Periodontics

In cases of periodontal disease, an osseous grafting procedure may be necessary to address the bony defects around a tooth that have been caused by the progression of periodontal disease. An osseous grafting procedure, which involves guided tissue regeneration, rebuilds the bone and supporting tissues that have been lost. During this surgical procedure, the roots of the involved teeth are thoroughly cleaned and the bony defects prepared and filled with a suitable bone graft material. The bone graft is then covered by special membrane and the gums are then sutured back into place. With healing and time the osseous graft will fill in for the lost bone, thereby providing renewed support for the tooth.

While the goal of periodontal procedures are to eliminate pocketing and maintain bone support, some periodontal procedures are indicated to improve esthetics or to allow for the maintenance of a severely broken down tooth. One such procedure is periodontal crown lengthening.

This procedure is indicated in the case of a gummy smile where the teeth have adequate length but are covered by too much gum tissue. During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural smile.

We may also recommend crown lengthening for restorative reasons. If a tooth is too short to restore or is broken down below the gum line, we can perform a crown lengthening procedure to expose more tooth structure in order to save the tooth and to place a long lasting restoration.

Gingivitis is the mildest and most common form of periodontal disease. It is characterized by gum inflammation without involvement of the supporting bone structures of the teeth. If treated at an early stage, gingivitis is totally reversible.

Treatment

Gingivitis is treated by a combination of meticulous home care and professional cleaning. The dentist may perform root planing and deep scaling procedures to remove the plaque and calculus which are the causative factors of the inflammation.

Gingival recession is a problem which effects millions of Americans. It may be caused by toothbrush abrasion, periodontal disease or simply as a product of aging. When gingival recession occurs the teeth appear longer, the root surface is exposed and generalized sensitivity of the teeth occurs. These problems can all be addressed by the use of gingival grafting. This is a procedure where we can literally move the gum to a position that covers more of the tooth structure. This can also be accomplished by using graft tissue - either an autograft from the patient's palate or a synthetic graft to cover the exposed tooth surfaces. Any type of this procedure will alleviate the sensitivity and will allow for an outstanding aesthetic result.

In order to begin treatment, it is essential to do a thorough, complete and extensive examination. We will review the patient's medical history to determine if there are any factors that may influence the development of periodontal disease or limit the scope of treatment. Additional x-rays may be taken as a further diagnostic tool. An oral cancer screening will also be performed during your initial visit to our office.

A periodontal charting of the entire dentition with measurement and recording of several key parameters for each tooth will be completed. We will then be able to assess the degree and severity of the periodontal disease present. A comprehensive periodontal evaluation typically includes gently measuring the depth of the pocket between the tooth and gum with a periodontal probe. One measurement is recorded for each of six zones on each and every accessible tooth. Any gum recession or tooth mobility will also be charted and evaluated at this stage.

For those patients interested in dental implants, we may suggest that a 3 dimensional CBCT dental scan be taken. This will allow us to assess the thickness and height of the jaw bone to evaluate the proper placement of the dental implant.

An accurate diagnosis is the foundation upon which all of your treatment recommendations are made. Whether the patient is seeing us for a full mouth rehabilitation or a single tooth procedure, the correct diagnosis is the key to any and all treatment planning.

When periodontal disease is detected early in its onset, conservative or non-surgical methods of care in combination with improved hygiene routines can restore periodontal health. While periodic, professional cleanings are sufficient to maintain periodontal health in patients that do not have gum disease, once gingivitis is present, deeper cleanings and possibly other non-surgical methods of care are recommended to treat the condition.

The American Academy of Periodontology emphasizes achieving periodontal health by means of the least invasive and cost effective treatment approaches to care. Deeper cleanings, which include Scaling and Root planing, are non-surgical procedures that are considered the first line of defense against the progression of periodontal disease.

With scaling and root planing, any plaque and tartar (hardened dental plaque) that have accumulated below the gumline are carefully removed and then the root surfaces of the teeth are smoothed. Since, periodontal disease is an inflammatory response to plaque, tartar and bacterial toxins, by simply mechanically eliminating these agents, the progression of gum disease can be halted. In addition to removing plaque and tartar with a scaling and root planing procedure, antimicrobial medication placed under the gumline or systemic medications can be used as adjuncts to care to further reduce the bacterial population.

If non-surgical approaches to managing periodontal disease do not achieve the desired outcome, surgery may be recommended to halt its progression and repair damage as possible.

When gum disease has advanced beyond the initial stage, periodontal surgery is often recommended to effectively remove bacteria and tartar from around the teeth, reduce gingival pocket depth, restore lost tissue as possible and halt the disease process. Untreated gum disease is a progressive condition, which will continue to compromise the appearance of one’s smile, dental health, oral function and overall well being if the appropriate measures are not taken.

With proper surgical treatment and maintenance care, the chances of tooth loss, further damage to the bone and soft tissues supporting the teeth, and complications from health problems that are linked to periodontal disease can be decreased.

Gum disease is typically the result of inadequate or ineffective oral hygiene practices that lead to the accumulation of dental plaque, which is sticky film that is colonized by oral bacteria. The harmful bacteria and the products they produce provoke a defensive, inflammatory response in the gums. When this inflammation is not resolved, tissue damage ensues and spaces between the gums and teeth that are known as periodontal pockets develop. As the periodontal pockets deepen, the bacteria become more difficult to remove and the gaps between the surface of the teeth and gums get larger. When pocket depth increases to the point of being beyond the reach of deep cleanings and other conservative methods of care (5mm or more), gum surgery to clean and treat the damage to gums and underlying bone is recommended.

By performing pocket reduction surgery the following is accomplished:

• Sub-gingival bacteria beneath the gums and from the surfaces of the roots of the teeth is removed
• Damage to the underlying bone is halted and affected bone is re-contoured
• Effective oral hygiene to clean the teeth and gums is made easier

While a surgical procedure known as flap surgery during which the tissue is surgically reflected away from the teeth and bone so that the area can be treated before the tissue is sutured back into place, is typically performed, some practitioners are now using soft tissue laser procedures to reduce pocket depth.

While a surgical procedure, periodontal surgery is generally very well tolerated by patients and in most cases can be performed under local anesthesia.

An incision will be made to allow us to gently pull the gum tissue away from the teeth. All calculus and plaque will be meticulously removed and all root surfaces will be smoothed. Antibiotic may be placed in the surgical site. The gum tissue will then be sutured back into place eliminating the pocket. In many cases a protective packing may be placed to keep the area clean and to facilitate faster healing.

The suture material (stitches) generally will remain in the mouth for 7-10 days.

Though the gums will be more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums.

After conducting a thorough examination of the oral tissues and viewing radiographic findings, we may suggest scaling and root planning treatments. Depending on the severity of the disease process and the amount of plaque and calculus, local anesthesia may be used to make the treatment more comfortable.

Scaling involves the removing of debris from the crown and root surfaces. This may be accomplished with the use of a combination of ultrasonic and hand scalers. After all the plaque and calculus are scaled away, root planning may be undertaken using hand instruments to smooth the root surfaces of the tooth. Smooth root surfaces help prevent the buildup of the agents which cause periodontal disease.

After scaling and root planning procedures eliminate the causative factors, the remaining pockets may be treated with antibiotics.

When replacing posterior upper teeth with dental implants, one of the limiting factors is the amount of bone available between the gum and the maxillary sinus. If there is insufficient bone to allow for the placement of an implant, we may suggest a procedure called a sinus augmentation procedure or a sinus lift. During this procedure, the sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. After several months of healing, the bone becomes part of the patient's jaw and dental implants can be inserted and stabilized in this new sinus bone. Routine dental implant procedures can then be performed.