Managing your periodontal condition with non surgical treatments
The first line of treatment against periodontal diseases is non surgical therapy. This phase of treatment is extremely important and needs teamwork. The dental hygienist will work with patient at improving the plaque control with more efficient methods of cleaning the teeth. Afterwards deposits of both hard and soft plaque bacteria deposits are removed with use of both hand instruments and ultrasonic scalers. Once scaling has been completed then if there any deeper areas of infection (periodontal pockets) then these are cleaned with hand instruments called gracey scalers under local anaesthetic. The use of local anaesthetic makes the procedure virtually pain free and with almost no post treatment discomfort. After this has been carried out then patient is reviewed approximately 2 months later. At this visit we will measure all then pockets again to see if there has been any improvement.
Usually at our periodontal and dental implant clinic we tend to get on average almost over 90% reduction in pocket depths with just the non surgical therapy.
Non surgical treatment does not always cure deep periodontal pockets
If there are still sites which have residual infection and deep pocketing then we have the option of surgical therapy. Surgical therapy is still used in cases where non surgical management has not completely resolved the problem. A surgical procedure is used to smooth or correct defects and irregularities in the bone/soft tissue surrounding the diseased teeth with the ultimate goal of reducing or eliminating the periodontal pockets. Due to the fact that deep cleaning and rootplaning is a blind procedure we are treating the periodontal condition more by touch and feeling.
Surgical periodontal therapy can be used to cure periodontal pockets
With surgical therapy after the gum has been anaesthetised, this is gently peeled back. Once this is done, the infected gum tissue around the roots (granulation tissue) is gently removed and the roots become visible. The purpose of this is to give the periodontist access, and allow him to see if there are any deposits of hardened plaque bacteria (calculus) on the roots. The roots can then be cleaned and all bacterial deposits removed. The periodontist will also establish how much bone still exists around the roots, because in advanced cases of periodontitis bone can be lost due to the infection.
Surgical periodontal therapy can regenerate lost bone
In many cases we can regenerate some of the “lost bone” by using a regenerative material called Emdogain. Regenerating lost bone will help to keep the tooth for longer as it will have extra support. You can read more about bone grafting procedures here. Following the surgical therapy the gum is then placed back where it was originally, or if it was for periodontal pocket reduction then it may be placed at slightly lower level to completely remove the gum pocket. Post operative pain can be kept to minimum with the use of over the counter pain medication. By accessing the root directly and also removing the periodontal pocket we are clearing the infection and this will lead to healthier gums around the roots and thereby keep the tooth for a lot longer.