Periodontal Disease (Periodontitis) is a bacterial infection that affects the supporting structures of teeth. In most cases Periodontitis does not cause any symptoms until it reaches advanced stages of progression. The bacterial infection destroys bone around teeth and causes the gums to separate from the tooth surface. As a result, “pockets” form around the affected teeth which harbor more bacteria leading to a progressively severe infection (Figure 1). For more information on causes and effects of periodontal disease click here or visit our “Patient Information” section.
The goal of periodontal therapy is to decrease the presence of bacteria around teeth. This is accomplished through non surgical and in some cases surgical procedures.
Figure 1: Effects of Periodontal Disease
Scaling and Root Planing
Typical periodontal treatment usually is initiated by thorough debridement called Scaling and Root Planing (SRP). Scaling and Root Planing is intended to remove plaque and tartar deposits under the gums. As a result, the tissues around teeth become healthier and less inflamed due to decreased amounts of bacteria under the gums (Figure 2a-b). Most patients experience less bleeding from the gums after completion of SRP. Scaling and Root Planing is usually completed in two to three appointments. For patient’s comfort, the gums are anesthetized with local anesthetic or topical numbing gels during the appointment. The condition of the gums is re-evaluated about a month after completion of SRP.
Figure 2a: Inflamed and Swollen Gums
Figure 2b: Gums after SRP
In moderate and advanced cases of periodontal disease, Scaling and Root Planing alone may not provide enough benefit. If after SRP, the condition of the gums has not sufficiently improved and periodontal pockets around teeth are still remaining, minor surgical treatment may be indicated. Periodontal surgery is intended to thoroughly debride areas that were not reachable with SRP and further reduce the pockets around teeth. This procedure is done with local anesthetic, however patients may choose to be sedated to relieve any anxiety. During the procedure the gums are carefully trimmed to eliminate infected and unhealthy tissue, and roots of the teeth are cleaned. Gums are then repositioned using sutures (Figures 3a-c).
Figure 3a: Periodontal pockets remaining after SRP
Figure 3b: Pockets treated with periodontal surgery
Figure 3c: Gums repositioned with sutures at the completion of surgery
Bone Grafting and Regeneration
During periodontal surgery it may be possible to regenerate the bone around teeth which was lost due to periodontal disease. This is accomplished by placing a bone graft in the areas around teeth (Figures 4a-d). Recent developments in techniques and materials have greatly expanded treatment options with growth factors and biologic modifiers. These materials induce the bone to grow at a faster rate and provide more predictable results.
Figure 4a: Bone loss around a tooth as a result of Periodontal Disease
Figure 4b: Defect around the tooth is cleaned during a surgical procedure
Figure 4c: Defect in the bone is filled with a bone graft material and growth factors
Figure 4d: Newly regenerated bone is formed around the affected tooth
Typically about six months is needed for the new bone to mature after a regeneration procedure. As a result, increased support around the tooth is formed. Regenerated bone can be observed on an X-Ray at the end of the healing period (Figures 5a-b).
Figure 5a: Bone loss as a result of periodontal disease
Figure 5b: Newly formed bone after a regeneration procedure
Periodontal Laser Therapy
Laser technology has been in use for a number of years in both dentistry and medicine. New advancements in laser instruments as well as the techniques with which laser therapy is applied have greatly expanded treatment options for our patients. Currently lasers have not replaced traditional means of therapy in periodontics: however, in many cases, it can be used with traditional treatment to provide added benefits. It is important to properly identify situations where laser use is appropriate in achieving the needed therapeutic effect. Our doctors routinely provide our patients with the necessary information to help educate them and to help in determining whether laser treatment is right for them.
Laser Assisted Surgery
Lasers can be used during surgical procedures to manage soft tissues and debride infected areas. When used properly lasers may provide additional benefit to the conventional surgical techniques, resulting in less bleeding, better access, and more rapid healing for the patient.
Laser Assisted New Attachment Procedure (LANAP)
The LANAP is an FDA approved and patented procedure specifically designed to treat periodontal disease. During active periodontal disease gums around teeth are inflamed, swollen, and have separated from the tooth surface. As a result, periodontal pockets form between gums and teeth that harbor bacteria which lead to progressive infection. Using the LANAP the infected gum tissue is removed along with bacteria and tartar deposits below the gums. This allows the gums to reattach to the tooth surface, thus decreasing the periodontal pockets (Figure 6). This type of laser therapy is not indicated for all cases, and our doctors can determine with a thorough periodontal evaluation whether the LANAP is appropriate for a patient.
Figure 6: Sequence of steps in the LANAP treatment. A) Untreated periodontal pocket. B-D) Treament and removal of diseased gum tissue using the laser. E-F) Reattachment of the treated gum tissue to the root surface.
Please visit www.lanap.com for the animated demonstration of the LANAP.
Following the completion of periodontal therapy, a periodontal maintenance program is recommended to prevent recurrence of the disease. Much like blood pressure problems, or diabetes, control of periodontal disease requires commitment on the part of the patient and treating doctors. In addition to proper oral hygiene, dental cleanings four times per year have been shown to significantly reduce recurrence of periodontal disease and tooth loss. By having your teeth and gums thoroughly cleaned every three months, bacteria that can cause periodontal disease is drastically reduced. Periodontal maintenance is typically arranged so patients alternate their visits every three months between the periodontist and their general dentist.