treatment

Cosmetic Periodental Treatment
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Gingivoplasty and Gingivectomy

is a type of gum surgery used to reshape healthy gum tissue around teeth. It often is done simply to make gums look better. The gum may have an unusual shape or may not be formed normally. The causes can include a person's genes, disease or trauma. Gingivoplasty reshapes the gums to make them look more natural. It often is done alone, but can be done during or after a gingivectomy. Gingivoplasty also can be done along with a gum graft. This type of surgery adds tissue to the gum line.

Procedure

Gingivoplasties usually are done with scalpels. They also can be done with electrosurgery or laser units. The periodontist might use special tools that were designed for gingivectomies. They have angled blades to help them get around teeth.

Before either procedure, you will receive a local anesthetic shot to numb your gums. The length of time depends on how much tissue is being removed. Gingivoplasties typically are done in a couple of minutes. 

Follow Up

After either procedure, a periodontal dressing will be placed on your gums to protect the wound for a week to 10 days. A periodontal dressing is soft and has the texture of modeling clay. During this time, you will need to follow a somewhat soft diet and avoid spicy and crunchy foods. Your dentist might give you prescriptions for pain medicine and an antiseptic mouthwash.

It is very important to keep your mouth clean during the healing period. You should not brush your teeth in the surgical area while the periodontal dressing is in place. You will be able to brush and floss the rest of your mouth normally. When the pack comes off, you can brush and floss normally, but ently. The healing tissues may bleed when you floss or brush right after the dressing is removed. Your gums will begin to look normal in three to four weeks. It can take two to three months for the tissue to heal completely.

Risks

There are no major risks to either procedure. Infection and prolonged bleeding may occur. However, this is unusual. The affected area might ooze blood for the first 24 to 48 hours. After that, it should not bleed much, if at all. 


Crown Lengthening

is done when a tooth needs to be fixed. Sometimes, not enough of the tooth sticks out above the gum to support a filling or crown.

This can happen when a tooth breaks off at the gum line. It also can happen when a crown or filling falls out of a tooth and there is decay underneath. To place a filling or crown, your dentist needs to expose more of the tooth. This is done by removing some gum tissue or bone. Some people have a lot of gum tissue around their upper teeth. Dentists call this "gummy smile." This also can be treated with crown lengthening.

Crown lengthening to enhance the success of a dental restoration

Before

After

 

Esthetic Crown lengthening

Before

After

 


Procedure

Crown lengthening is done using local anesthesia. How long it takes will depend on the number of teeth that need treatment. Even if only one tooth is involved, crown lengthening typically includes neighboring teeth, too. That allows the tissues to be reshaped gradually. If both bone and soft tissue are removed, the procedure will take longer than if only soft tissue is removed.

The periodontist will make cuts that will pull the gums away from the teeth. This will expose the roots of the teeth and the surrounding bone. In some cases, simply removing a little gum tissue will expose enough tooth for your dentist to place a crown or filling. However, in most cases, the periodontist will need to remove some bone from around the roots of the teeth. Once the periodontist has exposed enough tooth, the surgical area will be washed with sterile salt water and the gums will be stitched together. Some dentists put a bandage over the stitches.

If you have temporary crowns on any of the involved teeth, the crowns may be removed before the procedure begins. The periodontist will put them back afterward.

You will be given prescriptions for a pain reliever and a mouth rinse. Your dentist will ask you to follow a somewhat soft diet. You can brush the teeth near the stitches, but avoid the gums. Remove food particles with a toothpick or a water irrigator.

After the tooth is completely numbed the periodontist will make an incision.

The gums are gently lifted to expose the alveolar bone crest.

The bone and gum tissue is then reshaped.

 

The depth is just enough to expose more of tooth length to create secure anchor for a crown.

Couple of stitches are placed to speed healing

After a few weeks of healing, a crown is placed to cover and protect the damaged tooth.

* Crown lengthening is a predictable and effective way to save the tooth that might otherwise, we lost.


Follow Up

For the first two days, use ice on your face. This will reduce swelling.
You will go back to the periodontist in 7 to 10 days to have the stitches taken out. You will go back again 4 to 6 weeks later for a follow-up visit.
Your gums should heal for about three months before the tooth is prepared for the final crown. Gums can shrink as they heal. If you don't wait long enough, the edges of the crown could show. Your regular dentist will put in the crown or filling.

Risks

The area may bleed for some time after the procedure. In addition, an infection may develop after the surgery. These complications may occur after any type of surgery.
Some people find that after the surgery, their teeth are sensitive to hot and cold. This is because the roots of the teeth are now exposed. The sensitivity goes away with time, or when a crown is put on the tooth.
Because of the tissue and bone removal, the affected tooth may look longer than the teeth next to it.
Removing bone from around a tooth can make it feel looser. If that tooth is ever lost, it could be more difficult to put in a dental implant to replace it. The periodontist will talk about these possibilities with you.

Treatment Periodontal disease
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Periodontal disease is an inflammation or infection of periodontal tissues, gingiva, alveolar bones, periodontal ligaments which are supporting tissue that holds the tooth in placed

There are two main types of periodontal disease.

Gingivistis

  • This is inflammation or infection of the gums only.
  • Most people have gingivitis at some time or other.
  • Untreated gingivitis may lead to periodontitis.

 

The symptoms of gingivitis include swollen gums, mouth sores, a bright red or purple appearance to the gums, shiny gums, gums that are painless except when touched, and bleeding gums. Often the first signs of gingivitis have no symptoms except for visual symptoms and are likely only to be diagnosed by a dental professional.

Plaque which has been deposited on the teeth for a long period of time is likely to cause gingivitis. Plaque develops on the exposed portions of the teeth, is sticky in substance, and is made up of food debris, bacteria, and mucous. The unremoved plaque deposits build up along the gum line of the teeth first, where it typically turns into a harder substance known as tarter. Plaque and tarter are likely to irritate, inflame, and infect the gums causing gingivitis. Plaque turns teeth yellow, and eventually brown in its thickest build up.


Treatment of Gingivitis

1.Homecare

  • Careful brushing at least twice daily
  • Regular and thorough use of dental floss

2. Regular professional cleaning

  • Scaling and Polishing at least twice yearly

 

 

Dental scaling

is a basic professional cleaning using special hand instruments or Ultrasonic scalers vibrate at a frequency that breaks down bacterial cell membranes and as such, because the bacteria are what make the plaque and calculus stick, the ultrasonic scaler removes a lot of both plaque and calculus.

Hand instruments are used to complete the fine hand scaling that removes anything the ultrasonic scaler left behind.

Dental scaling

is a basic professional cleaning using special hand instruments or Ultrasonic scalers vibrate at a frequency that breaks down bacterial cell membranes and as such, because the bacteria are what make the plaque and calculus stick, the ultrasonic scaler removes a lot of both plaque and calculus.

Hand instruments are used to complete the fine hand scaling that removes anything the ultrasonic scaler left behind.

Although the final result of ultrasonic scalers can be produced by using hand scalers, ultrasonic scalers are considerably faster and often less irritating to the client.

Dental polishing

Following the scaling, many dentists polish the teeth. While not as critical as scaling, polishing simply provides that fresh-from-the-dentist feeling that many people associate with having their teeth professionally cleaned.

Your dentist will apply pumice (sand-like substance) to a polishing bur attached to the dental drill.

Running the device across teeth surfaces helps polish them and remove any remaining plaque.


Periodontitis

  • This is a destructive infection that can affect all the periodontal tissues, that is, the gums, the bone and the periodontal ligaments.
  • Chronic periodontitis develops slowly, other kinds of periodontitis develop more rapidly.
  • This is a common disease - at least 50% of adults show some symptoms of periodontitis.
  • It is the major cause of tooth loss.

When periodontitis progresses to the advanced stage, pockets deepen and may fill with pus. There may be swelling around the root, and you may experience sensitivity to hot or cold or feel pain when brushing your teeth. As bone loss increases, your teeth may lose so much support they become mobile, fall out, or need to be removed to preserve the overall health of your mouth.

Periodontal disease is caused by one or more of the following:

  • Puberty and pregnancy can make people more susceptible to periodontal disease.
  • Medical problems such as diabetes and blood or genetic disease.
  • Smoking is known to contribute to periodontitis and other oral diseases.
  • Medications such as birth-control pills, and drugs for treating heart disease.

Periodontitis

Advanced Periodontitis


The treatment for a periodontitis

  1. Home care
    ​As with the treatment of gingivitis, correct and regular cleaning at home by the patient is essential.
  2. Professional treatment
    This can include one or more of the following:
    • Non-surgical treatment
      • Scaling and root planning : This is an important part of the treatment. It may take many visits to complete and have to be repeated. 2.1.2 Medications (antibacterial) : The use of antibiotics to treat periodontitis remains open to debate. Our periodontist may recommend using topical or oral antibiotics to help control bacterial infection. Topical antibiotics are generally the treatment of choice. They can include antibiotic mouth rinses or insertion of threads and gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning. However, oral antibiotics may be necessary to completely eliminate infection-causing bacteria.
    • Surgical treatment
      If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, your periodontitis treatment may require dental surgery, such as:
      • Flap surgery (pocket reduction surgery)
      • Soft tissue grafts
      • Gingivectomy
      • Bone grafting
      • Guided tissue regeneration
      • Bone(Osseous) Surgery
  3.  ​Etc

Scaling and Root Planing

Scaling is a type of cleaning that removes plaque and calculus from the teeth at and slightly below the gumline. Root planing smooths and decontaminates root surfaces, so the supportive tissues can better re-attach to the tooth surface. We may use local anesthesia because this procedure goes deeper than regular cleaning.

There is some confusion about the difference between scaling and root planing. Scaling is basically the process of removing dental tartar from the surfaces of the teeth. Root planing is the process of smoothening the root surfaces and removing any infected tooth structure. If you have gum disease or gum pocketing, the gum pockets around the teeth will have deepened, thereby allowing tartar deposits to form under the gumline.

The two processes tend to blur together since during the cleaning process, the dental worker scales away tartar and performs any necessary root planing at the same time. Any roughness can be planed away to result in a silky smooth surface.

The dentist may wish to make the area numb so that the process is comfortable for you. Sometimes if the pockets are not too deep, there may be little or no discomfort during the procedure - even without numbing. The only sensation may be the physical scraping feeling along the teeth as the area is cleaned and smoothened. A root planed root surface free of tartar has a better chance of allowing the gum tissues to heal and reattach to it. As a result, some deep gum pockets can be reduced after a deep cleaning.

What you can expect afterwards

  • Discomfort can vary after root planing, but one can expect it to be more sore afterwards since it's usually in a deeper region under the gums.
  • The teeth themselves can become a bit more sensitive to temperature, and bleeding might occur for a little while.
  • Over-the-counter painkillers such as ibuprofen work very well to alleviate discomfort, but stronger painkillers can be given should you need them.
  • Brushing and flossing can be delayed or done more gently to avoid aggravating any bruised or tender gum areas.

Flap surgery (pocket reduction surgery)

In this procedure, the periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. The procedure generally takes from one to three hours and is performed under local anesthesia.
 

Calculus forms in a deep pocket where scaling and root planing cannot reach.

During surgery, the gum is lifted to allow root plaing and removal of diseased tissue.

The new gumline may be lower, which eliminates the pocket and makes cleaning easier.

Gum may be replaced at or near the original gumline to expose less of the tooth.

 

 

Soft Tissur Grafts

When you lose gum tissue to periodontal disease, your gumline recedes, making your teeth appear longer than normal. You may need to have damaged tissue replaced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or another donor source and attaching it to the affected site. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetically pleasing appearance.


Gingivectomy

Though originally started as a treatment for periodontal diseases, nowadays these procedures are partly cosmetic also. Gum tissue removal may be required under the following two circumstances:

  • Sometimes empty pockets develop between an individual's gums and teeth. These spaces may become breeding ground for bacteria, and food particles may get stuck in them. The problem can be rectified by trimming of gums with gingivectomy.
  • The problem can also be cosmetic with excess gum tissue marring the appearance. Extra gum tissue can also lead to non-cosmetic problems like speech impediments and chewing difficulties. The condition, which can sometimes be caused by medicines, will also make cleaning process a bitcumbersome.

Either scalpels or laser units can be used for gingivectomy. There are also angled blades used in these procedures. Besides these, since medical technologies are evolving fast, specialized tools with a high level of precision are also being used now.


Bone Grafting

This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own bone or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone. Bone grafting may be performed during a technique called guided tissue regeneration.

1. The graft material is packed into the area where bone has been lost.

2. The gum is then closed and new bone growth is stimulated by the graft.

3. New bone tissue fills in the crater, providing strong support for the tooth.


Guided Tissue Regeneration

This allows the regrowth of bone that was destroyed by bacteria. In one approach, the periodontist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.

1. After a cleaning, a special membrane is inserted between the gum and bone.

2. The membrane blocks unwanted tissue, allowing ligament fibres to grow.

3. Once strong ligament fibres attach root to bone, the membrane desolves or is removed.


Bone (Osseous) Surgery

This procedure is used to smooth shallow craters in the bone due to mild or moderate bone loss. After gaining access to the damaged bone with flap surgery, we reshape the bone around the tooth to decrease the craters. This makes it harder for bacteria to accumulate and grow.


Supportive bone around the root is diseased and partially destroyed.


First, plaque and calculus are removed from the infected pocket and the root is planed.


The bone is smoothed and reshaped, reducing the number of spaces where bacteria can grow.


The gum is then closed over reshaped bone at or below the gumline.

Periodontics
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Periodontists often treat more problematic periodontal cases, such as those with severe gum disease or a complex medical history. Periodontists offer a wide range of treatments, such as scaling and root planing (in which the infected surface of the root is cleaned) or root surface debridement (in which damaged tissue is removed). They can also treat patients with severe gum problems using a range of surgical procedures. In addition, periodontists are specially trained in the placement and repair of dental implants.

During the first visit, the periodontist usually reviews the patient’s complete medical and dental histories. It is extremely important for the periodontist to know if any medications are being taken or if the patient is being treated for any condition that can affect periodontal care, such as heart disease, diabetes, or pregnancy.

 

The periodontist examines the gums, checks to see if there is any gum line recession, assesses how the teeth fit together when biting, and checks the teeth to see if any are loose. The periodontist will also take a small measuring instrument called a probe and place it between the teeth and gums to determine the depth of those spaces, known as periodontal pockets; this helps the periodontist assess the health of the gums. X-rays may also be taken to observe the health of the bone below the gum line.