Periodontal Treatment

What do periodontists do?

We provide the detection and prevention of periodontal disease as well as its treatments. “ Periodontal care” is required for healthy as well as diseased tissues. For patients without notable periodontal disease, “periodontal care” is a prophylactic (or preventative) measure. For patients with periodontal disease, it consists of effective treatment for the elimination of disease and the creation of conditions conducive to periodontal health. Treatments will be tailored to each patients needs using interdisciplinary approaches in coordination with other specialists. The procedures range from non-surgical to surgical periodontal treatments, implant surgery, and cosmetic procedures such as gum graft surgery (the addition of gum tissue), crown lengthening surgery (increase tooth length) , and ridge augmentation (the addition of bone to the jaw). Maintenance is as important as treatment itself.

What is periodontal disease?

In order to know what is periodontal disease, we need to understand what makes the periodontium. The periodontium consists of the tissue all around teeth, such as gum, bony structure and periodontal ligaments. All of which support the tooth in function, health and aesthetics. Periodontal disease, including gingivitis and periodontitis, are not minor infections. If left untreated, these infections can lead to tooth loss, bone deterioration and eventual destruction of the jaw. It is usually chronic in nature, beginning with the bacteria commonly known as plaque (the sticky, colorless films that constantly forms on the teeth).

Gingivitis—is the mildest form of periodontal disease. The gum tissue will become red, swollen, and bleed easily. It is caused by inadequate oral hygiene and also some local factors such as ill-fitting crowns or can be caused by some hormone and systemic conditions. However, the disease is reversible with professional treatment and good oral hygiene.

If left untreated, gingivitis can advance to periodontitis. Periodontitis consists of bacterial toxins that stimulate chronic inflammation. This inflammation can lead to the breaking down of supporting tissues and eventually bone destruction. Periodontal pockets form and create space between the teeth and gums. As these pockets become deeper, bacterial pathogens thrive and become more aggressive. Often times, the destructive process has mild symptoms. Therefore, it is not uncommon for patients to not be aware of the problem until their symptoms occur as pain, gum enlargement, excessive gum bleeding, tooth loosening and/or tooth migration.

Signs and Symptoms-

  1. Swollen gum tissue
  2. Bright red or purplish gum tissue
  3. Gum recession
  4. Lesions of the gum tissue resulting in the formation of pus
  5. Bad breath (chronic halitosis)
  6. Bad taste in your month
  7. Loose teeth
  8. Tooth migration or change of the bite
  9. Tooth loss

Research suggests that the periodontal pathogens can be inhaled or enter to your bloodstream through your gum tissue, affecting lungs, heart and other parts of your body. This can lead to more serious conditions.

Phase I-Initial Preparation ( non-surgical treatment)

Usually very effective in slight to moderate periodontitis. The treatment includes:

  1. Supra/subgingival scaling (a full cleaning of the tooth structure)
  2. Root planning
  3. Adjunctive antibiotic (local application or systemic distribution of antibiotics) 
  4. Occlusion Analysis, selective occlusal adjustment (bite adjustment)
  5. Interdepartmental Consultation-Endodontists, Orthodontists, Prosthodontists
  6. Eliminating local factors: removing faulty restorations, Root canal retreatment, restoration of decayed areas (cavities filling)
  7. Systemic health / nutrition evaluation and consultation
  8. Phase I re-evaluation

Phase II –Surgical Treatment

Research has shown that non-surgical treatment (as mentioned above) has its limitations, especially for the teeth with pocket depths more than 5mm. Hand instruments efficiency is less than 4mm, and the limitation is about 5.52mm. Also, multi-rooted teeth (such as molars) are more difficult to access in terms of the anatomy of the roots, than single-rooted teeth (such as canines). Therefore, surgical treatments provide accessibility and precision in the detection of bony defects for regenerative and pocket reduction procedures. To assure a good result, a definitive prosthetic treatment plan will be provided prior to surgical treatment to cooperate with crown lengthening, soft/hard tissue augmentation and implant surgeries.

Regenerative Procedure

Using resorbable (self-dissolving) and non-resorbable (manually removed) membrane combined with allograft (human bone material) or xenograft (bovine bone material) to maintain the space for future new bone growth.

Mucogingival Surgery (soft tissue augmentation/ Root coverage procedure)

Using allograft or autograft from the hard palate connective, tissue is transferred to the exposed root sites or the deficient ridge (thin jaw bone) to cover the root. Thickening the tissue size and providing more keratinized tissue is necessary

Crown Lengthening Procedure

(Usually combined with the patient’s prosthetic treatment plan) Using the provisional crowns to re-create sufficient tooth structure and reshape the bone to have a better soft tissue profile around new prosthesis

Dental Implant Surgery

A dental implant is placed into the missing tooth area for 4-6 months to allow for ossteointegration (allowing the implant to directly connect with the bone). The procedure can be performed in a one-staged or two-staged approach depending on the bone augmentation needed or not.

Ridge Augmentation (adding bone to the jaw)

(Usually needed in severe atrophy ridges.) Guided bone regeneration will be performed with non-resorbable or resorbable membranes and allograft/xenograft bone materials.

Ridge (socket) Preservation

After tooth extraction, 2/3 of bone resorption occurs within the first 3 months. Therefore, resorbable membrane and bone graft materials can be placed to decrease the rate of the resorption and preserve the ridge morphology.

Sinus Bone Augmentation

Upper posterior teeth roots are located adjacent to the sinus floor. Severe ridge deficiency is often found after tooth extraction. Dental implants or the allograft/xenograft materials are used to provide space in the sinus cavity for bone regeneration.

 

Prosthetic/Orthodontal Treatment

After the surgical phase, the patient’s oral hygiene and the periodontal condition should be stable and ready for any following prosthetic or orthodontal treatment. However, during this period, the patient‘s condition should be also monitored every 2-3 months (or less) depending on the patient’s oral hygiene.

Maintenance

Maintenance is as important as the treatment itself. Patients should be examined every 3 months or 6 months depending on their condition and prior treatment. Follow up treatment should include thorough examination, radiographs, supra/sub-gingival cleaning, and fluoride treatment.