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Gingival Flap Surgery

Last updated Feb. 21, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Gingival Flap Surgery, also known as Pocket Reduction Surgery, is the most common surgical technique to treat gum disease.

Background Information:

What are the other Names for the Procedure?

  • Flap Procedure for Gum Disease
  • Periodontal Flap Surgery
  • Pocket Reduction Surgery

What is Gingival Flap Surgery?

  • Gingival Flap Surgery, also known as Pocket Reduction Surgery, is the most common surgical technique to treat gum disease
  • Gum disease (periodontal disease) is commonly due to bacterial infection that results in excess formation of plaque. This may affect the teeth and roots of the teeth, resulting in its destruction

What part of the Body does the Procedure involve?

Gingival Flap Surgery involves the affected region of the gums, teeth, surrounding tissue, and blood vessels.

Why is the Gingival Flap Surgery Performed?

A Gingival Flap Surgery is performed to treat gum disease (periodontitis), to prevent the gum infection from spreading, and for improving one’s cosmetic appearance.

What are some Alternative Choices for the Procedure?

A Gingival Flap Surgery is performed when medical therapy has failed. However, there are several surgical techniques to treat gum disease or periodontitis, which include:

  • Guided tissue regeneration technique
  • Crown lengthening surgery or gingivectomy (or muco-gingival surgery)
  • Gingivoplasty
  • Soft tissue graft technique
  • Periodontal laser therapy

What are the Recent Advances in the Procedure?

Laser therapy to treat gum disease or periodontitis is advancement to the procedure. 

What is the Cost of performing the Gingival Flap Surgery Procedure?

The cost of Gingival Flap Surgery procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding a Gingival Flap Surgery procedure and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

https://www.ndcs.com.sg/ForPatientsAndVisitors/ConditionsAndTreatments/Glossary/Pages/PeriodontalSurgeryGumSurgery.aspx (accessed on 01/02/2018)

https://www.colgate.com/en-us/oral-health/conditions/gum-disease/gingival-flap-surgery (accessed on 01/02/2018)

Prior to Gingival Flap Surgery:

How is the Gingival Flap Surgery Performed?

The Gingival Flap Surgery is performed in the following manner:

  • The oral surgeon will conduct an oral examination and clean the affected region/teeth. He/she will also enquire about health conditions and current medications that are being taken
  • Local anesthesia is then administered to numb the region and an incision is made on the gums at the affected site
  • The gums are folded back like a flap, to gain access to the underlying infected tissue, which is then removed. Also, any plaque and disease-causing bacteria is removed
  • The area is then scaled or planed to smoothen the ridges or rough areas that may cause the gum disease to recur (deep gum pockets are cleaned/planed)
  • The removal of plaque, tartar below the gum line may be done manually and/or using an ultrasound scaling device. This may be removed over 2-4 sittings
  • After surgery, the gums are pulled over the teeth, sutured, and secured. The sutures may have to be removed after a week, or the stitches may be of the dissolvable type (meaning they do not require removal)
  • A special dressing called periodontal pack is then placed over the surgery site

Where is the Procedure Performed?

A Gingival Flap Surgery is usually performed in an out-patient surgery center facility, a dentist’s or periodontist clinic/office, or a hospital.

Who Performs the Procedure?

A dental professional expert or a periodontist performs a Gingival Flap Surgery.

How long will the Procedure take?

The time depends on the type of Gingival Flap Surgery technique used. However, it may take anywhere between 1-2 hours or more, over several sessions.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Gingival Flap Surgery and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed 
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure 
  • Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure 
  • It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery 
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed 
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged 
  • For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Gingival Flap Surgery using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Gingival Flap Surgery?

Before a Gingival Flap Surgery, the patient has to undergo certain tests such as:

  • Routine blood and urine analysis
  • X-rays of the mouth

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Gingival Flap Surgery?
  • Why is this procedure necessary? How will it help? 
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure? 
  • What are the complications that might take place during recovery? 
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
  • What are the costs involved?

During the Gingival Flap Surgery:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection is administered prior to the Gingival Flap Surgery procedure.

How much Blood will you lose, during the Procedure?

The blood loss during a Gingival Flap Surgery is usually minimal.

What are the possible Risks and Complications during the Gingival Flap Surgery?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
  • Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk 
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders and chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Gingival Flap Surgery are:

  • Excessive bleeding
  • Infection of the surgical wound
  • Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Gingival Flap Surgery?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise

After the Gingival Flap Surgery:

What are the possible Risks and Complications after the Gingival Flap Surgery?

The possible risks and complications that may arise after Gingival Flap Surgery are:

  • Excessive bleeding
  • Severe facial swelling
  • Infection in the surgical wound
  • Cold or heat sensitivity of teeth due to exposed roots

What is the Prognosis after the Surgery?

A complete recovery from Gingival Flap Surgery procedure is usually achieved. The prognosis is excellent without any serious complications being observed. However, the procedure is not a cure for periodontal infection and proper oral hygiene following surgery is essential.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Worsening pain and swelling of the surgical wound
  • Bleeding or fluid drainage from surgical wound
  • The dressing falls off
  • The occurrence of any symptom that causes uneasiness such as nausea or vomiting
  • Prolonged or excessive bleeding after the surgery
  • Numbness or cold sensation of the gums
  • Signs of an infection
  • Headache, muscle aches
  • Fever, feeling sick
  • Dizziness
  • Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Gingival Flap Surgery?

At home, the following post-operative care is recommended after a Gingival Flap Surgery:

  • Use ice packs to relieve pain over a few days; apply ice packs regularly to reduce facial swelling, at intervals of 10-15 minutes each
  • If necessary, pain-relief medication may be prescribed
  • Complete the course of prescribed medication/antibiotics as advised by the physician
  • Individuals are advised to have to clear liquids after surgery, after bleeding is stopped (for the next 24 hours); then soft foods, till recovery (for about 3-5 days)
  • Have a well-balanced diet, which can aid in a faster recovery; avoid spicy or hard foods for a certain period of time
  • Keep mouth clean/clean teeth using suitable toothbrush and toothpaste

How long does it normally take to fully recover, from the Procedure?

A complete healing and return to normal color of the affected gum tissue should take between 1-2 weeks after the surgery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

In many cases, no tissue is removed during a Gingival Flap Surgery. However, if any tissue is removed, then it is taken for further examination and later disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Gingival Flap Surgery?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility, dentist’s or periodontist clinic/office, or a hospital
  • An anesthesiologist (if anesthesia was administered) 
  • A dental professional or a periodontist
  • A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before the Gingival Flap Surgery is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Feb. 21, 2018
Last updated: Feb. 21, 2018