To better understand periodontal diseases and treatment you need to know the anatomy of the tooth supporting structures. They include the periodontal ligament which attaches the tooth roots to the interdental bone (socket) and the gum tissue which attaches to the bone and surround the tooth neck like a collar. The word periodontal literally means "around the tooth". Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth.
Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) releases toxins causing gum inflammation.
Complete dentures replace full set of teeth from upper and lower jaws of the dentition. They can aid in chewing and biting functions. Dentures can be directly fixed over gums or can be supported by implants. Complete dentures are one of the oldest methods of replacing lost teeth. There are two types of complete dentures, namely conventional and immediate dentures. With immediate dentures dentists can restore teeth in just one visit. The conventional type of dentures has a healing period of few weeks during which the gums shrink. The patient should visit the dentist the second time to get his dentures adjusted after the gums shrink.
This causes the gums to swell, appear puffy and bleed easily. This early stage of gum inflammation is called gingivitis. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with regular professional treatment and good oral home care.
Untreated gingivitis can advance to periodontitis. With time, plaque hardens to form tartar and begins to grow below the gum line detaching the gums from tooth. Toxins produced by the bacteria in plaque stimulate a chronic inflammatory response causing bone resorption. Gums separate from teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Symptoms include bleeding gums, bad taste in the mouth, halitosis (bad mouth odor) and in severe cases abcesses. Eventually, teeth can become loose and may have to be removed.
The first step towards gum health is regular professional cleaning and good home care. Gingivitis and early periodontitis can be easily be treated by scaling and root planing .Scaling and root planing is careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets using hand instruments and ultrasonics and simultaneously smooth the root surfaces. This may be accompanied with local delivery of anti-microbial agents to aid healing.
After scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, majority of the patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal health.
When routine scaling and root planing does not help to restore periodontal health periodontal surgery may be advised. Most common surgical procedures are:
When with routine scaling and root planing deep periodontal pockets cannot be cleaned your periodontist may recommend pocket reduction procedures. During this procedure, your periodontist folds back the gum tissue and removes the disease-causing plaque and tartar. In some cases, irregular surfaces of the damaged bone are smoothened. This allows the gum tissue to better reattach to healthy bone. The gum tissue is then secured at its new position with sutures.
Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult for you and your dental care professional to clean, so it's important to reduce them. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth – and decrease the chance of serious health problems associated with periodontal disease.
If there is a defect in the bone, often times a bone graft can be placed to stimulate new bone formation. A combination of natural or synthetic bone can be used for regeneration. Sometimes specialised membranes may be used during this procedure to prevent the gum tissue from creeping in between the tooth and the bone. This helps allow a regeneration of new bone and periodontal ligament.
This procedure involves the removal of gum tissue (gingiva), bone or both to expose more of a tooth's structure.What it's Used for
Crown lengthening is done when a tooth needs to be restored, but not enough tooth is present to support a crown or a filling.
This can happen when a tooth breaks off at the gum line, or a crown or filling falls out of a tooth that has extensive decay underneath. If your dentist wants to repair the tooth using a crown or a large filling, he or she may need to expose more of the tooth by removing some soft tissue and/or bone.
In some cases, a condition called gummy smile —in which an unusually large amount of gum tissue shows around the upper teeth —can be treated using crown lengthening.Procedure
This procedure is usually done under local anesthesia. Incisions are made to reflect the gums away from the teeth. This provides access to the roots of the teeth and the bone that surrounds them. In some cases, by simply removing a little gum tissue when the incisions are made enough tooth structure will be exposed for your dentist to place a crown of filling. However, in most situations it will also be necessary for the periodontist to remove some bone from around the roots of the teeth. The bone is removed using a combination of hand instruments (resembling chisels) and rotary instruments (similar to the drill and burs used to treat cavities).
Then the gum tissue is secured with sutures. At this point, your teeth will look longer because the gums are now sitting at a lower level then before the surgery. Sometimes a periodontal dressing may be used —an intraoral bandage —to cover the surgical site. It helps protect the surgical site and aids in healing.
Any temporary crowns will be removed before the procedure begins and replaced afterward.Soft tissue Grafts
Soft tissue grafts are used for treating gum recession, and/or to improve the esthetics of your gum line.
Gum Recession could be due to a variety of reasons including aggressive tooth brushing, periodontal disease or clenching of teeth.
Exposed tooth roots are the result of gum recession. Gum recession makes your teeth longer giving an older look. Also since the roots are exposed your teeth will be sensitive to cold liquids and foods. Soft tissue grafts can easily eliminate this problem.
Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. During this procedure, your periodontist takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth. A soft tissue graft can reduce further recession and bone loss. It also protects the root from decay and reduces sensitivity.
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