Periodontal disease is a chronic bacterial infection of the supporting structures of the tooth (Gum and underlying bone) that, if left untreated, can lead to tooth loss. In the initial form of the disease, Gingivitis, redness, swelling and bleeding are usually noticeable. This condition is caused by poor oral hygiene and is usually reversible with good home care and professional cleanings. If left untreated, Gingivitis can lead to Periodontitis where the underlying tissues are destroyed. Pocket formation (separation of the gum from the tooth) along with bone loss are the first signs of Periodontitis. This condition is usually asymptomatic. WHAT CAUSES PERIODONTAL DISEASE? Bacterial Plaque is the principal cause of gum disease. It is a thin, sticky, colourless film that forms around teeth. Risk factors such as smoking, diabetes, stress, hormonal derangement and genetic predisposition play a major role in the extent and severity of the disease.
Treatment options for periodontal disease may vary depending on the extent and severity of tissue destruction. Usually it is divided into surgical and non-surgical treatment. The main objective of periodontal therapy is to eliminate all the disease causing bacteria and regenerate the supporting structures of the affected tooth. Non-surgical pocket reduction therapy, also called scaling and root planing, is the initial procedure that reduces the signs of infection. The result of this initial phase is a noticeable improvement in the clinical condition. This includes a significant reduction in swelling and bleeding as well as reduction in pocket depth. Surgical pocket reduction therapy is indicated in more advanced cases where scaling and root planing alone are not sufficient. If it is not possible to eradicate all the bacteria colonizing the deep pockets with scaling and root planning alone, surgical access is then necessary.
Bacterial Plaque is the principal cause of gum disease. It is a thin, sticky, colorless film that forms around teeth. Risk factors such as smoking, diabetes, stress, hormonal derangement and genetic predisposition play a major role in the extent and severity of the disease.
Resective Pocket Reduction Procedures Periodontal pockets are the result of the separation of the gum from the affected tooth. A space will develop where bacteria will colonize and infect the underlying supporting bone. Over time these pockets become deeper allowing more bacteria to grow and more destruction to occur. If too much bone is lost, the teeth will need to be extracted. The periodontist measures the depth of the pocket and determines if a surgical flap procedure is necessary. This includes the separation of the gum from the tooth under local anesthetic and the removal of the disease causing bacteria. The infected tissues are then removed before securing back the gums, usually with sutures. Regenerative Procedures These procedures could reverse the destructive process by regenerating lost bone and soft tissue. This includes the separation of the gum from the tooth under local anesthetic and the removal of the disease causing bacteria along with the infected tissues. Bone graft or growth stimulating proteins could be applied to help regenerate the bone. The gums are then repositioned and secured back in place with sutures.
Connective Tissue Graft: Gingival recession can lead to increased sensitivity of the tooth, increased incidences of root surface caries, impairment of oral hygiene measures and an unappealing look. Individuals that get recession tend to have thinner tissues and consequently are more vulnerable to developing these recessions. In addition, periodontal disease and/or excessive trauma could contribute to the development of recession. Connective tissue graft is a gingival augmentation procedure that uses the patient’s own tissue (usually taken from the palate) to graft directly onto the recessed area. As a result, the graft will cover the denuded area, reduce further recession, and protect the tooth against decay. We can also use alternatives to the patients own palatal tissue, e.g. AlloDerm, Mucoderm and Mucograft.
The lack of adequate width of gingiva in conjunction with restorative procedures, orthodontic therapy, or poor oral hygiene could lead to the resorption of the gingival margin. The free gingival graft will provide an adequate zone of attached gingiva that will allow proper long-term maintenance. The tissue is usually harvested from the palate and placed onto the affected area.
Frenectomy is the removal of the frenum which is a fold in the gingiva that passes from the lip to the gingival margin. A high frenum insertion sometimes retracts the gingiva when the lip is stretched. This stretching and distention can be associated with spacing between teeth, malalignment, recession and impairment of proper hygiene. The removal of this frenum is done under local anesthesia, the frenum base is separated from the gingiva and sutures are placed to close the wound.
Gingivectomy/Gingivoplasty is the surgical removal and recontouring of the gingiva in cases of excessive gingival display (gummy smile) or drug induced gingival overgrowth. This procedure will provide a cosmetic enhancement of the gingiva as well as improved access for proper hygiene and maintenance.
The benefit of Crown lengthening procedure are both Functional and Aesthetic. As one of the most commonly used procedures in Periodontics, it is included when insufficient crown length prevents adequate retention of the future restoration. This procedure will adjust the bone and gingival levels to expose more tooth structure. It will improve the health and appearance of the tissue around the future prosthesis.
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