This procedure modifies the bony support of the teeth by reshaping the alveolar process to achieve a more physiologic form. This may include the removal of supporting bone (ostectomy) and/or non-supporting bone (osteoplasty). Osseous surgery is performed in the presence of periodontal disease. The procedure is designed to modify and reshape deformities in the alveolar bone surrounding the teeth and to reduce pocket depths.
Bone, or bone regenerative materials used in an area that has lost bone to trauma, tooth loss, or disease process. Bone may be harvested from the patient (“autogenous” bone), or obtained from a tissue bank.
If human bone is obtained from a tissue bank, the term is “allogenic.” If non-human animal bone is used, the term is “xenoplastic.” Synthetic bone materials are referred to as “alloplastic.” Bone grafting procedures are prescribed to rebuild deficient areas of bone for restorative or cosmetic purposes.
An example includes rebuilding a site where a tooth was lost in order to place a dental implant. Dental billing codes used to document and report the surgery itself typically do not include the bone graft materials, or non-bone materials (like barrier membranes) which may aid in the grafting process.
Guided Tissue Regeneration
A membrane is placed over the root surfaces or defect areas following surgical exposure and debridement. The membrane is placed to exclude epithelium and gingival connective tissue from the healing wound. Guided tissue regeneration may also be carried out in conjunction with bone replacement grafts or to correct deformities resulting from inadequate faciolingual bone width in an edentulous area.
Pedicle Soft Tissue Graft
A surgical procedure in which a thin piece of keratinized gum tissue (i.e. the tough, fibrous connective tissue through which teeth emerge into the mouth) is released within an area with a surplus to donate, and moved sideways or vertically to an adjacent area where there is a deficiency. Prescribed for areas where there is inadequate fibrous tissue to resist mechanical forces (e.g. toothbrushing, food abrasion) over time—most commonly exposed tooth root surfaces, and those with thin overlying gum tissue.
Free Gingival Graft
A surgical procedure in which a piece of fibrous gum tissue is removed from one area in which it is abundant, and grafted onto another (typically non-adjacent) area where it is needed. Both the donor site surgery, and the grafted site are documented using this single code. Commonly prescribed for areas of thin fibrous tissue; where edentulous ridges need to be lengthened (e.g. prior to having dentures made); and to cover exposed tooth roots.
Subepithelium Tissue Graft
A surgical procedure in which fibrous connective tissue is removed from an area of abundance (usually the palate) and grafted INTO an area around a tooth where it is deficient. The graft is typically tucked into a specially prepared pocket at the recipient site. It is prescribed most commonly for teeth that have a narrow (measured along a line from the crown to the root tip) or thin (from surface of the skin inward) band of fibrous connective tissue over the root, for which the tooth is at risk, or has already experienced receding of the gums.
Soft Tissue Graft
Procedure is performed to create or augment the gingiva, with or without root coverage. This may be used to eliminate the pull of the frena and muscle attachments, to extend the vestibular fornix and correct localized gingival recession. There is no donor site.
This procedure is employed to allow restorative procedure or crown with little or no tooth structure exposed to the oral cavity. Crown lengthening requires reflection of a flap and is performed in a healthy periodontal environment, as opposed to osseous surgery, which is performed in the presence of periodontal disease. Where there are adjacent teeth, the flap design may involve a larger surgical area.
Removal of a tooth that is visible (i.e. “erupted”) in the mouth, in such a way that it is necessary to section the tooth into pieces, or raise a surgical flap of gum tissue to get it out. Usually prescribed for teeth with multiple roots, and/or that are extensively damaged or decayed, and are not feasible to save.
Ridge Preservation is a technique use to place when an extraction or implant has been removed (at the time of the extraction or implant removal) in an effort to preserve the alveolar ridge or in preparation for a future implant replacement.
Removal of an oral soft tissue sample from an area of suspected disease process, for evaluation in a pathology laboratory, in order to establish a diagnosis and appropriate course of treatment (if necessary).
A regenerative surgical procedure in which hard and/or soft tissue graft material is harvested – either from another site on the patient (or obtained from a tissue bank) – and inserted into an area that is deficient in those tissues. An example is reconstruction of the tooth-supporting “alveolar” bone—which used to house the teeth, and often dissolves away (i.e. “resorbs”) when the teeth are removed. Generally, regenerative procedures are prescribed when the patient’s dentition is to be reconstructed with dental implants, fixed or removable dentures, or a combination of these.
Placement of bone graft or synthetic graft materials into the maxillary sinus floor, where there is insufficient bone to place dental implants. Prescribed when upper back teeth have been removed and the sinus floor bone has remodeled to the point where it is too thin to accommodate dental implants (for replacement of the missing teeth).