Diagnosis and treatment of inflammatory periodontal disease (gingivitis, periodontitis etc.)


Everyone has bacteria in their mouths. Bacteria stick to teeth as a film called plaque. When plaque is not removed consistently through proper oral hygiene and regular visits to the dentist, inflammation can occur in the gum next to the site of this plaque. We call inflammation that is confined to the gums gingivitis. Gingivitis is relatively easy to reverse, and by definition does not leave any lasting effects once it is treated.

Underneath the gums is the bone which holds our teeth in our mouth. The bone and our teeth are attached via the periodontal ligament. Sometimes, if gingivitis remains untreated for too long, it can progress into periodontitis, which means that the bone and the periodontal ligament have become inflamed as well. This is characterized by the development of periodontal pockets (the space between the gums and the teeth), which are now so deep that the bacteria living at the base of them cannot be effectively removed on a regular basis, and thus create more inflammation, starting a vicious cycle. This can also lead to bone loss, which reduces the support of the tooth, and if left unchecked, will eventually lead to the tooth needing to be extracted.
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Treatment for gingivitis and periodontitis usually follows a specific sequence, and can include non-surgical therapy such as deep cleaning (we call this scaling and root planing), and depending on the severity, can also include surgical therapy, such as a pocket reduction. Every case is different, and requires an individualized treatment plan. Ensuring that no inflammatory periodontal disease is present in the mouth is very important, because many other dental treatments, such as crowns and bridges, removable partial dentures, and implants, all depend on the teeth having solid foundations in bone.

Crown lengthening


Sometimes, a dentist wants to put a crown or a bridge on a tooth/teeth, but the tooth/teeth have fractured or decayed to the point where there is insufficient tooth structure left upon which to put the crown. One option to deal with this situation is called a crown lengthening procedure, where a small procedure can be done to lengthen the amount of tooth which is present so that the dentist’s crown or bridge will be better supported long-term.
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Soft tissue surgery

 

Root coverage

Often, a patient’s gums have experienced recession, and the patient has some root exposed. This can be unaesthetic, and can lead to sensitivity in the area of the root exposure. If such a patient has healthy bone in between their teeth, then a root overage procedure can be undertaken, to attempt to over the area of exposed root.
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Gingival augmentation

Some patients have gums which are thin and friable. Such a patient is said to have inadequate attached gingiva, and may be at risk for progressive recession of the gums in the region. A gingival augmentation procedure can be performed, in order to increase the amount of attached gingiva, which is strong enough to withstand the normal forces our gums are subjected to, such as eating and brushing and flossing.
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Frenectomy

In certain patients, there is a small piece of tissue, called a frenum, which is attaching a patient’s lips to their gums. Because the lips are filled with muscle, this means that there is an increased pull on the gums, which can lead to progressive recession if not addressed early. A frenectomy is a procedure which removes this piece of tissue.
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Dental implant placement


When a patient is missing a tooth, or teeth, often they want that tooth or teeth to be replaced with an implant-supported restoration. First, dental implant placement is performed, during which a titanium screw or screws about the same size as the root of a tooth get placed. Then, after a suitable healing period, the patient returns to his or her dentist for the crown, bridge, or denture.
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Procedures to support dental implant placement

 

Extraction and ridge preservation

Imagine we know that a tooth needs to be extracted, and that an implant needs to be placed. If we are not planning on placing the implant right away, we want to make sure that when we do place the implant, we have enough bone to stabilize it. Under these circumstances, we most often will perform a ridge preservation at the same time as the extraction.
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Ridge augmentation

In some cases, a tooth was extracted a long time ago without ridge preservation, and now a patient wants an implant or implants to be placed, BUT, the patient has experienced ridge resorption, and there isn’t enough bone to stabilize the implant/implants properly. In this situation, a ridge augmentation can be performed, where the width and sometimes the height of bone can be increased, in order to prepare the ridge for dental implant placement.
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Sinus augmentation

Sometimes, after an upper back tooth has been extracted, the maxillary sinus, which is a big air space that sits over top of the roots of these teeth, increases in size. This is called pneumatization of the sinus. While it isn’t dangerous, it does mean that the available height of bone for dental implant placement might be inadequate. A sinus augmentation procedure, often called a sinus lift, can create the extra height of bone necessary to achieve proper implant stability.
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Orthodontic surgery

Surgical exposure of impacted teeth

Infrequently, a patient’s permanent teeth don’t erupt the way they’re supposed to. We call an un-erupted tooth an impacted tooth. While this happens most often to wisdom teeth, it can also frequently occur to canines, which are very important teeth to have. A simple procedure called a surgical exposure will allow the attachment of a short chain, which can be used to pull the impacted tooth into the arch.
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Surgically-facilitated orthodontic treatment

When a patient is undergoing orthodontic treatment, he or she might want to reduce the treatment time by having the teeth moved faster. Surgically-facilitated orthodontic treatment involves combining orthodontic treatment with a surgical procedure which allows the teeth to move faster through the jaw bone into their final positions, thus decreasing the overall treatment time.

Treatment of inflammatory peri-implant disease (peri-implant mucositis, peri-implantitis)


After an implant has been placed, inflammation can develop around it, just like it can around a tooth. When inflammation occurs around a tooth but is confined to the gums, we call it gingivitis. This same process around an implant is referred to as peri-implant mucositis. When the inflammation progresses to the bone, and begins causing bone loss around a tooth, we then call it periodontitis. When inflammation causes bone loss around an implant, we refer to this as peri-implantitis. As with gingivitis and periodontitis, there are a variety of both non- surgical and surgical means to treat peri-implant mucositis and peri-implantitis.
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