NON SURGICAL TREATMENT

Oral hygiene is the first step toward periodontal health. If you have been diagnosed with periodontal diseases, you may be more susceptible to the disease and for this reason, need to keep your teeth cleaner that most people. This can be accomplished through toothbrushing, flossing and special oral hygiene aids such as interdental brushes.

Scaling and root planing (SRP) is a careful deep cleaning of the root surfaces to remove plaque and calculus from deep pockets. This type of more-in-depth cleaning may require local anesthesia and involve more than one appointment. Scaling and root planning is usually the first mode of treatment recommended for most patients. Research has consistently shown that SRP reduces gingival inflammation and pocket depths (Figures 4a and 4b). Many patients may not require any further active treatment, including surgical therapy following SRP and performance of adequate oral hygiene.

 
Gum inflammation between the 2 front teeth before SRP.
Healthy gum appearance after SRP.
 

REEVALUATION OF THE FIRST PHASE OF TREATMENT

Following adequate time to allow your gums to respond to treatment, you will be asked to return to the periodontist’s office for a reevaluation to determine if further active therapy is indicated. If the answer is “yes”, you may require surgical treatment to remove any residual infection and decrease pocket depths to reduce your risk for disease progression in the future.

If the answer is “no”, then you will be enrolled in a maintenance phase that involves regular cleaning appointments every 3, 4 or 6 months depending on your needs.

SURGICAL POCKET REDUCTION OR ELIMINATION

During this procedure, the periodontist folds back the gum tissue to gain direct access to the roots and remove the bacterial plaque and residual calculus. The gum tissue is then secured into place. In some cases, the irregular surfaces of the damaged bone are smoothed to limit areas where bacteria can hide and grow. This allows the gums to better reattach to the bone.

This type of periodontal surgery may be required to further reduce deep residual pockets that are more difficult for you and your dental care professional to clean.

PERIODONTAL PLASTIC SURGERY

In addition to periodontal surgical therapy aiming at pocket reduction or elimination, there is a variety of cosmetic surgical procedures available that could enhance your smile.

Soft Tissue Grafts

Periodontal procedures are available to stop gum recession, and/or to improve the esthetics of your gum line. Exposed roots resulting from gum recession make teeth appear too long or are associated with sensitivity to hot or cold foods and liquids. They may also in some cases develop root caries (decay).

Gums recede because of a variety of reasons, including aggressive tooth brushing or periodontal disease. Once these factors are controlled, a soft tissue graft procedure will repair the defect (totally or partially) and help prevent additional recession and bone loss.

Soft tissues grafts can be used to cover roots or develop gum tissue which is absent due to excessive gum recession. During this procedure, the periodontist takes gum tissue from the palate or another donor source to cover the exposed root
 
Before soft tissue grafting.
After soft tissue grafting.
 
Note gum recession on all upper anterior teeth before grafting.
More natural tooth length after grafting.
 

Crown Lengthening

In some cases, teeth appear too short and the smile is too “gummy” or the gumline is uneven, covering too much of some teeth, while leaving others the right length. The teeth may actually have the proper length, but they are 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 (Figures 7a, 7b). If restorations are necessary, this procedure sets the stage for new veneers or crowns to have the correct length and shape.
 
 
Teeth appear short before crown lengthening.
More natural tooth length after crown lengthening.
 
 
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