Surgical Treatments for Gum Diseases

Flap surgery/pocket reduction surgery: In this procedure the gums are lifted & calculus is removed. Irregular surfaces of bone are smoothened. The gums are then placed so that it fits snugly around the tooth. This reduces the size of the space between the gum & tooth, decreasing the areas where harmful bacteria can grow.

Bone grafts: involves using fragments of your own bone, synthetic bone to replace bone destroyed by gum disease. The grafts serve as a platform for the regrowth of bone, which restores stability of teeth.

Soft tissue grafts: This procedure reinforces thin gums or fills in places where gums have receded. Protect root surface from sensitivity, caries/abrasions & improves hygiene.

Depigmentation of dark gums: Pigmentation affects most of gum tissue with a complete brown appearance. The pigmentation can be completely removed surgically. Discomfort to the patient pre & post surgery is minimal.

Crown lengthening: is a surgical technique for gummy smile. It is a procedure performed to expose greater amount of tooth structure to restore prosthetically & esthetically. Appropriate crown margins can violate the requirements for periodontal health. An Inappropriate crown margin increases plaque accumulation in close proximity to bone crest.

Guided tissue regeneration: is a procedure in which a barrier membrane is placed under the gum & over the remaining bone. It is performed to stimulate growth when the bone supporting your teeth has been destroyed. A small piece of mesh-like fabric is inserted between the bone & gum tissue.

Bone surgery: modifies bone support altered by periodontal disease, either by reshaping the bone, without removal or by the removal of some alveolar bone.

Looking for treatment of periodontal disease?? 

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  • Laser treatment is becoming widely recognised and can be applied to prevent caries from developing and to reduce the progression of caries.
  • The mechanism of laser should be understood before a dentist could apply in his daily practice.
  • The Enamel surface of tooth is made of crystals called ‘Hydroxyapetite’ and it is permeable in nature therefore allowing diffusion of ions.
  • During laser treatment, moderate heat(CO2 laser produces temp > 1000 degree celcius) is produced which changes the composition of Enamel from ‘hydroxyapetite’ to ‘carbonated apetite’ in which there is loss of water in the crystals, as a result the pores of Enamel shrink down to form ‘Microspace system’. The Microspace system provides a means for trapping Calcium, phosphate and fluoride ions which release during demineralization and acts as site for re-precipitation.
  • The trapped minerals phases inside the Enamel and impedes lesion formation and progression causing enhanced resistance against demineralization.
  • As the microspaces are smaller in size, it decreases the permeability of the Enamel thereby reducing the diffusion of ions in and out thereby reducing the demineralization process. Thus a seal is achieved and so is resistance to caries.
  • The Dentin also gets acid resistance as there is increased mineral content due to burning of organic matter from tissue so there is increased Calcium and Phosphate found in recrystallized Dentin.

If you want to consider being mentored by Dr Rajat Sachdeva contact him directly on 01142464041 for an informal chat.

Soft Tissue Grafting

This is in preposition of a treatment planning of an appropriate surgical technique for increasing the width of the attached mucosa in order to maintain Peri-implant health.

The soft tissue around gingival being divided into gingival and mobile alveolar mucosa, the gingival width varies individually as 2-9 mm.There is a time-point to distinguish the peri-implant mucosa from the gingival around the teeth:  The peri-implant connective tissue has less number of fibroblasts & more collagen fibers’ as compared to gingiva.  The junctional epithelium is more permeable with scarce number of blood vessels than that of around the tooth. 

The peri-implant connective tissue fibers’ run in a parallel direction to the implant or abutment surface without being attached rather being perpendicular to the root cementum.

It has been concluded that presence of non-elastic collagen fibers’ in the connective tissue is responsible for keratinization. Based on findings, >2 mm of keratinized tissue is required for maintenance of healthy gingival tissues.However,around the dental implants, the crucial role of an adequate width of keratinized /attached mucosa for the clinical success is still controversial.

Recent studies have shown that lack of adequate width of Keratinized alveolar mucosa around dental implants is associated with more plaque accumulation, inflammation, soft tissue recession, attachment loss.

Since implant surgery includes one or two stage bone augmentation procedures, displacement of the mucogingival Junction does occur.hence, in order to regulate the width of keratinized attached mucosa, two different peri-implant soft tissue augmentation procedures can be concluded:

Increase in soft tissue volume using a sub epithelial connective tissue graft or soft tissue replacement graft

Enlargement of keratinized mucosa width by means of an apically repositioned flap/vestibuloplasty.

How to overcome dental anxiety

Have a visit due to your dentist that you have been avoiding for a long time? Is there a general sense of fear associated with that dental chair and the various sounds and noises it produces? Do not worry. You are not the only one. The idea of going to a dentist can cause as much anxiety as the pain that a decayed tooth may be causing. The responses are not age related. Different people could have different reactions dealing with dental anxiety. Some may be calm and composed and some may be total wrecks. A lot depends on the dentist and the environment he/ she creates for the patients. Understanding the patients and their levels of anxiety could be crucial in assessing their levels of anxiety and help them overcome it.

Assessment of dental anxiety

There are numerous ways available to assess dental anxiety, both in children and adults. A five point scale that is reliable and quick to administer. It has cut-offs for mild, moderate, and phobic levels of anxiety.

Interventions for individuals with low levels of anxiety

 For children attending with low levels of dental fear, approaches that can be adopted include:

  • Rapport building: like use of a magic trick. The use of magic trick increases cooperation when compared to no intervention or the use of tell-show-do technique.
  • Voice control: using loud voice with deep tone is more effective in reducing disruptive behavior of a child & interaction more pleasurable than the normal voice level
  • Distraction: there are number of ways which can be used for distraction such as: the use of video-taped cartoons, audio-taped stories and video games. Distraction techniques are equally effective as relaxation-based techniques, and superior to no intervention.
  • Modeling: modeling has been used extensively with children and is generally most effective if the observed child is similar in age, gender and level of dental anxiety to the child watching, if the child enters and leaves the surgery without adverse consequences.
  • Environmental change: three studies have sought to make the dental environment more attractive to children attending the dental surgery.

Approaches can be used in patients with low dental fear:

  • Enhancing the sense of control: One of the most commonly used techniques to do this is the stop signal.  In this patient can raise the hand and give signal to the dentist.
  • Cognitive distraction: the patient is encouraged to think about something other than the dental situation, be in  a happy place or think of a less stress causing situation.
  • Environmental change: soothing smell of lavender in dental waiting area to reduce the immediate fear of the patient but it will not reduce the underlying cognitive factor.

Interventions for individuals with moderate levels of anxiety

 Patients with moderate levels of dental anxiety may benefit from the prior preparatory information.

  • Information about what will happen (procedural information)
  • Information about what sensations the individual will experience (sensory information)
  • Information about what the individual can do to cope with the situation (coping information).

Interventions for individuals with high levels of anxiety

Pharmacological management

This includes relative analgesia, conscious sedation and general anesthesia. These management techniques are not much used but there are ongoing needs for such services when patient is not regular to visit for treatment or to the point where they are in severe pain or with compromised oral health

Cognitive behavioural therapy

It is a synthesis of behaviour therapy and cognitive therapy and uses both behaviour modification techniques and cognitive restructuring procedures to change maladaptive beliefs and behaviours. Behavioural aspects of CBT include learning relaxation skills, conducting mini-experiments and systematic desensitization. An important principle underlying CBT is its focus on the ‘here and now’ as what started a problem is often not the same as what is keeping it going.

Surgeries For Vestibular Deepening

Surgeries have explored rising trends in dentistry with its own skew. The speed at which new concepts enter the dental field often outpace our ability about tissues when we think we might get closer to make sense of it all.

Bone tissue is a specialized & mineralized connective tissue, most resilient with significant physical properties as high resistance to tensile, stress & compression forces with some elasticity.

Throughout existence the bone mass has a tendency to be remodeled through bone formation & resorption,specifically in the oral cavity due to lack of stimulus there is gradual bone loss post extraction in the alveolar process from the initial 12mm /year post extraction to 0.2mm /year after 2 years.

This chronic, irreversible, mounting process of alveolar ridge resorption prevails on an average of four times greater in the mandible compared with the maxilla.

Preprosthetic surgeries

Vestibuloplasty is a preprosthetic mucogingival therapy for the purpose of increasing the attached gingiva by repositioning the mucosa of bone augmenting the contact surface area of the denture to restore the stomatognathic function in cases where stability for prosthesis has lost or implant placement is contradicted.

The main indication of vestibuloplasty is lowering of the smile line for rehabilitation of the masticatory system.

It is also associated with implants to recontour the alveolar crest along with graft like hydroxyapatite or biomaterials. It may be performed in inflammatory areas & tissue recession around implants by traction of mentonian muscle to facilitate soft tissue health adjacent to implants.

The surgical techniques for vestibuloplasty may be divided into four groups: submucosal, secondary epithelisation; by transposition flaps; by grafts.

The following are some of the commonly used techniques:  secondary epithelisation; vesitbuloplasty by mucosal advancement; skin grafts i.e. mucosal or allogeneic and partial thickness material; the Clark technique for augmenting the depth of floor of the mouth; the obwegeser technique for augmenting the vestibular region & the depth of the floor of the mouth with grafts.

Kazanian technique consists of an incision in the labial mucosa of the mandible at 1.5 cm,elevation of the mucosal flap,& its repositioning in the bottom of the new sulcus.The technique described by the obwegeser is combination of kazanjian and Clark used simultaneously together with the aim of deepening the floor of the mouth.

Misch recommends vestibulolasty associated with the use of implants, with the intention of increasing the height & shape of  the vestibular ridge tissues & muscle insertions upto the height of the periosteum filling with hydroxyapatite or biomaterial (freeze dried bovine bone).

Predominantly the objective of such reconstructive surgeries is to establish a base to support the insertion of a dental prosthesis, transforming the anatomic structure into functional biologic platform for support or retention of prosthetic rehabilitation.


Dr.Prof.Rajat Sachdeva

Oral Surgery Clinical Training

This oral surgery course will cover all surgical procedures required in dental practice with video and live demonstrations and practical training on patients.

  • Infection Control
  • Local Anesthesia – Technique & Pitfalls
  • Radiographic interpretation for exodontias
  • Extraction
    • Technique
      1. Open
      2. Closed
    • Complications
  • Flap
    • Design
    • Rationale
  • Sutures
    • Materials
    • Techniques
    • Hands-on
  • Medically compromised patients
  • Impactions
  • Minor Oral Surgery
    • Biopsy
    • Frenectomy
    • Alveoplasty
    • Oro-antral communication
  • Hands- On
    • Flaps
    • Sutures
    • Extraction Technique
  • Patient – Extraction by open technique
  • Emergencies in dental office

Course Duration: 4 Days, 2 WEEKENDS