There are many forms of periodontal therapy. The method chosen for treatment will be decided after a comprehensive examination, x-ray evaluation, and discussion of the treatment options with the patient. I believe that it is very important to have the patient fully involved in the treatment planning. Educated patients have more successful results.
Periodontal therapy ranges from conservative non-surgical treatment to surgical therapy.
A majority of the periodontal treatment methods are designed to eliminate a bacterial infection around the teeth. The cause of this infection is the accumulation of bacterial (plaque) on the root surface below the gum line. This bacteria needs to be removed to stop the infection that causes damage to the connective tissue (gums), and bone.
Non Surgical Therapy
Non-surgical therapy is usually the starting point to remove the germs and associated infection. Root planing is the proper term for this non-surgical treatment. Terms like deep cleaning, and deep scaling are often used to describe the same technique.
A local anesthetic is administered prior to the root planing. Once anesthetized, the patient is totally comfortable during the procedure. The idea of root planning is to slide different instruments below the gum line into the areas of infection (pockets) and remove the bacteria on the root surface. We are also removing the outer layer of the root surface which has soaked up some of the toxins the bacteria has produced. When the bacteria and the contaminated outer layer of the root have been removed, the root surface grows back and new fibers in the root join with fibers in the gum tissue to form a new connection or attachment. This shrinks the pocket. In addition to this, the swelling and inflammation associated with the infection resolves further shrinking of the pockets.
When the anesthetic wears off, the patient is free to eat what they want and return to a normal routine the same day. If needed, Tylenol is recommended following the treatment.
Surgical Pocket Elimination
If the infection is advanced and the pocket is deep, the only way to get deep enough to remove the bacteria is to open the gum tissue and gain access to the infection.
In my office, we generally do these procedures with a local anesthetic like you would get to have a filling done. Our patients are comfortable throughout the treatment. Once the gum line has been folded back, the deep infection is removed and the root surfaces are thoroughly cleaned. Often, the bone around the teeth has changed in shape due to the infection. The bone doesn’t dissolve away in a nice horizontal pattern and irregularities often exist. One option is to smooth and reshape the changes in the bone to a better contour. Sometimes it’s possible to build back the bone through bone grafting and fill in the irregularities. The surgical area is then closed with sutures and a protective putty-like bondage is applied to the sides of the teeth to protect the area during healing. Post operatively; we prescribe a pain medicine, an antibiotic and an antibacterial rinse to help in the healing. When our patients take their pain medicine before the anesthetic wears off, they have very little, if any discomfort after treatment.
Soft Tissue Grafts
Another surgical technique commonly used by a periodontist is soft tissue grafting. These types of grafts are usually chosen to connect areas of severe recession. Recession is most often caused by either (1) over aggressive back and forth brushing or (2) periodontal disease. In either case, the gum line has receded and the underlying bone has also receded. When too much gum tissue has been lost through recession, it is necessary to build back a new protective level of gum tissue through soft tissue grafting. The source of the graft is most often the soft tissue of the palate next to the back teeth. This tissue has the same make-up of the tissue lost through recession and grows back completely after a few weeks. Stitches are used to connect the graft to the area of recession. A putty-like bondage is used to cover and protect the donor and graft site. The same postoperative medications are used as with the other surgical techniques.
This is a very predictable technique to stop further recession, build-back lost tissue and cover exposed root surfaces. An additional benefit that soft tissue grafting can provide is improved cosmetics. If the recession is in the upper front teeth and the teeth have started to look longer, soft tissue grafting can return the gum line to a normal healthy appearance.
Periodontal treatment can be non-surgical or surgical. Often times a combination of these two methods is used. Bone grafting, soft tissue grafting and regeneration of new bone are all every day techniques. Never before have we had so many weapons available to fight against tooth loss.