Minimally invasive procedures (non-surgical)
The periodontal health status must be obtained in the most non-invasive way, and therefore the most economical in financial terms. This is often done by non-surgical procedures, including “scaling” and “root planing” (a very careful cleaning of the tooth root surface to remove plaque and tartar from the periodontal pockets, root smoothing and removing toxic bacteria), followed by a local drug adjunctive therapy, or general as appropriate.
If the periodontal disease is more advanced, by affecting the deep tissues adjacent to the tooth a more invasive therapy is likely to be recommended, the periodontal surgery. Thus, there are four types of surgical treatments that can be described:
Reducing the depth of the pockets
Normally the gums around the tooth must be attached (adhered) to it. If the periodontal disease affects the tooth, both the gum and the bone suffer, thus forming the periodontal pockets. They deepen and widen in time, providing a larger and larger space for bacteria growing. Not removed on time, these bacteria continue destroying adjacent tissues, causing a greater gingival inflammation and a greater bone resorption, because in the end due to massive bone loss, the tooth becomes mobile, and the aim will be the extraction.
Thus, after a preliminary measurement of the depth of periodontal pockets, if they are already too deep to have them cleaned by the patient through daily cleaning it follows a surgical reduction of their depth. During this procedure, the doctor makes an incision in the gums, exposing the bone, which is subjected to rigorous cleanings, regulates its surface, thus limiting the areas where bacteria might ‘hide’ again. After cleaning the area of the affected gum, the doctor reattaches the gums on the recently cleaned bone by sutures.
The benefits of this procedure are that they prevent periodontal disease progression by eliminating the bacteria, giving the patient a healthy smile. The deep periodontal pockets are more difficult to clean, so a first necessary step is to reduce them, to associate an extremely rigorous oral hygiene, thus increasing the prognosis of preserving natural teeth on the archway.
If the tissues (gum, bone) are too damaged by bacteria, the doctor may recommend their regenerative surgical procedure. Following the steps described above, after cleansing the tissues, some stimulatory factors may be added to regenerate the tissue encouraging the body’s biological capacity to regenerate lost bone mass. There are currently several such factors and the best option for the patient will be chosen after discussing with the doctor.
Coronary elongation to treat periodontal disease
Within this procedure, the excess of gum and bone is reshaped, exposing more of the tooth crown. In this case, the patients have a ‘gingival smile’, that is their teeth are covered by a larger amount of gum, although they have a normal volume. To correct this, the doctor uses coronary elongation, by reshaping these tissues (gums, bone and gum).
Soft tissue grafts
Due to bone resorption, the periodontal disease leaves the tooth root (or a group of teeth) exposed, and this process is also immediately followed by gingival retraction, which makes teeth look much longer, be more sensitive to external factors exposure (heat, cold, citric, sweet). Gingival retraction can also occur due to ‘brutal’ or incorrect brushing, or constant trauma on the teeth, whatever the cause, your doctor may help you determine the cause and remove it before treatment. Once these factors controlled, a soft tissue graft applied at the right of the default will fade the continuation of retraction for both gum and bone. During this procedure, the doctor will take tissue from the palate, and will reposition it