PERIODONTOLOGY

PERIODONTAL EXAMINATION

Millions of people don't know they have this serious infection that can lead to tooth loss if not treated. Periodontal examination will help you see if you are at risk for having or developing periodontal (gum) disease. Some patients’ periodontal needs can be managed by the general dentist. However, as more and more patients are exhibiting signs of periodontal 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.

NON-SURGICAL PERIODONTAL TREATMENT

The bone and gum tissue should fit snugly around the teeth like a turtleneck around your neck. When the patient has periodontal 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. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.

The goals of the treatment 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.

I. Personalized oral hygiene instruction and advice

The goals of the treatment 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.

II. Professional cleaning

All soft deposits will be removed from accessible areas of the teeth and the teeth polished and treated with fluoride.

III. Scaling and root planning

Scaling and root planing 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. Deep cleaning does not eliminate deep pockets and may have to be redone periodically.  Scaling and root planing is often followed by adjunctive therapy such as local delivery antimicrobials and host modulation, as needed on a case-by-case basis. Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment. However, the majority of patients will require ongoing maintenance therapy to sustain health.

IV. 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

  • Extraction of untreatable teeth

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PERIODONTAL SURGERY

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. A special instrument called a 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 ≥5 mm, further treatment options may be suggested, including gum surgery.

 

REGENERATIVE PERIODONTAL SURGERY

Regenerative gum surgery will be recommended if it is likely to improve the long-term stability of the gum 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. 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.

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GRAFT SURGERY FOR THE GUM RECESSIONS

Exposed tooth roots are the result of gum recession. Gum graft surgery will repair the defect and help to prevent additional recession and bone loss.  Gum grafts are designed to cover exposed roots, to reduce further gum recession and to protect vulnerable roots from decay. This may reduce tooth sensitivity and improve esthetics of your smile. During gum graft surgery, your Periodontist takes gum tissue from your palate or soft tissue biomatherials to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.

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PRE-PROSTHETIC AND ESTHETIC CROWN LENGTHENING

Exposed tooth roots are the result of gum recession. Gum graft surgery will repair the defect and help to prevent additional recession and bone loss.  Gum grafts are designed to cover exposed roots, to reduce further gum recession and to protect vulnerable roots from decay. This may reduce tooth sensitivity and improve esthetics of your smile. During gum graft surgery, your Periodontist takes gum tissue from your palate or soft tissue biomatherials to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.

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GUM AUGMENTATION

In order to provide daily oral hygiene and to maintain long-term gum health the presence of keratinized and attached gum around the teeth and implants is very important. If there is not enough gum present, donor gum tissue from the palate of the patient ("gold standard") or substitute biomaterials are used to increase the volume of the gum.

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PERIODONTAL MAINTENANCE

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 3 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.

Copyright © 2017-2019 I Cavid Ahmedbeyli DDS MSc PhD