Periodontics

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The goal of periodontal therapy is to establish a healthy balance between the gum tissue and the supporting structures of the teeth.  Ultimately this gives the patient the ability to maintain adequate home care coupled with their routine visits to the dentist.  While gum disease is very visible, periodontal disease is not. It’s elusive because it is usually painless at the beginning, but can worsen and become quite serious without you even realizing it.   Periodontitis is a state of gum inflammation accompanied with the presence of bone loss.  The bone loss can occur either rapidly or in intervals and in most cases is irreversible.  Periodontitis breeds unhealthy anerobic bacteria that release byproducts that are linked to coronary heart disease. The severity of periodontitis is measured by the amount of bone loss (pocketing) as well as tooth mobility.   Like gum inflammation, bone destruction can be intercepted by your dentist during your regular hygiene visits. If the disease hasn’t reached severe levels, a treatment called Phase one perio therapy can be effective in stopping bone destruction.  

Phase One Perio 
Phase One Perio is non-surgical treatment that involves removing the calculus and debris above and below the gum.  It is lot of scraping, digging and smoothing of the diseased root surface called scaling and root planning.  Scaling removes the deposits of tartar above and below the gum. Scaling also removes any diseased bacteria (called bacterial endotoxins) that may have gotten under the gum and stuck to the root surfaces. Root planing goes after the bacterial endotoxins under the gum and removes any diseased cementum (that cell layer covering the outside of the root that keeps the tooth attached) that might be there as well. If the gum tissue is also inflamed, the hygienist or dentist will do something called curettage. Curettage removes the inner lining of the inflamed tissue, which then allows the new tissue to heal against the newly cleaned root surface. 

In addition to scaling and root planning, your dentist or hygientist may use additional tools to counter the anerobic bacteria accumulated in the periodontal pocket.  Such tools include the use of “Arrestin” which is chemotherapeutic agent placed as a chip or gel, which gets inserted with a syringe. This kills any remaining bacteria, speeds healing time and helps the pocket shrink faster.  Other tools include the use of a diode laser that removes inflamed and unhealthy tissue and also targets bacteria.  After phase one perio therapy a strong medicated mouthwash called peridex may be prescribed for short term anti-bacterial control.  

Phase Two Perio-Flap Surgery 
If the scaling and root planing and curettage aren't enough, the pockets have to then be surgically removed. This procedure is done by performing flap surgery which removes the excess soft tissue and shapes the underlying bone so that the pocket will heal back to a less deep, healthy sulcus. Afterwards, the gums get sutured back into place, so the tissue fits tightly around the tooth again.

Flap surgery allows the doctor to visualize the bone, so he can then either take away bone to remove the defect (which is the pocket) or graft new bone into the defect— in effect, adding to it. It all depends on the anatomy of the particular defect 

Crown Lengthening

      The term crown lengthening refers to a procedure that involves exposing more tooth structure hidden below the gum.  The procedure is done either flapless with a soft tissue laser or a surgical flap is used to expose the underlying hard tissue.  This procedure is ideal for patients who have very short teeth and retention for new crowns is compromised or have teeth that have fractured below the gum line.  After this procedure the gums get sutured back into place and the tissue  fits nicely around the tooth again. 

Periodontal Plastic Surgery: 

      Similar to the crown lengthening procedure but the ultimate goal is to create a positive gum architecture that is harmonious in height and shape as the adjacent teeth.  This procedure is usually integrated with a cosmetic case and helps in creating symmetry that did not exist previously.  This procedure can be performed either surgically or flapless with a diode laser, all depending on the relationship of hard to soft tissue.