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Candy Stripes

Periodontal Therapy 


Millions of people don't know they have this serious infection that can lead to tooth & implant loss if not treated. Periodontal examination will help you see if you are at risk for having or developing periodontal disease. Some patients’ periodontal needs can be managed by the general dentist. However, as more and more patients are exhibiting signs of periodontal and peri-implant disease, coupled with research that suggests a relationship between periodontal disease and other chronic diseases of aging, periodontal treatment may necessitate a greater understanding and increased level of expertise by a trained specialist.


Patients who present with moderate or severe levels of periodontal disease, or patients with more complex cases, will be best managed by a partnership between the dentist and periodontist. A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease, and in the placement of dental implants. They are also experts in the treatment of oral inflammation.


The bone and gum tissue should fit snugly around the tooth & implant like a turtleneck around your neck. When the patient has periodontal and peri-implant disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth. Over time, these pockets become deeper, providing a larger space for bacteria to live. 


Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Factors that may contribute to gingivitis include, diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, substance abuse, HIV infection, and certain medication use.


Untreated gingivitis can advance to periodontitis and can eventually lead to tooth loss and other health problems. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

Peri-implant diseases are inflammatory conditions affecting the soft and hard gum tissues around dental implants. Similar to a natural tooth, bacteria can build up on the base of the implant, below the gum line. Over time, the bacteria irritate the gum tissue, causing it to become inflamed, damaging the tissue and if not caught early, causing the bone structure below the implant to deteriorate. 


In peri-implant mucositis, gum inflammation is found only around the soft tissues of the dental implant, with no signs of bone loss. Generally peri-implant mucositis is a precursor to peri-implantitis. Evidence suggests that peri-implant mucositis may be successfully treated and is reversible if caught early.


In peri-implantitis, gum inflammation is found around the soft tissue and there is deterioration in the bone supporting the dental implant. Signs of peri-implant diseases are similar to symptoms of gum disease: red or tender gums around the implants, or bleeding when brushing. Other risks factors for developing peri-implant disease include previous periodontal disease diagnosis, poor plaque control, smoking, and diabetes. Peri-implantitis usually requires surgical treatment. 


Peri-implant Mucositis


Implant loss

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The goals of the periodontal therapy are to control the cause (bacterial plaque) and the risk factors, repair the damage present (pockets) and restore and maintain a healthy environment. With careful assessment and treatment, it is usually possible to completely halt the progress of the gum disease. Periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment. Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.


Periodontal therapy consists of several steps:


The goal of gum treatment is to reduce the amount of harmful bacteria in the oral cavity, thereby reducing the level of inflammation. After removing all soft and hard deposits from the accessible areas around the teeth and implants using special tools and devices, those surfaces are polished.

Evaluation of additional risk factors

Several risk factors, although incapable of starting periodontal disease on their own, can speed up its evolution and render it unstable when in the presence of inflammation.

In an effort to eliminate these factors, some of the following treatments may be required:

  • In some cases, with or without microbiological evaluation, antibiotics are prescribed to deal with active or persistent gum infections, which have not responded to oral hygiene measures.

  • Smoking cessation

  • Bite adjustment & making of a bite plane to control the trauma caused by teeth grinding (bruxism)

  • Splinting of weakened adjacent teeth

  • Removal of untreatable teeth or implants

Personalized oral hygiene instruction and advice

Your periodontist will first explain the causes of your periodontal disease and explain exactly how to keep your teeth and gums clean. You will be given individual advice adapted to your needs on how to use the various cleaning techniques and tools most effectively; for example, the most appropriate tooth brushing technique (Bass/Stilmann) and the correct use of dental floss and interdental brush.

Tooth brushing (The Bass technique)

Tooth brushing (The Stilmann technique)

Interdental brushing & flossing


Subgingival instrumentation is a careful cleaning of the root surfaces to remove plaque and calculus from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. Special instruments are used below the gum line to remove soft and hard deposits from the tooth surface. The irritants have to be removed from the root surface. Subgingival instrumentation does not eliminate deep pockets and may have to be redone periodically. Subgingival instrumentation is often followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis. After subgingival instrumentation, many patients do not require any further active treatment. However, the majority of patients will require ongoing maintenance therapy to sustain health.


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Between 6 and 12 weeks after the initial phase is completed, your periodontist will reexamine your gums in order to evaluate the healing that has occurred, determine if additional treatment is recommended and plan the latter. Periodontal probe is used to record the depth of any periodontal pockets and check for bleeding from the gums. If periodontal pockets are still present and deeper than ≥6 mm, further treatment options may be suggested, including periodontal surgery.


Periodontal surgery will be recommended if it is likely to improve the long-term stability of the periodontal condition. Surgical procedure is carried out to clean away plaque bacteria and deposits that are under the gum within periodontal pockets and on the root surfaces at the furcations (where the roots diverge) and implants surfaces. These areas are inaccessible to brushes and floss, so the inflammation will persist in these sites as long as bacteria are allowed to colonize them. Under local anaesthesia, the gum is lifted away, the root and implants surfaces are cleaned under direct vision to ensure that all bacteria are removed. Sometimes, it is possible to treat bone loss at the same time using a special regenerative treatment (bone grafts, membranes, growth factors). At the end of the procedure, the gums are sutured back into place around the teeth and implants.


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Successful periodontal treatment requires your full co-operation in regard to daily oral hygiene practices and attendance at regular follow-up appointments. The long-term success of periodontal treatment depends both on your own efforts with oral hygiene and those of the practice team who provide your regular care and ongoing assessment. In order to maintain the high level of periodontal health obtained with the treatment rendered thus far, it is of utmost importance to meticulously follow the recommended home care instructions daily. 


The frequency of your follow-up appointments will depend on the severity of disease and your individual risk of disease progression. Usually, follow-up visits are scheduled for every 4 to 6 months. Regular follow-up appointments are vitally important to determine the stability of your periodontal health, ensure that the disease process does not recur, causing further destruction of the gums and supporting bone. If there are signs of continuing disease, your dentist will be able to identify new or recurring sites of inflammation and treat them at an early stage. You will also be given advice on how to modify your oral hygiene practices to tackle the inflammation. When treated and maintained properly, long lasting and predictable results are expected.

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