PHASE I. DISINFECTION
We know that PD is an infectious disease, produced by bacteria that are commonly present in the mouth. PD is not produced by strange bacteria coming from elsewhere. PD is produced in patients that have had bad hygiene habits for years, which has lead to an excessive amount of bacteria, overwhelming the defensive capacity of the individual. In other patients the immune system is genetically unable to protect against bacteria and depending on the genetic information they will develop the disease earlier or later. This type of patients are much more susceptible to suffer from more aggressive periodontitis.
Although it is an infectious disease, we do not always use antibiotics, because the causing bacteria are part of the oral flora. It is readily noticed that we cannot give antibiotics on a permanent basis, but just for punctual situations.
Periodontal treatment will consist of infection control through mechanical elimination of debris, such as calculus, bacteria and toxins produced by them and embedded in the root.
Regular dental cleaning will not be enough for periodontal patients because this procedure eliminates only the superficial tartar. Furthermore, it fails to clean the bacteria located at the bottom of the pocket.
If you have delicate gums and you are prone to suffer from periodontal disease, you should be treated with dental Scaling and Root Planning. One or more sessions will be necessary depending on the severity of the disease. This is a specialized technique that eliminates deep calculus. It is performed without seeing what it is being done. This procedure must be performed by a specialized technician who will be able to detect minor amounts of calculus with hand pressure.
Scaling should be performed with or without anesthesia depending on the professionalability and technique of the dentist or hygienist. We recommend to do it on several visits because gingiva will heal from the treatment and will allow to reach deeper areas of the pocket as inflammation recedes.
Patients should be taught to take care about their teeth and to brush them properly because most people think they do it well, which is not the case most of the time. It is as important for the professional to create a healthy environment as for the patient to maintain it.
PHASE II. SURGICAL TREATMENT
Sometimes the dentist cannot properly clean the depth of the pocket because it is too deep or because there are anatomical difficulties. When this occurs, the periodontist will ask for a surgical treatment. This will enable him to easily reach inside the infected root and to see what he is doing. Also, after surgery, the gingiva will be placed in a better position in order to help the hygienist to do his or her work during future maintenance sessions.
Other surgical indications will be, bone remodeling or bone regeneration.
PLASTIC GINGIVAL SURGERY
Plastic gingival surgery belongs to the group of procedures that aim to improve aesthetics and function. The main plastic aesthetic procedure is the Gingival Graft. This is a technique that pretends to cover roots that have been previously denuded. Other techniques are: Frenectomy, Crown Lengthening, etc…
Let´s explain these techniques in a greater detail:
The Gingival Graft, pretends to create gingiva where it does not exist, either to cover roots to improve aesthetics or to create gingiva to protect a tooth that has only mucosa around it. To do this we take good quality gingiva from some locations that will give out tissue without creating any problem. In other words, the gingiva that we take will regenerate without even creating a scar. The donor site is usually the palate.
The Frenectomy is a technique that eliminates the frenum that goes from the inner part of the lip to the gingiva. Most of the time the frenum is inserted in between central incisors producing a separation and an ugly space. When the frenum is eliminated, teeth can be moved together with orthodontic treatment.
The Crown Lengthening procedure as the name indicates, pretends to make the tooth longer. It is used to reduce gummy smile, to expose caries that appear underneath the gingiva so the dentist can see it all for proper filling of the decay. Lengthening is necessary for better retention when teeth have been worn down, through dental grinding, and when teeth need to be crowned or a dental fractures has reached a point when it is not visible.
Crown lengthening procedure
Crown lengthening procedure at a upper molar
Crown elongation method for improving aesthetics
PHASE III. MAINTENANCE
To keep it clean we need a team made of the professional, the hygienist and the patient. It is most important not to miss the scheduled maintenance visits because the dentist is the one who knows how delicate the situation is and how resistant the patient will be to new bacterial colonization.