort, and promoting overall patient satisfaction. When deemed necessary, the procedure typically takes 1-2 hours per quadrant of the mouth under local anesthesia. The goal of periodontal flap surgery is to access the tooth roots and surrounding bone for thorough cleaning and repair, removing tartar deposits, smoothing damaged bone, and eliminating bacterial pockets. According to a recent study 1, the future of periodontology lies in minimal invasiveness, and clinicians should prioritize patient-reported outcomes and the entire treatment experience.
Some key considerations for periodontal flap surgery include:
- Reducing surgical and procedure chair time to minimize patient discomfort and disruption of daily activities
- Utilizing microsurgical instruments and biologics, bioactive mediators, and nonautogenous grafting substitutes whenever possible
- Focusing on patient satisfaction and overall treatment experience, rather than just clinical endpoints
- Promoting gentle oral hygiene and postoperative care to prevent infection and promote healing
In terms of post-surgery care, patients may be prescribed antibiotics (such as amoxicillin 500mg three times daily for 7-10 days) and pain medication (ibuprofen 600mg every 6 hours as needed), and should use a chlorhexidine gluconate 0.12% mouth rinse twice daily for two weeks to prevent infection. A soft food diet, avoidance of smoking, and gentle oral hygiene are also recommended during the recovery period, which typically takes 1-2 weeks. Follow-up appointments are usually scheduled at one week and one month post-surgery. As noted in the study 1, the concept of "necessity" in treatment outcomes is not fixed and depends on various situations and considerations, highlighting the need for a patient-centered approach.
From the Research
Periodontal Flap Surgery Overview
- Periodontal flap surgery is a treatment approach for periodontitis, which involves folding back the gum to remove bacteria and tartar [(2,3)]
- The goal of periodontal flap surgery is to improve clinical parameters such as plaque index, gingival index, pocket probing depth, and clinical attachment level 2
Adjunctive Therapies
- Adjunctive antibiotics, such as metronidazole and doxycycline, can enhance the surgical treatment outcome by improving clinical parameters 2
- Scaling and root planing before periodontal flap surgery can also improve treatment outcomes, including probing depth reduction 3
- Systemic antimicrobial therapy using a combination of amoxicillin and metronidazole as an adjunct to scaling and root planing can enhance the clinical benefits of non-surgical periodontal therapy 4
Post-Surgical Care
- The use of periodontal dressings, such as Diplen LX membrane and Coe-Pak, can minimize complications and improve patient comfort after periodontal flap surgery 5
- Intrapocket anesthesia, such as lidocaine prilocaine dental gel, can be effective for pain control during scaling and root planing 6
Clinical Outcomes
- Periodontal flap surgery can result in significant improvements in clinical attachment level and probing depth [(2,3)]
- The use of adjunctive therapies, such as antibiotics and scaling and root planing, can further enhance treatment outcomes [(2,3,4)]