The purpose of periodontal treatment is to stop infection and allow the gums and bone to heal.
Scaling & Root Planing
Scaling and root planing, also referred to as non-surgical treatment, involves careful cleaning of the root surfaces to remove plaque and calculus (scale, tartar) from deep periodontal pockets and to smooth the tooth root. A smooth, clean surface allows the gum to heal back against the tooth.
The gums are numbed before treatment. Scaling and root planing is performed with ultrasonic cleaners (an instrument that gently vibrates, loosening the scale) as well as hand-held scaling instruments that smooth the surface of the teeth and roots.
In most cases, the early stages of periodontal disease are best treated with non-surgical periodontal therapy.
Even in severe cases, non-surgical periodontal therapy often precedes surgical therapy. This is done to improve the overall tissue quality prior to surgery and also to help limit the areas requiring surgery.
The gum infection causes changes in the gum tissues with the gum “unzipping” down the root, creating what we refer to as a periodontal pocket or space. The plaque deposits fill this space allowing the infection to extend deeper into the gum tissues. An infection deep in gum is not painful. This is surprising and unfortunate as it is not until a tooth starts to get loose or a periodontal abscess forms that a person becomes aware that they have gum disease. By then it may be too late to do anything to help.
The tooth gets loose because an unusual reaction occurs in the bone. As the infection goes deeper into the gum, the bone shrinks away from the advancing infection until at some point, dependent on tooth size and load, the tooth starts to feel loose.
The purpose of periodontal treatment is to stop the infection and allow the gums and bone to heal. Unfortunately, again the infection is not one that can be cured by antibiotics or a mouthwash alone. The scale and plaque have to be physically removed off the surface of the teeth. This is what ‘scaling and cleaning’ accomplishes.
If after scaling and root planing pockets still remain, periodontal surgery is done to reduce pockets and improve the contour of the bone and gums around the teeth.
Periodontal surgery involves reflecting (folding back) the gum line to create access to adequately treat the root surfaces and the supporting bone. The ultimate goal is to reduce pockets and improve the attachment of the gums to the teeth. Periodontal surgery is typically done when the gums are numb and if you prefer, you can be sedated as well.
See following section on Patient Comfort: Sleepy Dentistry
Crown Lengthening – Restorative Purposes
The ‘crown’ of a tooth is what you see when you smile. It is the part of the tooth above the gum. The rest of the tooth is below the gum-line, imbedded in the jawbone. Sometimes teeth are relatively short or the existing fillings may finish below the gum-line. Fillings, which finish below the gum-line, can be difficult to clean and they also irritate the gums. Crown lengthening is done to solve this problem by replacing the gum lower down the tooth and thus increasing the amount of tooth extending above the gum line. The deep fillings are then no longer below the gum-line and a new crown or restoration can be placed. The procedure typically takes approximately one hour.
Following the crown lengthening procedure patients usually wait six weeks before proceeding with the final restoration.
Crown Lengthening – front of the mouth for aesthetic reasons
Cosmetic or aesthetic crown lengthening is a procedure that is used to increase the amount of tooth that extends above the gum line making the teeth look longer. Together with some cosmetic dentistry by your dentist, the appearance of your front teeth can be improved significantly.
There are a number of reasons why a patient may want to improve the appearance of their front teeth:
- sometimes because of crowding with teeth being different lengths and different angles
- because of tooth wear which is aging
- short teeth with a gummy smile
The crown lengthening procedure involves adjusting the levels of the gum tissue and bone around the tooth in order to create a new gum-to-tooth relationship. This procedure can be done under local anaesthetic or in combination with intravenous sedation.
Soft Tissue Grafting
As a person gets older their gums can gradually shrink or recede. This can be dramatically quickened by gum disease. Gum disease can be treated so the gums stop shrinking, but they do not grow back. The exposed root surface can also be sensitive to hot and cold.
The gums and skin are known as ‘soft tissue’ so soft tissue grafts are used to cover exposed root surfaces and replace gum tissue, which was lost due to gum recession. Apart from aging, gum recession may have occurred for a variety of reasons including aggressive tooth brushing, periodontal disease or a combination of factors. The benefits of grafting include improved appearance, protection to the teeth and reduced tooth sensitivity. Grafts can be provided for a single area or multiple teeth can be treated at one appointment.
For many of us our own natural teeth do not survive many years of daily use. Whether due to dental decay, periodontal disease or injury we may loose teeth prematurely. When this occurs we are faced with a variety of treatment choices – one of these choices is to use dental implants to replace the missing tooth or teeth.
Dental Implants represent the most significant advance in tooth replacement in the past 70 years. An implant is a hollow metal post or screw that is placed in the jawbone where a tooth has been lost. The bone is given a few months to grow in and around it – a process we refer to as osseointegration. At the end of that time a false tooth can then be screwed into the hollow centre of the implant. The gum grows around it and it looks and feels like a natural tooth.
Whilst there are a number of options, using dental implants as the foundation for the replacement may most closely duplicate the look and feel of your original natural teeth.
As part of your initial consultation appointment we will discuss the options that are available and also the pros & cons for each option. The timing for replacement may be critical, especially at the front of the mouth and options for what we refer to as temporization need to be considered.
Patients have questions about
- How long will treatment take
- Can I have a tooth or teeth fixed on the implants straight away
- If I have lost gum or bone due to infection or trauma, can this be repaired
These issues are considered at your initial consultation appointment and your questions answered. In some cases we need further x-ray examination before we can give you a final answer.
For single tooth replacement an implant is often the treatment of choice. The crown made to fit on the implant is designed to look and function like a real tooth. It is the easiest option in terms of cleaning but requires that you floss around it on a daily basis.
With proper positioning the implant-supported tooth helps to preserve the surrounding bone and soft tissue to provide a natural appearing result.
Multiple Missing Teeth
Using implants we can overcome the limitations of conventional tooth supported bridges and avoid the need to wear a removable partial denture. Conventional bridges are not ideal where the adjacent teeth are in pristine condition or there are multiple (2 or more) teeth missing.
Full Loss of Teeth
In days gone by once you lost all your teeth, dentures were the only option. Today with implants there are now options available to either improve the fit of a denture giving better suction and stability or have teeth fixed in place.
An implant that holds dentures in place does not have a tooth on it. Instead it has a small clip sticking up above the gum. Dentures have a small bracket placed on the under surface which allows them to clip onto the implants. This holds the denture in place and stops it from moving about.
With the first option your denture can still be taken in and out to clean. In the bottom jaw placing two implants can secure the lower denture, stopping it moving around. In the top jaw you need four implants joined by a bar to support the denture. An implant-supported removable denture requires fewer implants and results in less cost than the fixed option.
To have teeth fixed in place you need a minimum of four implants in the bottom jaw, more in the top jaw. You can regain the sensation of normal chewing. Cleaning however is more challenging than the removable-implant supported denture.
There is an optimal time for placing implants after teeth have been lost – normally within 6 -12 weeks. After that, with no teeth to need to hold in place, the jawbone shrinks back and flattens out. The degree to which this occurs varies from person to person.
This may leave a situation where there is an inadequate thickness of bone to allow placement of dental implants. In these situations, assessment often with 3-D x-ray examination may show that implant placement is possible with bone grafting to re-build the ridge or jaw contour.
Bone grafting can repair implant sites with inadequate bone structure that is due to previous extractions, gum disease or injuries. There are various options available for the source of graft material to rebuild the ridge. We discuss these options at your consultation appointment. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration.
Sinus Lift Procedure
Sinus bone grafts are also performed to replace bone in the back of the upper jaw. The sinuses are inside your cheeks on either side of your nose, and extend back along the top of the upper back teeth. These are the sinuses that get blocked when you have the flu. Some of the roots of the natural upper back teeth extend up into the sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the sinus and the mouth.
Dental implants need bone to hold them in place. When the sinus wall is very thin, there may be insufficient bone to place dental implants.
There is a solution and it’s called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus above where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus.
If there is enough bone between the upper jaw ridge and the bottom of the sinus to stabilize the implant well, then sinus augmentation or grafting and implant placement can sometimes be performed as a single procedure.
If there is not enough bone present, then sinus augmentation will have to be performed first and the graft will have to mature for several months before implants can be placed.
Our goal is to provide periodontal and implant care with the highest degree of patient comfort. Many potential patients put off needed dental care due to anxiety, sensitivity, or fear of pain. In our office we understand this anxiety and can help you to reduce possible apprehension about periodontal and implant treatment by providing you with the information that you need to understand what will happen. Additionally, we offer the following services to maximize your comfort:
Numbing the Gums
Topical anaesthesia is a numbing gel; it is often used during cleaning procedures by our hygienists. It is also wiped onto the gums prior to injection of a local anaesthetic to help make injection as comfortable as possible.
Sedative tablets can be prescribed prior to treatment to reduce anxiety and allay fears. The medication is usually taken at least one hour prior to treatment and is used in conjunction with intraoral local anaesthetic. After taking oral medication for conscious sedation, someone will need to drive you to and from the appointment.
Intravenous medication is recommended for patients undergoing extensive periodontal or implant procedures or to reduce fear and anxiety associated with even short procedures.
During I.V. conscious sedation small doses of a sedative medication is given until you feel drowsy and sleepy. During the procedure you are able to breathe on your own, clear your throat if necessary, and respond when spoken to. Your breathing and heartbeat are monitored and extra oxygen is delivered to ensure your safety during the procedure. Most people do not remember anything about the procedure after being sedated.
You must have someone drive you to and from the appointment and avoid eating or drinking for at least four hours prior to the procedure.