Background: Periodontal diseases include gingivitis, periodontitis, and peri-implant disease. There are different ways to treat these diseases, such as surgical and non-surgical periodontal treatments like gingivectomy, open flap debridement, and crown lengthening.

Aim: This study aimed to determine the most common periodontal surgery procedures performed in postgraduate periodontic clinics and to identify the associated periodontal diagnoses and patient demographics.

Materials and methods: This study is a retrospective cross-sectional study carried out at the postgraduate periodontic clinics in the College of Dentistry, University of Baghdad. Various information, such as demographic data, medical and dental history, periodontal diagnoses, and types of periodontal surgery that the subjects underwent, was collected from the periodontal records. The collected data were then analyzed statistically.

Results: A total of 271 patient records were included in this study, with a mean age of 38.7±11.9 years. The most frequently performed periodontal surgery procedures were open flap debridement (29.2%), followed by gingivectomy (19.1%) and guided tissue regeneration (17.5%). Regarding diagnosis, the most prevalent periodontal diagnoses were gingivitis (31%), followed by periodontitis (28.04%) and gingival enlargement (8.86%). Statistically significant associations were observed between periodontal diagnoses and types of periodontal surgeries performed. Sex-specific differences were noted in the selection of surgical treatments.

Conclusion: This study sheds light on periodontal surgery epidemiology in a postgraduate periodontic clinic. The data show that periodontal diseases and patient-specific characteristics require personalized treatment techniques.

epidemiology, periodontal surgery, postgraduate, periodontitis

Periodontal diseases are disorders of the gingiva and the surrounding tissues.^[1] They range from mild inflammation (gingivitis) to severe inflammatory conditions known as periodontitis, which may lead to tooth loss.^[2] Periodontitis, in its severe form, affects about 11% of adults worldwide.^[3]

Progressive destruction of the periodontal supporting tissues surrounding the teeth may result in tooth loss and reduced quality of life.^[4] Early detection and appropriate treatment of periodontitis offer significant cost savings by preventing severe destruction of the periodontium, tooth loss, and more complex treatment.^[5]

The initial treatment of periodontitis is based on non-surgical periodontal treatment, which involves scaling and root planing. This treatment significantly reduces the subgingival microbial burden by removing dental biofilm, calculus, and bacterial endotoxins.^[6] Oral hygiene instructions and motivation play a central role in the non-surgical and surgical treatment of periodontitis and aim to control biofilm through frequent mechanical removal by the patient.^[7]

The success of non-surgical periodontal therapy is evaluated 6 to 8 weeks after scaling and root planing.^[8] This re-evaluation aims to identify any persistent signs of periodontitis, including ongoing gingival inflammation by the presence of bleeding on probing, deep probing depths (>5 mm), continued attachment loss, gingival recession, or worsening tooth mobility.^[9] Based on the concept of critical probing depth, probing depths equal to 5 mm or less at the re-evaluation examination should be treated non-surgically, while sites with probing pocket depths of 6 mm or more are treated surgically with open flap debridement.^[10]

The international scientific community adopted the term ‘periodontal plastic surgery’ in 1996. This concept includes surgical interventions designed to address or prevent defects in the gingiva, alveolar mucosa, or bone resulting from anatomical issues, developmental problems, trauma, or disease. The scope of periodontal plastic surgery inclu- des a range of procedures targeting both soft and hard tissues.^[11] These interventions aim to enhance gingival volume, cover exposed roots, rectify mucosal abnormalities around implants, extend crown length, preserve gingiva during ectopic tooth emergence, eliminate irregular frena (high frenum attachment), mitigate ridge collapse following tooth extraction, and augment the edentulous ridge.^[12]

Despite the well-documented approaches to managing periodontal diseases, there is a scarcity of epidemiological data regarding the actual practices and outcomes of periodontal surgery in postgraduate clinical settings. This study seeks to bridge this gap by providing information about the most common periodontal surgeries and how sex and other factors could affect the choice of the surgery.

This study aimed to determine the most common periodontal surgery procedures performed in postgraduate periodontic clinics and to identify the associated periodontal diagnoses and patient demographics.

An analysis was conducted on the periodontal records of 271 patients who visited the postgraduate periodontal cli-nic; Fig. 1 and Table 1 present a summary of the patient’s sex and age distribution. Female patients were 65.68% of the patient population, with the predominant age group being 10-29 years, accounting for 41.33%. Male patients comprised 34.32%, exhibiting a more equitable distribution across age levels. The 50-70-year-old age group contains a notably reduced percentage of male patients relative to females.

Table 2 revealed that systemically healthy individuals predominate in all age groups and sexes, indicating an overall healthy population. However, age-related patterns arise, with “Systemically healthy” rates decreasing and conditions like hypertension increasing with age, particularly among females aged 50-70. Men display comparable trends, with the healthy majority declining and hypertension and diabetes emerging as age progresses.

Table 3 reveals the prevalence of periodontal conditions in the treated sample. Gingivitis (31%) and periodontitis (28%) are most common, indicating significant inflammatory gingival diseases. Women are more prone to gingivitis (20.66%) than men (10.33%), while periodontitis is almost equally distributed (women 16.24%, men 11.81%). Gingival enlargement (8.86%) and gummy smile (7.75%) are also notable, with gummy smiles predominantly in women (7.38%). Healthy gingiva appears in 7.01% of patients. Less frequent conditions include gingival recession (2.58%) and peri-implantitis (0.37%), highlighting the range of potential gingival issues.

Table 4 provides a detailed overview of surgical procedures in a postgraduate periodontal clinic. Gingivectomy and frenectomy, addressing excess gingival tissue and frenum issues, respectively, are the most common, comprising nearly 36% of all surgeries. The data also highlights a focus on advanced reconstructive techniques, such as open flap debridement with bone grafting, guided tissue regeneration, and various gingival grafting methods, which together constitute over 17% of surgeries. Aesthetic procedures, including crown lengthening and gingival contouring, account for 10.7% of surgeries.

Table 5 provides an overview of surgical interventions for periodontal conditions. Gingivitis, the mildest form, is sometimes treated with minimally invasive procedures like gingivectomy and frenectomy. Periodontitis requires more extensive interventions, including bone grafting and tissue regeneration. Even healthy gingival tissue may need minor surgeries for specific concerns. The table also includes aesthetic procedures like laser contouring for excessive gingival display and enlargement and addresses less common conditions such as peri-implantitis and pericoronitis treatments.

Table 6 shows how sex may affect postgraduate clinic periodontal surgery operations. The distribution of procedures is comparable for both sexes, although deeper inspection shows certain variances. Gingivectomies, frenectomies, and gingival depigmentation are 12.32% more common in women than men. Laser gingivectomy is performed more by women than men, maybe due to pain tolerance or treatment preferences.

Open flap debridement with bone grafting and directed tissue regeneration, considered “complex reconstructive,” are more sex-balanced (5.17% for women vs. 2.95% for men). Women get crown lengthening and lip repositioning flaps more often, possibly due to aesthetic concerns about teeth and smiles.

Figure 1.

Distribution of age groups by sex.

The results of this study offer information about the prevalence of periodontal surgery procedures in a postgraduate periodontic clinic. The list of the most frequent periodontal diagnoses and their relationship with definite surgical interventions shows how critical it is to develop an individual approach to the surgical treatment of the periodontal diseases.

Thus, the observed distribution of women needing periodontal treatment is consistent with higher gingivitis rates in women.^{[13, 14]} The increasing prevalence of younger patients (10-29 years) may indicate improved oral health awareness and periodontal or cosmetic demands. Young people are moderately aware of dental hygiene and aesthetics, with most concerned about aesthetic and willing to fix any issues.^[15] The fact that most of the patients are “systemically healthy” suggests that the clinic helps people take charge of their overall health, which may lead to better treatment results.^[16] Notably, the fact that hypertension and diabetes become more common with age shows how important it is to think about overall health when managing periodontal disease.^[17]

The significant occurrence of gingivitis and periodontitis corresponds with findings that identify these as the most prevalent periodontal diseases.^[1] The increased susceptibility of females to gingivitis may be associated with hormonal fluctuations, whereas the even distribution of periodontitis indicates common risk factors across sexes.^[18] The prevalence of gingival enlargement and gummy smile, especially in women, highlights the aesthetic issues commonly addressed in periodontal consultations.^[19] The clinic’s diverse range of surgical procedures demonstrates its capacity to address various periodontal conditions, encompassing both simple inflammations and complex bone regeneration requirements.

The rising use of gingivectomy, frenectomy, and depigmentation procedures among females may be linked to various factors. A potential factor is the increasing demand for aesthetic enhancements, as indicated by previous researchers.^[20] Patients, especially female patients, are increasingly focused on the aesthetics of their gingiva and smiles, seeking treatments to improve their self-confidence.^{[20, 21]} The prevalence of gingival hyperpigmentation may also influence the aesthetics of the gingiva. Multiple studies, including those by Kafle S, Mai et al. and Kumar et al.^[22–24], examine the management of gingival hyperpigmentation via depigmentation techniques^[25]. The procedures are designed to eliminate or reduce excessive melanin deposition in gingival tissue, thereby enhancing overall appearance.^[26] The interplay of these factors likely enhances the frequency of these procedures among females. Females undergo laser gingivectomy more frequently than males, possibly indicating variations in pain tolerance or treatment preferences.^[27]

The balanced distribution of bone grafting procedures indicates a similar severity of periodontitis across sexes^[28]; however, additional research is required to investigate the underlying causes of these observed differences. The prevalence of crown lengthening and lip repositioning flaps in women corresponds to their link to aesthetic-focused procedures.^[29]

This study recognizes that its single-clinic setting has several limitations and emphasizes the need for larger studies. Besides sex, other things like socioeconomic status and treatment preferences also definitely play a role in surgical decisions. We could learn more about how decisions are made in periodontal surgery if these topics were studied in the future in bigger, more diverse groups of people. Finding out the exact reasons why men and women use procedures differently could help with focused interventions and personalized treatment plans.

This study highlights the most common periodontal surgeries in a postgraduate clinic, with open flap debridement, gingivectomy, and guided tissue regeneration being the most frequently performed. Gingivitis and periodontitis were the predominant diagnoses, with treatment tailored to disease severity. Sex differences were noted, with females undergoing more aesthetic procedures while males receiving more reconstructive surgeries. These findings underscore the need for personalized treatment approaches and further research on long-term clinical outcomes and the impact of systemic health on periodontal surgery.

The authors have no funding to report.

The authors have declared that no competing interests exist.

This study has been approved by the Ethical Committee, College of Dentistry / University of Baghdad.

Data of study available from the College of Dentistry/ University of Baghdad.

The authors have no support to report.