Procedures for the Treatment of Periodontal Disease

Following are some of the procedures that periodontists use to treat patients diagnosed with a periodontal (gum) disease. The main cause of periodontal disease is bacteria in the form of a sticky, colorless plaque that constantly forms on your teeth; however, many other factors can cause periodontal (gum) disease or influence its progression.

Non-Surgical Treatments

We agree with the American Academy of Periodontology treatment guidelines which state that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such systemic antibiotics, 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, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

Periodontal Surgery

If you're diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment.

Following are the four types of surgical treatments most commonly prescribed:

Cosmetic Procedures

In addition to procedures to treat periodontal disease, periodontists also perform cosmetic procedures to enhance your smile. Oftentimes, patients who pursue cosmetic procedures notice improved function as well.

Cosmetic procedures include:

Pocket Reduction Surgery

This procedure combined with good oral hygiene and professional root planning is the traditional method to arrest the progression of adult periodontitis. It is necessary when the loss of bone and tissue results in the formation of a pocket that is too deep to be cleaned adequately by a hygienist. Usually the pocket would be 5mm or more in depth.

With this procedure, an incision is made in the gum tissue adjacent to the teeth. A portion of gum tissue is removed. The gums are gently reflected to allow access to the roots of the teeth and the bone surrounding them. The teeth and roots are cleaned thoroughly. The irregular surface of the bone is recontoured to reduce the defects in the bone created by the disease process.This procedure is also called Osseous Surgery because the bone surrounding and supporting the teeth is reshaped to allow the gum tissue to rest lower down on the root of the tooth thereby exposing more of the tooth. Sutures are used to secure the gum tissue around the teeth.

The goals of this procedure are:

  1. to gain access to the roots to facilitate thorough cleaning
  2. to reposition the gum tissue to affectively reduce the pocket
  3. to affect a change in the anatomy which will promote periodontal health
  4. to stop the progression of destructive periodontal disease

Regenerative Procedures

Numerous techniques and materials exist that are designed to stimulate or conduct a process of guided tissue regeneration of bone and skin previously lost due to periodontal disease or trauma. These procedures and materials are used to regenerate the lost hard and soft tissues. All periodontists would prefer to use a regenerative approach over a ressective approach unfortunately, these techniques are not predictably successful in all situations. Proper case selection, technique selection, and material selection are critical for obtaining complete regeneration.

After tooth loss the bone in the area is gradually resorbed by the body. This can result in an aesthetic defect. Bone grafting is possible to regenerate the missing hard tissue. This is particularly valuable when considering dental implant use to replace missing teeth. The feasibility of dental implant placement depends on the existence of adequate bone to accommodate the implant or on our ability to create adequate bone by grafting.

Crown Lengthening Procedures

This procedure is similar to pocket reduction surgery. It is utilized when a tooth has fractured in a manner that the margin of the fracture is at or below the gum tissue. It is also used when a cavity has progressed below the gum tissue. Often more of the tooth has to be exposed in order for the restorative dentist to be able to place a crown or other dental restoration on the tooth.

With this procedure, an incision is made in the gum tissue adjacent to the teeth. A portion of gum tissue is removed. The gums are gently reflected to allow access to the roots of the teeth and the bone surrounding them. The teeth and roots are cleaned thoroughly. Bone around the tooth is then gently reduced to allow the gum tissue to sit lower down on the root of the tooth. This effectively lengthens the tooth. Sutures are used to secure the gum tissue around the tooth.

Soft Tissue Grafts

When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. When gum recession is a problem, gum reconstruction using gingival grafting techniques is an option.

When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession reaches the mucosa, the first line of defense against bacterial penetration is lost.

In addition, gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance to the gum and tooth. Also, gum recession, when significant, can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root caries and root gouging.

A gingival graft is designed to solve these problems. A thin piece of tissue is taken 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.

The gingival graft procedure is highly predictable and results in a stable healthy band of attached tissue around the tooth. Enhancing the zone of attached gingiva is particularly important when gingival recession is progressing or restorative dentistry is planned. Increasing the amount of keratinized tissue enables the restorative dentist to more accurately and easily capture the impression of a subcrevicular preparation margin. The restorative dentist can feel confident that the margin will not recede further following insertion of the final restoration.

Cosmetic Procedures