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Periodontal Disease and Treatment (continued)

Non Surgical Treatment

The American Academy of Periodontics (AAP) treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner possible. This is often accomplished through a non-surgical treatment called ‘deep cleaning’ known as scaling and root planing.

By careful cleaning of the root surfaces to remove plaque and calculus (tartar) from periodontal pockets and to smooth the tooth root to remove the bacterial toxins, supportive tissues can then reattach to the tooth surface. For your comfort, this is done in sections over a few visits with local anesthesia (novacaine). If you have an acute infection, antibiotics may be prescribed in either pill form or directly placed into the infected pocket.

Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non surgical therapy does have its limitations, however, based on the initial actual pocket depth. When it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal disease and to facilitate oral hygiene practices.

Periodontal Surgery
Dr. Pezzullo will measure the depth of your gum pocket(s). Periodontal surgery is necessary when the tissue around your teeth is unhealthy and cannot be accessed for repair with non-surgical treatments. The gum pockets will have become too deep to clean out with deep cleaning alone or with daily home care. The following are the five types of surgical treatments most commonly prescribed:

Pocket Reduction Procedures (Laser Assisted)
Regenerative Procedures (Bone Grafts)
Crown Lengthening (Tooth Exposure)
Soft Tissue Augmentation (Gum Grafts)
Dental Implants (Root Replacement)

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Pocket Reduction Procedures
During this procedure, Dr. Pezzullo folds back the gum tissue to reach the base of the pocket. This flap provides access to the root surface in order to remove the disease-causing bacteria before securing the tissue back into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone and the tooth root. Also see laser periodontal surgery

Regeneration
Dr. Pezzullo may recommend a regenerative procedure when the bone supporting your teeth has been badly destroyed. These procedures can partly reverse damage by regenerating some of the lost bone socket. Tiny fragments of your own bone, synthetic bone or bone from a bone bank are placed into the defect where bone was lost. These grafts act as a scaffold for new bone growth. A special membrane covers the graft like an apron. The membrane blocks unwanted tissue from growing into the graft.

Crown Lengthening
Your dentist may recommend crown lengthening to make a restorative (or cosmetic) dental procedure possible. Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.

You may have asked Dr. Pezzullo about cosmetic procedures to improve a “gummy” smile because your teeth appear short. Your teeth may actually be the proper length, but they’re covered with too much gum tissue. To correct this, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.

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"Remember - you only have to floss the teeth you want to keep."