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Periodontal treatment - speciality

1) Periodontal disease

Gum disease begins with gingivitis. The symptoms of gingivitis usually occur before the deterioration of bone support. If not treated, this inflammation can progress to periodontal disease.

Where periodontal disease occurs, the bacteria grow down below the gum margin along the root surface. The gums detach from the tooth and form so called "pockets".
The body's immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body's natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bone, gums, and tissue that support the teeth are destroyed.

As gum disease progresses, loss of bone support becomes evident with the loosening of teeth, gum recession giving the appearance of elongated teeth, separation of gum tissue from teeth resulting from the loss of bone and the accumulation of debris (plaque and tartar) on the root surfaces. The space that forms between the teeth and gum tissue becomes pockets filled with inflammation, infection and possible pus formation.

If periodontal disease is left untreated it can lead to tooth loss.

2) Non-surgical debridement (Scaling and root planning)

The first phase of treatment normally consist of "deep" cleaning of the root surfaces below the gum level (subgingival root debridement). This meticulous deep cleaning of the gums is carried out under local anesthetic.

The dentist or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather and helps remove bacteria that contribute to the disease.

How effective is this procedure?

A scaling and root planing procedure is to be considered effective if the patient is subsequently able to maintain their oral health without further bone or attachment loss and prevent recurrent infection with plaque and calculus.

Are there adverse effects of the treatment?

The gums may be sore for 2-3 days.
The reduction of the depth of the pockets is likely to show in the form of some gum shrinkage (recession/root exposure), which can vary greatly in its extent. This is inevitable in cases where the gum was very swollen in the first place. In some patients this may cause increased tooth sensitivity. However, this is usually temporary and rarely lasts more than a few weeks/months.

What is the long-term effect of this treatment?

The long-term effectiveness of this treatment depends upon a number of factors. These factors includes patient compliance, disease progress at the time of intervention, probing depth and other factors such as grooves in the roots of teeth and concavities. It is recommended that after the treatment that the patient returns every 3 to 4 months to sustain healthy gums.

For many patients deep cleaning will be sufficient to control the disease. However, in advanced cases of periodontal disease the "deep" cleaning alone may not be enough to control the disease. A second phase of therapy may include gum surgery to gain access to deep areas for cleaning.

3) Periodontal flap surgery

Periodontal flap surgery is performed after a course of thorough non-surgical treatment. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. The advantage of flap surgery of non-surgical techniques is that it gives direct visibility and access to the plaque/calculus deposits.

Before surgery begins, you will be given a local anaesthetic to numb the area. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer. Your dentist may cover the surgical site with a bandage. This is called a periodontal pack or dressing. They will let you know whether you need to return to the practice to have any sutures removed.

After Care to Periodontal flap surgery

Following the procedure, you may have mild to moderate discomfort for a few days, which can be controlled with over the counter pain relief or your dentist can prescribe something to control the discomfort too.
It is very important for you to keep your mouth as clean as possible whilst the area which had the procedure carried out on is healing. This means you should brush and floss the rest of your mouth normally. If the surgical site is not covered by a periodontal pack, you can use a toothbrush to gently remove plaque from the teeth. Antimicrobial mouth rinses containing chlorhexidine are often prescribed after gum surgery. These rinses kill bacteria, delay plaque growth and help your mouth to heal.

What is the long-term effect of this treatment?

If successful, inflammation will resolve and the gum will shrink and tighten up around the teeth eliminating the deep pockets. This will however result in recession as successful treatment is aimed at eliminating further destruction and will not bring back the soft tissues and bone that have already been destroyed.
If you do not keep on top of oral hygiene the gum disease will not resolve. It is therefore of the utmost importance that you stick to a rigorous routine of brushing, flossing, mouth wash etc. as you will have been advised. You will need to see your dentist regularly so that he or she can follow your progress.

Regeneration surgery

Periodontal regeneration refers to the restoration of supporting tissues of the teeth such as bone, cementum, and periodontal ligament to their original levels following damage caused by periodontal disease. Your dentist may recommend this procedure when the bone supporting your teeth has been destroyed due to periodontal disease. These procedures can reverse some of the damage by regenerating lost bone and tissue.

What happens during this procedure?

During this procedure, the dentist folds back the gum tissue and the area is thoroughly cleaned out to eliminate disease-causing bacteria. A bone graft and covering membrane is placed in the defect. The gum tissue is then replaced and sutured to hold it in place.

How effective is this procedure?

Regeneration of supporting tooth structures is a huge step up in managing advanced periodontal disease and preventing tooth loss. However it cannot be used in all defects, your dentist can advise you when it is and isn't appropriate.

Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success.

With a combination of daily oral hygiene and professional maintenance care, you'll increase the chances of keeping your natural teeth and decrease the chances of other health problems associated with periodontal disease.

Mucogingival Surgery and Crown lengthening

Mucogingival surgery and/or crown lengthening are carried out to correct defects of the gums. Not all cases are suitable for treatment; your dentist will be able to advise you about this.

Crown lengthening may be required for aesthetic reasons or if your dentist wants to make more of the tooth visible in order to be able to place a crown on it for example.

Mucogingival surgery aims to improve defects where severe gum recession has occurred and aims to widen the band of attached gingivae. It can improve the appearance of a tooth significantly.

A number of mucogingival surgical procedures are available to increase the width of attached gingiva. These include the use of free gingival grafts, pedicle grafts (e.g. laterally re-positioned grafts, coronally repositioned flaps) and subepithelial connective tissue grafts. The use of these procedures can lead to the formation of a stable, non-inflamed band of attached gingival tissue.

Peri-Implantitis

Despite the high success rates observed with dental implants in dental practice, complications and implant loss can occur. An important complication to dental implant treatment is a pathologic process called Peri-Implantitis.

Peri-Implantitis is an infectious disease caused by tissue changes that causes an inflammatory process in soft tissues (similar to Periodontitis) and bone loss around an integrated implant in function. The disease state is generally thought to be caused by plaque and biofilm, which has been shown to accumulate on implant surfaces as well as teeth.

Symptoms of this disease can be anything from tissue inflammation, bleeding upon probing, to advanced bone loss, which is often observed around a dental implant affected with Peri-Implantitis.

What Factors Can Contribute to Peri-Implantitis?

The following facts can contribute to Peri-Implantitis:

      • Poorly controlled gum disease
      • The effects of tobacco use have also been shown to negatively impact implant success rates. Implant patients who smoke, suffer significantly greater marginal bone loss after implant placement and the occurrence of Peri-Implantitis increases.
      • Genetic factors have been correlated with occurrence of Peri-Implantitis.

Treatment of Peri-Implantitis

      • Antimicrobials such as Chlorhexide (mouthwash) and Dentomycin (antibiotics) into the area.
      • Debridement of the area (method used will be dependent on factors specific to each case).
      • Strict oral hygiene regime.
      • Systemic antibiotics may be considered.
      • The clinician can then consider whether to attempt to regenerate the bone around the implant or perform peri-implant flap surgery.