Periodontal Diseases

What is periodontal disease? This is a type of periodontitis, which is inflammation of the supporting tissues of the teeth (resulting in loss of supporting bone). It is the major cause of tooth loss in adults and unfortunately can only get worse without appropriate treatment (periodontitis is a progressive disease). The bacteria that accumulate on the teeth in the form of plaque and the body's immune reaction to it are considered the main causative factors. Of course susceptibility of the individual is an important factor in disease initiation and progression. You should also be aware that there is a potential association between periodontal disease and heart disease, although it has not yet proven to be causative. However, periodontal disease treatment tends to improve inflammation markers related to heart disease. Please note that a major risk factor for periodontal disease is smoking. Further people with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk. Research has suggested that the relationship between diabetes and periodontal disease goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications. Periodontal disease often tends to progress almost silently without giving much cause for concern, until it has reached an advanced stage and the supporting tissues around the teeth are seriously compromised. Research has shown that periodontal disease is associated with several other diseases. For a long time it was thought that bacteria was the factor that linked periodontal disease to other disease in the body; however, more recent research demonstrates that inflammation may be responsible for the association. Therefore, treating inflammation may not only help manage periodontal diseases but may also help with the management of other chronic inflammatory conditions.

Periodontal Treatment

The plaque is removed under the gum line through a deep-cleaning method called scaling and root surface debridement. Scaling means scraping off the tartar from above and below the gum line. Root surface debridement gets rid of rough spots on the tooth root where the germs gather under the gum line, and helps remove bacteria that contribute to the disease. Then a periodontal review appointment is the next step where the pockets are re-measured to evaluate the degree of healing, the pocket depths and the plaque score. If inflammation and deep pockets remain following treatment with deep cleaning and medications the periodontal surgery may be considered. Your periodontist may need to pull gently the gum away from the teeth surfaces to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient to keep the area clean. This common procedure involves lifting back the gums and removing the tartar. The gums are then sutured back in place with tiny stiches so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer. In addition to flap surgery, your periodontist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration.

Guided Bone / Tissue Regeneration

When periodontal disease is established in the mouth, inflammation is present, periodontal pockets are formed around the teeth and the bone that supports the teeth is lost. The harmful bacteria that hide in the deep pockets create bone irregularities. When the shape of these irregularities allows it, we can use artificial bone substitutes with growth factors that enhance periodontal regeneration and re-grow the bone that was lost, increasing the longevity of the teeth and eliminating the depth that the harmful bacteria could hide. This periodontal surgical grafting technique is called Guided Tissue and Bone Regeneration and the most up to date procedures that contribute to periodontal regeneration are available in the clinic by Dr. Evdokia Chasioti Treatment results depend on many things, including how far the disease has progressed, how well you will keep up with oral care at home. Given the current evidence it is essential to act in the prevention, early diagnosis, and effective treatment of periodontal disease in order to combat the devastating oral and general health effects for the individual and society. For more information the dentists could visit: http://www.efp.org/ http://www.bsperio.org.uk/ http://www.perio.org/

Teeth Splinting

When the teeth are compromised from a periodontal point of view and lost most of their bone and gum support due to periodontal disease, they become wobbly. As a result the chewing efficiency, phonetics and function is compromised. To increase patient comfort during chewing we can connect multiple teeth together (teeth splinting) to reduce mobility and improve the patients function and chewing efficacy. Also, when the teeth are used as abutments for partial dentures they can be connected together to increase support of the periodontally compromised teeth. However, splinting makes oral hygiene procedures difficult. To ensure the longevity of the connected teeth, special attention must be taken towards oral hygiene. To connect teeth to each other, the enamel surface of the tooth is etched, most commonly with a 37% solution of phosphoric acid and composite resin can then be bonded to the etched surface to rigidly connect the teeth to each other. The connection cab be strengthened by adding a fibre or metal framework. No healthy tooth substance is removed and if the splint requires repairs in the future it can be easily reinforced without harming sound tooth structure.

Treatment of Gummy Smile - Crown Lengthening Procedures

You may ask your periodontist about procedures to improve a "gummy" smile because your teeth appear short or because you feel you expose excessive gum when you smile. Your teeth may actually be the proper lengths, but they're covered with too much gum tissue. To correct this, your periodontist performs a dental crown lengthening procedure. During the crown lengthening 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 a crown lengthening procedure for a tooth which will soon receive a dental crown or veneer to make a restorative or cosmetic dental procedure possible. Your tooth may be decayed, broken below the gum line, or it may have insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening redefines the gum and bone level to expose more of the tooth so it can be restored.

Lightening of Dark Gums

Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of “black dark gums” are common, particularly in patients having a very high smile line (gummy smile). With the removal of unsightly pigmented gingival areas we create a pleasant and confident smile. This could be easily attained by using various methods including laser lightening of dark gums.

Socket Preservation

After having a tooth extracted, there will be an empty "socket" , a void, where the tooth used to be. If the void is left empty to heal by itself, the bone that used to support the tooth starts to disappear and becomes thin and shallow. This can cause a problem when we look at possible treatment to replace the gap with a partial denture, bridge or dental implant. Socket preservation is the act of minimizing bone shrinkage, and therefore preserving the bone's depth and height to allow better outcome for a future restoration. Once the tooth has been extracted, a bone graft material is inserted inside the socket. This bone graft material will harden overtime and become part of the jaw bone, ensuring provision of sufficient foundation for placement of future implants, bridges and dentures. After insertion of the bone graft material, a collagen membrane is placed on top to cover the graft material and allow good healing of the gum tissue. Socket preservation after having a tooth extracted has several advantages: -Prevents the bone from shrinking therefore maintaining horizontal facial bone structure -Less likely for a replacement denture or reline to be needed, as less bone and gum shrinkage occurs -Lower gap formation under the pontic (part of bridge replacing a missing tooth)of a bridge -Better bone depth and height and therefore a better prognosis when placing a dental implant and less need for future bone graft

Atraumatic Tooth Extraction

This technique is specifically designed to remove teeth using specialized tools. With an atraumatic tooth extraction minimal damage or trauma is caused to the surrounding bone and tissues. It is a minimally invasive technique, which is something that will certainly appeal to any patient that needs a tooth extraction, and is the technique we use wherever possible at contemporary Periodontics & Implant Surgery.

Dental Implants

A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge or denture. Dental implants may be an option for people who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason. This procedure is a team effort between the periodontist and the restorative dentist. The periodontist and dentist will consult with you to determine where and how the implant should be placed. Depending on the specific condition you will receive a tailored treatment plan to meet your needs. To learn more about dental implants, please contact our office.

Sinus Lift Procedures

A key to implant success is the quantity and quality of the bone where an implant is to be placed. If you've bone quantity and quality in close proximity to the sinus area in upper back jaw due to reasons such as periodontal disease or tooth loss, you may be left without enough bone to place implants. Sinus lift surgery can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants. Your periodontist can explain your options for graft materials, which can regenerate lost bone and tissue. Undergoing sinus lift surgery has been shown to greatly increase your chances for successful implants that can last for years to come.

Conventional Gum Graft

Porcine Gum Grafts