Osseous Surgery

Osseous surgery (pocket reduction surgery) is a common gum disease treatment. It gets rid of bacteria and infection hidden beneath your gums.


What is osseous surgery?

Osseous surgery is a type of gum disease treatment. Periodontists use this procedure to treat moderate to severe periodontitis. The main goal of osseous surgery is to reduce the pockets around your teeth so plaque and bacteria can’t hide there.

Gum disease destroys the bone and tissues that support your teeth. Left untreated, it can lead to a host of oral health issues, like gum recession and tooth loss. It can also have a negative impact on your overall health, contributing to conditions like heart disease, diabetes and stroke.

Types of osseous surgery

There are two main types of osseous surgery:

  • Traditional osseous surgery: Your periodontist makes incisions to get to your teeth roots. They reshape the bone around your teeth to get rid of deep pockets where bacteria like to hide, and then stitch you up.
  • Laser osseous surgery: This newer method uses laser energy to target and kill bacteria around your teeth while keeping healthy tissue intact. Although it doesn’t require cuts or stitches, this procedure has mixed results.

Ask your healthcare provider which option is best for your situation.


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Procedure Details

How should I prepare for osseous surgery?

You should talk with your periodontist about how to properly prepare for osseous surgery in your particular situation. In general, take all of your prescription medications unless your periodontist tells you otherwise. Additionally, you may need to:

  • Stop taking blood-thinning medications (anticoagulants), like aspirin or warfarin. (Your healthcare provider will tell you when to stop taking these.)
  • Eat a good meal before the procedure, as you’ll be tender afterward.
  • Have a trusted friend or family member drive you to and from your appointment if you choose sedation dentistry. You won’t need a ride if you opt for local anesthesia or laughing gas (nitrous oxide).
  • Avoid smoking or drinking alcohol 24 hours before (and after) your procedure.

What happens during osseous surgery?

During osseous surgery, your periodontist will:

  1. Give you anesthesia to numb your teeth and gums. (If you want sedation, they’ll also give you those medications before they begin the procedure.)
  2. Make an incision (cut) along your gum line.
  3. Carefully fold back your gums so they can see your teeth roots.
  4. Clean the dental plaque and bacteria off your root surfaces.
  5. Smooth and reshape the bone around your teeth to get rid of pockets or areas of damage.
  6. Regenerate bone in areas of bone loss, if necessary. This could include the placement of membranes and dental bone grafts.
  7. Reposition your gums.
  8. Close the incisions with stitches.

How long does osseous surgery take?

It depends on the number of teeth that need treatment. In most cases, periodontal osseous surgery takes around 30 to 60 minutes.


Risks / Benefits

What are the benefits of osseous surgery?

Osseous surgery can:

  • Reduce harmful oral bacteria.
  • Reduce the size of the periodontal pockets around your teeth.
  • Improve your overall oral health.
  • Discourage plaque and bacteria from reattaching to your teeth roots.
  • Reduce your risk for heart disease, stroke and other conditions linked to gum disease.

How successful is osseous surgery?

Osseous surgery is very successful in treating gum disease. Osseous surgery jumpstarts your path to healthier teeth and gums, but you have to maintain your results with proper oral hygiene. This includes brushing and flossing your teeth daily and visiting your dentist regularly for cleanings.

What are the risks or complications of osseous surgery?

Like any surgical procedure, osseous surgery carries some risks, including:

Your periodontist can tell you how to manage these complications. But in general, the benefits of osseous surgery outweigh the risks.


Recovery and Outlook

How long does it take to recover after osseous surgery?

Osseous surgery recovery time depends on several factors, including the number of teeth treated, the severity of your condition and your body’s healing capacity. On average, recovery takes between two and four weeks.

Osseous surgery side effects

Common side effects that can occur after osseous surgery include:

  • Soreness.
  • Bleeding.
  • Swelling.
  • Bruising.

These side effects are normal and should go away in a few days. If you have lingering side effects or pain that doesn’t improve, let your periodontist know.

Taking care of yourself after osseous surgery

There are things you can do to ease your symptoms and foster a comfortable recovery:

  • Take all medications exactly as directed.
  • Use an antibacterial mouthwash to keep the surgical site clean.
  • Avoid drinking through straws for one week.
  • Eat soft foods, such as mashed potatoes, scrambled eggs and macaroni and cheese. (Ask your periodontist for a complete list of what to eat after osseous surgery.)

When To Call the Doctor

When should I call my periodontist?

If you’ve recently had osseous surgery, you should call your periodontist if you develop:

  • Bleeding that doesn’t slow down.
  • Pain that doesn’t improve with medication.
  • Infection or pus at the surgical site.
  • Fever over 101 degrees Fahrenheit (38.3 degrees Celsius).

Additional Details

Is osseous surgery the same as deep cleaning?

Osseous surgery is different from a deep cleaning (tooth scaling and root planing). A deep dental cleaning treats mild to moderate gum disease. It’s similar to a routine dental cleaning, but it reaches deeper beneath your gums. Periodontists reserve osseous surgery for people with moderate to severe gum disease.

How painful is osseous surgery?

Like most surgical procedures, you can expect some degree of soreness after osseous surgery. But you shouldn’t have severe pain or discomfort that keeps you up at night. If you develop pain that doesn’t get better with medication, let your periodontist know.

Do gums grow back after osseous surgery?

No, your gums won’t grow back after osseous surgery. Once periodontal disease destroys your gum tissue, gum graft surgery is the only way to get it back. This procedure helps add thickness and volume to areas of gum recession.

Just because you have osseous surgery doesn’t mean you’ll definitely need a gum graft. But if your gums recede and expose your teeth roots, this procedure can help restore your oral health.

Is osseous surgery really necessary?

Osseous surgery is only necessary when gum disease is too advanced for nonsurgical treatments. That’s why early detection is so important. The longer you wait to treat gum disease, the more bone and tissue you’ll lose around your teeth. In turn, you’ll need more invasive, more expensive treatments to manage the disease.

The best way to avoid osseous surgery is to practice good and consistent oral hygiene. This includes brushing twice a day, flossing once a day and visiting your dentist regularly for exams and cleanings.

Are there alternatives to osseous surgery?

LANAP (laser-assisted new attachment procedure) is the only realistic alternative to osseous surgery. Even then, it might not be the best option for everyone.

While other gum disease treatments exist, their purpose is to address milder forms of gum disease or regenerate lost tissue once infection is gone.

A note from Cleveland Clinic

Osseous surgery is the gold standard for treating moderate or advanced gum disease. It effectively reduces harmful bacteria and plaque that hide where your toothbrush and floss can’t reach. Once you have osseous surgery, the best thing you can do is visit your dentist regularly for cleanings and improve your oral hygiene at home. With proper management, you can keep harmful bacteria at bay and get back on track to long-lasting oral health.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 04/10/2023.

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