Treatment of periodontal disease:
Non-Surgical Treatments
AAP treatment guidelines stress 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 planning
(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 as local delivery antimicrobials
and host modulation, as needed on a case-by-case basis.
Most periodontists would agree that after scaling and root planning, 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:
• Pocket Reduction Procedures
• Regenerative Procedures
• Crown Lengthening
• Soft Tissue Grafts
Pocket Depth Reduction
Your bone and gum tissue should fit snugly around your teeth like a turtleneck
around your neck. When you have periodontal disease, this supporting tissue and
bone is destroyed, forming "pockets" around the teeth.
Over time, these pockets become deeper, providing a larger space for bacteria to
live. As bacteria develop around the teeth, they can accumulate and advance
under the gum tissue. These deep pockets collect even more bacteria, resulting
in further bone and tissue loss. Eventually, if too much bone is lost, the teeth
will need to be extracted.
Your periodontist has measured the depth of your pocket(s). A pocket reduction
procedure has been recommended because you have pockets that are too deep to
clean with daily at-home oral hygiene and a professional care routine.
During this procedure, your periodontist folds back the gum tissue and removes
the disease-causing bacteria before securing the tissue into place. In some
cases, irregular surfaces of the damaged bone are smoothed to limit areas where
disease-causing bacteria can hide. This allows the gum tissue to better reattach
to healthy bone.
Benefits of this procedure
Reducing pocket depth and eliminating existing bacteria are important to prevent
damage caused by the progression of periodontal disease and to help you maintain
a healthy smile. Eliminating bacteria alone may not be sufficient to prevent
disease recurrence. Deeper pockets are more difficult for you and your dental
care professional to clean, so it's important for you to reduce them. Reduced
pockets and a combination of daily oral hygiene and professional maintenance
care increase your chances of keeping your natural teeth – and decrease the
chance of serious health problems associated with periodontal disease.
Regeneration
Your bone and gum tissue should fit snugly around your teeth like a turtleneck
around your neck. When you have periodontal disease, this supporting tissue and
bone is destroyed and pockets develop. Eventually, if too much bone is lost, the
teeth will need to be extracted.
Your periodontist may recommend a regenerative procedure when the bone
supporting your teeth has been destroyed. These procedures can reverse some of
the damage by regenerating lost bone and tissue.
During this procedure, your periodontist folds back the gum tissue and removes
the disease-causing bacteria. Membranes (filters), bone grafts or tissue-
stimulating proteins can be used to encourage your body's natural ability to
regenerate bone and tissue.
There are many options to enhance support for your teeth and to restore your
bone to a healthy level. Your periodontist will discuss your best options with
you.
Benefits of this procedure
Eliminating existing bacteria and regenerating bone and tissue helps to reduce
pocket depth and repair damage caused by the progression of periodontal disease.
With a combination of daily oral hygiene and professional maintenance care,
you'll increase the chances of keeping your natural teeth – and decrease the
chances of serious health problems associated with periodontal disease.
Crown Lengthening
Periodontal procedures are available to lay the groundwork for restorative and
cosmetic dentistry and/or to improve the esthetics of your gum line.
You may have asked your periodontist about procedures to improve a "gummy" smile
because your teeth appear short. Your teeth may actually be the proper lengths,
but they're covered with too much gum tissue. To correct this, your periodontist
performs crown lengthening.
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, broad smile.
Your dentist or periodontist may also recommend crown lengthening to make a
restorative or cosmetic dental procedure possible. Perhaps your tooth is
decayed, broken below the gum line, or has insufficient tooth structure for a
restoration, such as a crown or bridge. Crown lengthening adjusts the gum and
bone level to expose more of the tooth so it can be restored.
Benefits of this procedure
Whether you have crown lengthening to improve function or esthetics, patients
often receive the benefits of both: a beautiful new smile and improved
periodontal health – your keys to smiling, eating and speaking with comfort and
confidence.
Soft Tissue Grafts
Periodontal procedures are available to stop further dental problems and gum
recession, and/or to improve the esthetics of your gum line.
Exposed tooth roots are the result of gum recession. Perhaps you wish to enhance
your smile by covering one or more of these roots that make your teeth appear
too long. Or, maybe you're not bothered by the appearance of these areas, but
you cringe because the exposed roots are sensitive to hot or cold foods and
liquids.
Your gums may have receded for a variety of reasons, including aggressive tooth
brushing or periodontal disease. You may not be in control of what caused the
recession, but prior to treatment your periodontist can help you identify the
factors contributing to the problem. Once these contributing factors are
controlled, a soft tissue graft procedure will repair the defect and help to
prevent additional recession and bone loss.
Soft tissue grafts can be used to cover roots or develop gum tissue where absent
due to excessive gingival recession. During this procedure, your periodontist
takes gum tissue from your palate or another donor source to cover the exposed
root. This can be done for one tooth or several teeth to even your gum line and
reduce sensitivity.
Benefits of this procedure
A soft tissue graft can reduce further recession and bone loss. In some cases,
it can cover exposed roots to protect them from decay. This may reduce tooth
sensitivity and improve esthetics of your smile. Whether you have crown
lengthening to improve function or esthetics, patients often receive the
benefits of both: a beautiful new smile and improved periodontal health – your
keys to smiling, eating and speaking with comfort and confidence.
