Treatments: Periodontal plastic surgery

	PERIODONTAL SERVICES
1	Non-surgical management of periodontal diseases.
2	Periodontal plastic surgery.
3	Surgical periodontal and regenerative therapy.
4	Root resection/hemisection surgical procedure
5	Crown lengthening.



	(1) Non-surgical management of periodontal diseases.
	This could include any of the following, instruction in plaque control, scaling and root surface debridement, bacterial analysis and antimicrobial therapy, occlusal analysis and adjustment and splinting of teeth. The patient’s response to non-surgical therapy is closely monitored; if periodontal problems persist further treatment may be required.
	Severe Periodontitis Case
		BEFORE Severe Chronic Periodontitis together with drug induced gingival hyperplasia (Nefidipine). After liasing with the General Medical Practitioner to change medication, the patient underwent a full course of non-surgical therapy.
		AFTER After treatment the periodontal condition has been stabilised with just non-surgical therapy and has been maintained by excellent plaque control by the patient.
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	(2) Periodontal plastic surgery.
	Problems such as excessive recession around teeth that cause aesthetic and sensitivity problems can now be dealt with great success. The use of soft tissue grafts can increase the zone of keratinised tissue and cover exposed roots. They can also be used for ridge augmentation and papilla regeneration around implants. The use of microsurgical techniques has greatly enhanced the predictability and success rate whilst also minimising post-operative discomfort.
		BEFORE Gingival recession with root exposure on premolars causing aesthetic and tooth sensitivity problems.
		AFTER A sub epithelial connective tissue graft harvested from the palate together with a coronally advanced flap is used for root coverage. The outcome shows excellent aesthetics and a decrease in tooth sensitivity.

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	(3) Surgical periodontal and regenerative therapy.
	This is usually performed if there are still problem areas after non-surgical therapy. Various surgical techniques are used for pocket elimination and predictable regenerative therapy using the latest materials available.
	Periodontal resective therapy
		BEFORE Non-responding sites that after root surface debridement still have deep pocketing and bleeding on deep probing.
		AFTER Pocket reduction periodontal surgery was carried out resulting in minimal probing depths and no bleeding on deep probing. This also provides the patient with proper access for plaque control in home maintenance.
	Periodontal regenerative therapy
		BEFORE Advanced bone loss on the distal surface of the premolars. Surgical regenerative therapy was carried out using Emdogain bone regenerative material.
		AFTER Bone regenerative therapy establishes new tooth support through new bone growth thereby enhancing the long-term prognosis of the tooth.

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	(4) Root resection/hemisection surgical procedure
	Often multi-rooted teeth have a localised infection around one root. This surgical procedure is used to remove an infected root or to divide a two rooted tooth. The tooth remains functional because the infection is eliminated making it possible to perform effective plaque control and keep the site healthy.
		BEFORE Extensive bone loss and failed root filling around the distal root of the molar. The mesial root was found to be sound.
		AFTER The distal root has been removed and the mesial root retained. The mesial root will be subsequently restored by the referring dentist.

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	(5) Crown lengthening.
	Short and inadequate tooth length prevents the placement and retention of a new crown or bridge. This procedure increases the amount of tooth structure to support a crown or bridge by contouring the gingiva and the underlying bone. In addition it can also be used to improve the appearance of the anterior teeth prior to any advanced dental treatment or by removing excess gum tissue in the case of a ‘gummy’ smile.
	Case A
		A tooth fracture with inadequate tooth structure for crown retention.
		After crown-lengthening procedure was carried out additional tooth is available to provide successful placement of a crown.
		A full coverage crown that is more retentive and natural looking.
	Case B
		BEFORE Short teeth and a gummy smile that compromises the aesthetic appearance of the smile.
		AFTER After aesthetic periodontal surgery the gums were positioned in a more pleasing position and contour. The beauty of this smile was completed with new porcelain veneers.

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