Periodontal Treatment

Periodontics is that branch of dentistry which deals with the tooth and its supporting structures like the gum and the bone.

Periodontal treatment is done to bring back the normal and healthy state of the tooth and its supporting structures through the following measures:

Non Surgical

Such treatments will be applied if the patient is still in the early stages of periodontal disease.

Oral Hygiene:

If the disease is still in the first stage (Gingivitis) the dentist may prescribe an anti microbial mouthwash and advise you to brush and floss the teeth on a regular basis.

Dental Prophylaxis:

Treatment for the prevention of periodontal diseases or other dental diseases by the cleaning of the teeth in the dental office using the procedures of dental scaling and polishing. The treatment may include plaque detection, removal of supra and sub gingival plaque and calculus, application of caries preventing agents, checking of restorations and prostheses and correcting overhanging margins and proximal contours of restorations and checking for signs of food impaction.

Scaling:

It is a procedure that meticulously removes contamination toxins, micro organisms, plaque, tartar, cementum, dentin that is rough and/or permeated by calculus from around, below and under the gum line down to the bottom of the pocket. This is done to remove biofilm, calculus and toxin down to the bottom of each periodontal pocket in order to obtain a healing response.

Root Planing:

Root planing involves smoothening the root surfaces of your teeth with thin curettes so gum tissue can more firmly reattach to roots that are clean and smooth to prevent tooth loss and sensitivity problems. The procedure makes it more difficult for plaque to accumulate along the root surfaces. Because this procedure goes deeper than a regular cleaning, your mouth may be numbed. The cleaning may take 2 visits to complete. Depending on the extent of the disease you may need 1 or more sections (Quadrants) of the mouth to be treated with scaling and root planning. Treatment may require 1 or more visits.

Scaling and Root Planing:

Periodontal scaling is a treatment procedure which involves the instrumentation of the crown and root surfaces of the teeth. Plaque, calculus and stains will be removed from these surfaces. It is performed on patients with periodontal disease and is therapeutic, as opposed to prophylactic treatment and may precede root planing. It is a definitive, meticulous treatment procedure aimed at the removal of cementum and/or dentin that is rough and is possibly permeated by calculus or even contaminated with toxins or microorganisms. When carried out thoroughly, some unavoidable soft tissue removal occurs. This procedure can be used as a definitive treatment or as part of pre surgical therapy (Tissue Preparation) depending on how far the periodontal disease has advanced. Debriding the root surface is a critical element in establishing periodontal health.

Surgical

Crown Lengthening:

It is a simple surgical procedure which adjusts the position of the gum around the affected tooth, thereby providing a more solid tooth on which to anchor the restoration of choice. A functional crown lengthening will help you regain a beautiful smile and allow you to eat and speak with comfort and confidence. Crown lengthening is available to prepare a tooth for restorative dentistry or to cosmetically enhance your smile. Periodontist may also recommend crown lengthening to make a restorative or cosmetic dental procedure possible.

Restorative Dentistry

When decay occurs below the gum line or has insufficient tooth structure for a restoration, such as a crown or bridge there must be adequate tooth structure. It's a common occurrence that there is not enough tooth structure to attach the restoration and preserve the health of the surrounding gum tissue. The ultimate success of any dental restoration is dependant upon the amount of natural remaining tooth structure. Crown lengthening is a surgical procedure that adjusts the gum and bone level to expose more of the tooth so it can be restored. Crown lengthening is important for the overall strength of the final restoration, providing better health, comfort and function. Reshaping the gum and supporting tissues will allow your general dentist adequate room to place a quality final restoration.

Cosmetic Treatment

Crown lengthening is used to correct what's commonly referred to as a 'Gummy Smile' that hides the beautiful teeth underneath the gums. A gummy smile is apparent when the gum line appears to be creeping down over the teeth, making them appear short. During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth and more beautiful smile. This can be done to 1 tooth, to even your gum line or to several teeth to expose a natural, broad smile.

Crown lengthening is used to keep the gums around a crown healthy. The gums drape around a tooth and protect the tooth and bone that holds the tooth in the mouth. The gums bond to the tooth surface and this bond prevents food from getting stuck between the tooth and gums. The gums need at least 2 millimeters of tooth to attach to in order to be effective in preventing food from trapping under the gums, otherwise serious problems can develop.

Sometimes part of a tooth will crack off so that the 2 millimeters for the gums to bond is not available. Crown lengthening surgery is needed. Another reason that the needed 2 millimeters might not be available is when a tooth decays and after removing the decay, the dentist finds that there is less than 2 millimeters of tooth left above the bone. This procedure is used to recreate this needed amount of exposed tooth.

The patient is numbed and an incision is made around the tooth needing crown lengthening. The gum tissue is gently peeled away from the tooth to show the supporting bone holding the tooth in place. Now the dentist can see that there is not 2 millimeters of tooth available to stick to. In the procedure the dentist removes several millimeters of bone around the tooth to expose the tooth that was previously underneath the bone. After the dentist is sure there is 2 millimeters or more of tooth sticking out of the bone, the gums are replaced and stitched carefully back in place. The surgery is now complete. The gums are allowed to heal 6 weeks and a crown can then be constructed.

Periodontal Flap Surgery:

It is also called pocket depth reduction, which is recommended in many cases where pocketing depths have reached a level that makes maintenance or cleansing difficult. It is often associated with areas of bone loss and inflammation of the gum tissue around the teeth.

When scaling and root planning have been unsuccessful in eliminating the entire pocket of decay or when there has been bone loss that needs to be surgically corrected, then a dentist may perform periodontal flap surgery. In flap surgery, under local anesthesia, small incisions are made in the gum, so that it can be lifted back to expose the tooth and bone. The entire area is carefully cleaned and all tartar and infected granulation tissue are removed and the bone is examined. Because periodontal disease causes bone loss, often the bone will need to be recontoured in order for the gum to heal properly.

After scraping away the bacteria laden plaque and tartar, the dentist removes diseased tissue and smoothes the surface of damaged bones and fills the area with artificial bone graft material. Then the dentist sews the tissue back into place. Removing or smoothing damaged tissue allows the gum tissue to better reattach to healthy bone.

Soft Tissue Grafts:

Periodontal flap surgery is sometimes necessary to treat advanced periodontal disease if scaling and root planing proves ineffective. Deep pocketing along with underlying bone defects can prevent the gum tissues from fully healing and staying healthy. The procedure involves the loosening of the gums from around the teeth in order to fully expose and the clean the parts of the teeth which were previously covered by the gums.

Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. A thin piece of tissue is grafted from the roof of the mouth or gently moved over from adjacent areas, to provide a stable band of attached gingiva around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root. During this procedure, the periodontist takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for 1 tooth or several teeth to even your gum line and reduce sensitivity.

A soft tissue graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. Soft tissue grafts and other root coverage procedures are a predictable way to cover unsightly, sensitive or exposed root surfaces, to prevent future gum recession and restore healthy gum tissue. This will reduce further bone loss and recession, make the tooth less sensitive, protect the root from root cavities and look more natural when you smile. If you are unhappy with the appearance of short unsightly teeth this can be greatly improved by a combination of periodontal procedures by our periodontists.

Bone or Gingival Augmentation:

Surgical augmentation treatments, along with non surgical treatments, are performed when the periodontal disease has reached a more advanced stage.

These include:

Augmentation

This is a surgical procedure which uses a barrier membrane and or bone graft replacement material placed under the gum and over the remaining bone support (Ridge or Jaw Bone) to aid the regeneration of new bone in an area where teeth are being extracted or have already been removed. The graft material may be taken from the patient's own body (Autogenous Bone). If not, an artificial, synthetic or natural substitute may be used. This prevents the surrounding bone from collapsing into the extraction socket after the removal of a tooth. If this procedure is not carried out, the ridge will become narrow and sharp and it will not be possible to insert an implant or a comfortable fitting denture.

Guided Tissue Regeneration

This procedure is practiced in tandem with a surgical flap operation. Gum growth into a defect is cordoned and this allows slower growing bone, cementum and ligament cells to take its place.

Bone Grafts

In cases of gum recession a graft is usually taken from the palate and transplanted onto the affected area. This reinforces the thin gum and makes it difficult for the gum to recede further and may even help to cover the exposed root. It may also reduce tooth sensitivity and even improve the esthetics of your smile.

Periodontal Regenerative Procedures

A regenerative procedure is often recommended when the bone supporting your teeth has been destroyed. It is possible to reverse some of the damage by regenerating lost bone and tissue. The gum tissue is folded back and the bacterium which is causing the disease is removed. Membranes (Filters), bone grafts or tissue stimulating proteins can then be used to encourage your body's natural ability to regenerate bone and tissue. There are many methods which will enhance support for your teeth and help to restore your bone to a healthy level.

The benefits of this procedure include the elimination of existing bacteria and the regeneration of bone and tissue which helps to reduce pocket depth and repairs much of the damage caused. Through daily oral hygiene and professional maintenance care, the chances of keeping your natural teeth will be increased. There will also be less chance contracting any of the serious health problems associated with periodontal disease.

Gingival Curettage:

It removes the soft tissue lining of the periodontal pockets in order to completely eliminate bacteria and diseased tissue. It may be used along with scaling and root planing, but achieves a deeper and more complete cleaning. Evidence indicates, however, that it does not contribute any additional benefits beyond simple scaling and planing.

Gingivectomy:

A gingivectomy is a periodontal surgical procedure which includes the removal of gingival tissue in order to achieve a more esthetic appearance and/or functional contour. Gingivectomies are frequently performed using electrosugery to cauterize away the undesired gum tissue.

A gingivectomy removes and reshapes loose, diseased gum tissue to get rid of pockets between the teeth and gums. A gum specialist (Periodontist) or oral surgeon often will do the procedure. The periodontist will start by numbing your gums with a local anaesthetic. The periodontist may use a laser to remove loose gum tissue. After removing the gum tissue, the doctor will put a temporary putty like substance over your gum line. This will protect your gums while they heal. You can eat soft foods and drink cool or slightly warm liquids while the putty is in place and your gums are healing.

Gingivoplasty:

It is a procedure in which we surgically reshape and recontour the gum tissue for cosmetic, physiological or functional purposes.

Gingivoplasty is the surgical reshaping of the outer surface of the gums and it's usually done in combination with gingivectomy. The term comes from gingiva meaning gums and the word ending plasty meaning to reshape. Many patients have a gummy smile which is caused by excessive and overgrown gum tissue. Excess gum tissue can usually be removed to reveal a beautiful smile underneath.

After a gingivectomy procedure, the gingivoplasty procedure thins the remaining gums tissue so the tissue looks natural and pleasing. It's done this using an electrosurgery unit and a specially designed electrical cutting tip. The electrosurgery unit uses electricity to cut the gum tissues and at the same time, causes the gum tissues to clot and stop bleeding.

Gingivoplasty corrects the remaining thick and unnaturally shaped gum tissue left after the gingivectomy procedure exposes the hidden teeth. Natural gum tissue thins as it approaches and surrounds teeth. It can get confusing because the 2 procedures are almost always used at the same time. These procedures can also be used to reshape irregularly shaped and unattractive gums.

Gingivoplasty procedures are usually done with local anaesthetics. The electrosurgery equipment minimizes bleeding and most patients experience very little post operative pain after the procedure.