Treatment methods depend upon the type of disease and how far the condition has progressed. The first step is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gum line. The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and re-attach to the tooth. In some cases, the occlusion (bite) may require adjustment.
Our emphasis is on conservative periodontal therapy. Many times, the early stages of periodontal disease are best treated with non-surgical therapy, periodontal pockets are smaller due to gum shrinkage. With this result, you can personally maintain these areas with routine brushing and flossing.
Even in more severe cases of periodontal disease, non-surgical periodontal therapy most often precedes surgical therapy. This is done so that the overall tissue quality is improved prior to surgery and fewer areas require surgery. When indicated, we use modern techniques to help rebuild lost bone support.
Scaling & Root Planing
The initial stage of treatment is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gum line. The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and re-attach to the tooth. Scaling consists of carefully placing a fine delicate instrument in between the tooth and gum tissue to remove plaque and calculus that is below the gum line and to smooth the root. Additionally, a fine ultrasonic tip may be used. Scaling and Root Planing is performed comfortably using topical anesthetics and local anesthesia to numb the gum tissue.
Antibiotics or irrigation with antimicrobials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause Periodontitis. In some cases, antibiotic micro pellets may be placed in the periodontal pockets after scaling and root planning. This may be done to control infection and to encourage normal healing.
When deep pockets between teeth and gums are present, it is difficult for us to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health.
Cosmetic Periodontal Surgery
These procedures are a predictable way to cover unsightly, sensitive or exposed root surfaces and to prevent future gum recession. If you are unhappy with the appearance of short insightly teeth this can be greatly improved by a combination of periodontal procedures by our doctors and cosmetic dentistry by your dentist.
Tooth loss causes the jawbone to recede and can lead to an unnatural looking indentation in your gums and jaw, giving an appearance of general aging. The original look of your mouth may not be recaptured because of spaces remaining under and between replacement teeth. The teeth may appear too long compared to nearby teeth. These defects may be corrected with cosmetic periodontal surgery.
Some teeth appear short because they are covered with too much gum tissue. We can correct this by performing a periodontal plastic surgery procedure known as crown lengthening.
During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to more than one tooth, to harmonize uneven gum lines, and to create a beautiful smile.
Crown lengthening (or crown exposure) is required when your tooth needs a new crown or other restoration and the edge of that restoration is deep below the gum tissue and not accessible. The procedure involves adjusting the levels of the gum tissue and bone around the tooth in question, to create more visible tooth above the gum line. This allows your dentist to reach the edge of the restoration, ensuring a proper fit to the tooth. It should also provide enough tooth structure so the new restoration will not come loose in the future. Lastly, you can clean the edge of the restoration when you brush and floss to prevent decay and gum disease.
Another cosmetic procedure is the soft tissue graft. It is used to cover unattractive tooth roots, reduce gum recession and protect the roots from decay and eventual loss. When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma.
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 softer 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. Gum recession, when significant, can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root caries and erosion.
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. Complete root coverage was accomplished.
Traditionally, gum disease is treated by eliminating the gum pockets. The infected gum tissue is trimmed away and uneven bone tissue is contoured. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are routinely used today.
Bone Regeneration surgery attempts to regenerate the previously lost gum and bone tissue. We use bone substitutes and/or bone stimulating proteins to fill the bone defects; the grafts may be covered with bio-absorbable membranes. Bone grafting following tooth loss can preserve the socket and jaw bone and minimize gum and bone collapse. With better healing and less shrinkage of natural gum and bone, your dentist can create a more esthetic tooth replacement for either an implant crown or a fixed bridge.