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What is periodontal diseases?
Millions of people have periodontal disease and don't know it. The word periodontal literally means "around the tooth."
Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced
by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence
turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth,
forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and
more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become
loose and may have to be removed.(AAP)
Examination and Diagnosis:
To diagnose periodontal disease, a periodontist will examine several things:
Color and condition of the gum line
Pocket depth measurements
Bone line as revealed by x-rays
Mobility of teeth
Amount of calculus
These findings determine the periodontal stage and therefore determine the appropriate treatment plan.
(AAP)
Non-Surgical Therapy:
Non-surgical therapy includes plaque control, supra- and subgingival scaling, root planing, and the adjunctive use of chemical
agents.
Scaling and Root Planing
Scaling is the process by which plaque and tartar ( aka. calculus - calcified deposits on teeth ) are removed from tooth surfaces
above and below the gum tissue.
Root Planing is the process by which residual embedded tartar ( aka. calculus ) and portions of cementum ( the surface layer
of the tooth root ) are removed from the roots to produce a smooth, hard and clean surface.
The primary objective of scaling and root planing is to restore gingival health by removing inflammation inducing substances
from the tooth surface.
Surgical Therapy:
Periodontal surgery is any surgical procedure used to treat periodontal disease or to modify the morphology of the periodontium.
It's goal is to restore health and function to the periodontium.
Gingivectomy / Gingivoplasty Techniques
A gingivectomy is a periodontal surgical procedure which includes the removal of a portion of the gingiva ( gum tissue );
performed to reduce the soft tissue wall of a periodontal pocket.
Gingivoplasty is a surgical reshaping of the gingiva ( gum tissue ).
An illustration of flap design- a surgical blade is used to cut gum tissue and an elevator ( a periodontal instrument ) is
used to reflect it exposing the root surface and the bone around the teeth
( Note the bone defect caused by periodontal disease indicated by the dark spot next to the third tooth from the left )
Flap closure indicated in the lower right illustration
An illustration of the classification of intrabony defects which can be addressed by flap curettage, removal of the osseous
defect and/or regeneration (bone grafting/membrane)
Osseous Surgery
Osseous surgery is a periodontal surgery involving modification of the bony support of the teeth. It creates a bony architecture
which is compatible with the maintenance of a physiologic gingival ( gum ) architecture.
In this series of illustrations bone irregularities caused by periodontal disease ( top and lower left ) are corrected ( lower
right )
Osseous Grafting
Osseous grafting uses bone to replace a damaged or missing anatomical part of the alveolus ( bone supporting the teeth aka.
socket ). It can eliminate pockets and regenerate the functional attachment apparatus, stabilizing a periodontally compromised
tooth or group of teeth.
Guided Tissue Regeneration( GTR )
Guided tissue regeneration ( GTR ) attempts to regenerate lost periodontal structure using a barrier under the gum tissue
and over the remaining bone. GTR and the osseous grafting procedure may be performed at the same time.
In this illustration a bone defect is covered by a membrane
Crown Lengthening
Crown lengthening is a periodontal surgical procedure performed to expose a greater height of tooth structure in order to
properly restore a tooth.
Frenectomy
A frenectomy ( aka. frenulectomy or frenotomy ) is the removal of a frenulum, a small fold of tissue.
The labial frenulum often attaches to the center of the upper lip and between the upper two front teeth. It can also attach
to the lower lip and between the lower two front teeth. This can cause a large gap and gum recession. A labial frenectomy
removes the labial frenulum.
A series of illustrations of a labial frenectomy procedure ( upper lip reflected back in front of nose )
Mucogingival Surgery
This periodontal surgery procedure corrects defects in the morphology, position and/or the amount of gingiva ( gum tissue
).
A series of illustrations showing one type of mucogingival surgery using connective tissue ( upper left lateral and canine
)
Dental Implants
A dental implant is an artificial tooth root that a periodontist places into your jaw to hold a replacement tooth or bridge.
Dental implants are natural looking. They are more tooth-saving than traditional bridgework, since neighboring teeth are
not altered or necessary for support. Endosteal (in the bone) implants are the most commonly used type ( see illustrations
below ). Dental implants are a viable option in the treatment of partial and full edentulism. The ideal candidate for a dental
implant is in good general and oral health. They are considered an excellent option for tooth replacement.
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