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Gum disease is a common condition that dentists treat. It occurs when bacteria in the mouth infect tissue surrounding the tooth and cause inflammation around the tooth. Osseous surgery (also known as pocket reduction surgery), is a procedure that removes bacteria living in pockets. During the procedure, a surgeon cuts back the gums, removes the bacteria, and repairs damaged bone. Getting reimbursed for dental surgery can be challenging. Dental practices can rely on the services of a professional dental billing company for accurate claim submission.

Poor oral hygiene causes different types of oral conditions including gum disease. In a healthy mouth, there is a 1-3 mm gap or pocket between the teeth and gums at the base. When gum disease occurs, this gap or pocket increases to more than 5mm. An increased gap between the teeth and gums will make it easy for food particles to get stuck between them, making it hard to clean them and remove those food particles. This could lead to tartar and plaque buildup and also cause growth of bacteria in the mouth, leading to several other dental diseases. If left untreated, these gaps or pockets may continue to get deeper and the tooth would have to be removed.

If gum disease is mild and the gum pockets have not spread, antibiotics will be prescribed to fight the bacteria. Osseous surgery is recommended in cases of severe gum disease that cannot be treated with antibiotics or root planning. The main goal of osseous surgery is to eliminate/reduce pockets and remove any build-up in them formed by gum disease. The procedure also reshapes the bones supporting the teeth to prevent potential tooth loss.

How is the Pocket Reduction Surgery Performed?

The dentist will at first examine the general health of the patient and evaluate their previous medical history. This helps to determine the extent of gum disease and determine whether a person is a good candidate for the surgery. Typically, pocket reduction surgery is performed by a periodontist and takes about 2 hours.

The surgery begins with administering local anesthesia and cleaning the teeth to remove any dirt on the surface. A small incision will be made along the gumline and the gums will be folded back to remove any bacteria, tartar, plaque, and other debris stuck beneath the gum pockets. The areas of the gum roots where the bone is damaged or irregularly shaped will also be smoothened. If the bone is severely damaged, periodontal regeneration techniques like bone grafting and guided tissue regenerative membranes will be performed. Excess flesh is removed and the gums are stitched back in place. This will be covered with a periodontal dressing to manage the bleeding. Osseous surgery prevents damage caused by the progression of periodontal disease and helps patients maintain a healthy smile.

In most cases, patients get back to their normal routine within a few days. The recovery time will depend on the severity of gum disease and the extent of surgery performed. Following recommended dietary changes and medication advice will speed healing. In addition, patients may be advised to avoid smoking, avoid physical activity (for a specific time), rinse the mouth with saltwater, use ice packs to manage swelling, and eat soft foods for the first few days after the surgery.

CDT Codes for Osseous Surgery

  • D4260 Osseous surgery (including flap entry and closure) – four or more contiguous teeth or tooth bounded spaces per quadrant
  • D4261Osseous surgery (including flap entry and closure) – one to three contiguous teeth or tooth bounded spaces per quadrant
  • D4263 Bone replacement graft – first site in quadrant D4264 Bone replacement graft – each additional site in quadrant
  • D4270 Pedicle soft tissue graft procedure
  • D4273 Autogenous connective tissue graft procedure (including donor and recipient surgical sites) first tooth, implant, or edentulous tooth position in graft
  • D4275 Non-autogenous connective tissue graft (including recipient site and donor material) first tooth, implant, or edentulous tooth position in graft
  • D4276 Combined connective tissue and double pedicle graft, per tooth
  • D4278Free soft tissue graft procedure (including recipient and donor surgical sites) each additional contiguous tooth, implant, or edentulous tooth position in same graft site
  • D4283 Autogenous connective tissue graft procedure (including donor and recipient surgical sites) each additional contiguous tooth, implant, or edentulous tooth position in same graft site
  • D4285 Non-autogenous connective tissue graft procedure (including recipient surgical site and donor material) each additional contiguous tooth, implant, or edentulous tooth position in same graft site
  • D4341Periodontal scaling and root planing – four or more teeth per quadrant
  • D4342 Periodontal scaling and root planing – one to three teeth per quadrant
  • D4910 Periodontal maintenance

Maintaining dental hygiene, eating a healthy and balanced diet and getting regular dental checkups are key strategies to prevent gum disease.

Billing and coding for oral surgery procedures requires in-depth knowledge of the changing codes, billing guidelines, and payer rules. Partnering with an experienced dental billing company can ensure correct claim submission and maximum reimbursement.

Amber Darst

Amber Darst is our Solutions Manager in the Healthcare Division, Practice and RCM. With a rich background in dental services, her expertise ranges from insurance coordination to office management.

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