Periodontics

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Gum disease (also called periodontal disease) is an infection of the tissues that support your teeth. It is a major cause of tooth loss in adults. Because gum disease is usually painless, you may not know you have it. At each regular checkup the dentist will measure the depth of the shallow v-shaped crevice (called a sulcus) between your tooth and gums to identify whether you have gum disease.

Gum disease is caused by plaque, a sticky film of bacteria that constantly forms on the teeth. These bacteria create toxins that can damage the gums.

Periodontal diseases attack just below the gum line in the sulcus, where they cause the attachment of the tooth and supporting tissues to break down. As the tissues are damaged, the sulcus develops into a pocket; generally, the more severe the disease, the greater the depth of the pocket.

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Periodontal Disease

  • periodontal disease
    The plaque and tartar on these lower teeth have caused the significant bone and tissue loss that has occurred around these teeth.
  • periodontal disease
    In this individual, we can see that the teeth are drifting due to lack of bone support around the roots of the teeth as a result of advanced periodontal disease.
  • periodontal disease
    This woman in her early 40′s has advanced periodontal disease. The teeth have moved significantly and have very little bone support. They are extremely loose, painful and unesthetic, and will require extraction.
  • periodontal disease
    Although it may appear in this individual that there is only a minimal amount of bone loss, in fact the bone loss is advanced as is indicated by the movement of some of the teeth. All of these teeth will be lost.

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Stages of Periodontal Disease

  • stages of periodontal disease
    Gingivitis is the first stage of Periodontal disease. Plaque, (a sticky substance filled with bacteria) settles along the gum line of the teeth and causes the gums to swell, become red in appearance and bleed.
  • stages of periodontal disease
    If the plaque is not removed, bacteria settles around the roots of the teeth and starts to destroy the supporting bone. The bone loss is not reversible. The gums become infected and pull away from the teeth, forming pockets.
  • stages of periodontal disease
    As the pockets become deeper and the infection progresses, more bacteria accumulates and further bone loss occurs. The gums shrink away and the teeth start to become loose and may shift. Many people suffer from bad breath at this stage.
  • stages of periodontal disease
    When periodontal disease has reached its advanced stage, painful abscesses can form in the gum. There is very little bone support left and the teeth are loose. In most cases, teeth that have reached this stage require extraction.

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Root Coverage Graft

Root Coverage Graft

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Crown Lengthening for Esthetics

crown lengtheningCrown lengthening is a procedure used to increase the amount of tooth which is above the gum line. Crown lengthening is sometimes performed so that the teeth can be made longer to receive a restoration, or is sometimes performed for an improved esthetic appearance. In this individual, the lower teeth are very short in appearance and will be crown lengthened.

crown lengtheningWhen crown lengthening is performed, some bone and gum tissue is removed around each tooth, so that there is more tooth structure remaining above the gum line. Once the area is healed, we can see that there is more tooth showing, giving this individual a more aesthetic appearance.

Crown Lengthening

Crown Lengthening

Gingavectomy with Laser

Gingavectomy with Laser

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Bone Loss with Furcation Defect

bone loss with furcation defectWith periodontal disease, there is bone loss. When the bone loss extends past the point where the roots divide on molar teeth, an opening is created between the roots. This area is the furcation of the tooth. Once bone loss extends to expose the furcation, the prognosis of the tooth declines, since this area becomes a trap for plaque, tartar, debris and bacteria, and is very difficult to clean. Treatment of a furcation involvement may involve surgery to make the furcation area easy to clean. Maintaining oral hygiene is a vital component of periodontal therapy to prevent tooth loss.

bone loss with furcation defectOnce the furcation has been exposed and the excess tissue has been removed, it can now be cleaned using small dental brushes. Maintaining these areas is critical in the longevity of the tooth, since a furcation is an excellent hiding place for harmful bacteria that will continue to cause inflammation and bone loss.

Vertical Bone Loss

Vertical Bone Loss

Horizontal Bone Loss

Horizontal Bone Loss

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Grafting for Periodontal Defect

grafting for periodontal defectBone loss with Periodontal Disease can occur throughout the mouth, or can be localized around one tooth. Bone will not grow back around the root of a tooth where it has been lost. In areas where the bone loss is not severe, bone grafting may be an option in an attempt to fill in the defect. Without treatment, the bone loss may advance, resulting in possible loss of the tooth. In this example, there is a bone defect (outlined in yellow) around the root of the molar tooth.

grafting for periodontal defectThe bony defect around the root of this tooth was treated with a bone graft procedure. The graft can consist of a variety of products, all of which are bio-compatible (accepted by the body). The defect is filled in with the graft product and then allowed to heal. The success of this procedure depends on the amount of defect, the presence of infection and the healing abilities of the individual.

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Pocket Reduction Esthetic Consideration

pocket reduction esthetic considerationThis individual has moderate periodontal disease. There is bone loss around the roots of the teeth, creating deep pockets within the gum tissue. Plaque and tartar (which are filled with harmful bacteria) settle into these pockets, and the bacteria causes inflammation of the tissue and further bone loss. If left untreated, the disease process will advance and may result in tooth loss. Treatment consists of scaling and root planing and possible gum surgery to reduce the pockets around the teeth.

pocket reduction esthetic considerationAfter treatment has been completed, the gum tissue is healthy, and the pockets have been reduced. This treatment however, can cause some esthetic concerns. With the reduction of the tissue, the teeth now appear longer. The roots of the teeth are visible, and spaces are present between the teeth which
were once filled with tissue. In individuals who do not display the gum tissue even in a full smile, this may not be a concern. However, in individuals (such as this individual) who have a broad smile, treatment of the teeth with restorations may be an option to create a more esthetic result.

Pocket Reduction Procedure

Pocket Reduction Procedure

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Scaling and Root Planing Therapy

scaling and root planning therapyPeriodontal (gum) disease is one of the leading causes of tooth loss. Plaque and tartar that build up on the teeth contain bacteria, which cause tissue inflammation and destroy the supporting bone around the roots of the teeth. Removal of this bacteria is the initial step in treatment, and although deep cleaning cannot restore the lost bone and tissue, it can prevent the disease process from advancing and help to prevent tooth loss. The initial phase in the treatment of periodontal disease is scaling and root planing.

scaling and root planning therapyScaling involves removal of the bacteria and other debris from the crown and root surfaces of the teeth. Root planing involves smoothing the root surfaces of the teeth, in areas where they have become rough due to tartar. Depending on the severity of the disease process, some individuals require local anesthetic for the scaling and root planing appointment. Once the teeth have been thoroughly cleaned, the disease process is slowed, however, proper home care is a vital component of successful treatment.

Scaling Calculus

Scaling Calculus

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Tissue Graft to Treat Recession

tissue graftingThere are two types of tissue around teeth-attached tissue and mucosal tissue. The attached tissue is the firm, pink tissue close to the teeth, and is vital in maintaining health around the teeth. The mucosal tissue is loose, thin and located further away from the teeth. When the gums recede, there is loss of the attached tissue. This can compromise the health of the tissue and lead to bone problems around the teeth.

tissue graftingTreatment of loss of attached tissue is most commonly done using a tissue graft. This procedure involves taking tissue from another part of the mouth (usually the roof of the mouth), and moving it to the area where the tissue defect exists. This procedure helps rebuild some of the lost tissue to maintain health of the gums and teeth.

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Frenectomy

frenectomyThe frenum is a small tissue band inside the upper and lower lips, that attaches to the gum tissue. Normally, this attachment is away from the teeth. In some situations, the frenum attaches to the tissue very close to the teeth and as the lips move around, the frenum pulls on the tissue. This can cause the tissue to be pulled away from the teeth and can compromise the health of the tissue and lead to problems around the teeth.

frenectomyA frenectomy is done to correct this problem. A frenectomy involves releasing the attachment, so that it can no longer pull on the tissue around the teeth. In some situations, a tissue graft may be required in conjunction with a frenectomy, if the health of the tissue around the teeth has already been compromised (as seen in this example). A frenectomy is generally a very simple and quick procedure.

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