Fundamental to the treatment of periodontal diseases is conservative periodontal treatment and infection control. This consists of homecare instruction and frequently scaling and root planing. Scaling refers to removal of plaque, calculus (tartar), and stain removal above the tooth/gum junction. Root planing is the removal of plaque, calculus, and the smoothing of rough root surfaces so that these materials are less likely to reform on these surfaces, harboring bacteria, and so that the gums around the teeth can repair and heal. In some instances, when the results are improved, but not optimal, periodontal surgery may be recommended. This may consist of treatments to reduce "pockets", soft tissue grafts for root coverage, and bone regeneration. If teeth are lost to periodontal disease, then a dental implant may be an option for the tooth's replacement.
Because a patient remains susceptible to the bacteria that caused the infection in the first place, it is vital that once periodontal health is established that consistent, effective homecare be maintained. Daily brushing and cleaning between the teeth with floss and/or a proxabrush or other inter-dental cleaning aid can keep plaque at a minimum. Professional cleanings are required at least 3, but more typically, 4 times a year, generally can keep your teeth healthy for a lifetime.
Cosmetic surgery and cosmetic dentistry have become mainstream in the past few years. As the majority of the population ages, many want to look better, more vital and younger. One aspect of how we feel about ourselves is our "smile" Periodontal plastic surgery consists of number of tools that can be used to correct deficiencies and perfect the "picture frame" that surrounds the teeth. Tooth symmetry and the architecture of the gums are vital to the way smiles look.
Sometimes teeth look short and square or "gummy". The teeth may be in fact be of normal length, but not all the tooth enamel is exposed. The gumline can be re-sculpted to expose the tooth more fully. This may consist of removal of soft tissue and/or bone. If esthetic or cosmetic crown lengthening is done on the front 6 to 8 upper teeth, you may be able to have the beautiful smile that you've always wanted without changing or modifying the teeth at all.
Sometimes in order to restore a tooth, more of the tooth needs to be exposed. This can be necessitated because of decay below the gumline, tooth fracture, root resorption, or root perforation to name a few. At least 8 weeks of healing needs to occur after more of the tooth is exposed before definitive restoration should be considered. Many times, a crown that keeps "coming off" can be fixed by functional crown lengthening and the placement of a new crown.
Teeth with exposed roots can be unattractive, can result in tooth sensitivity, and increased susceptibility to tooth decay (tooth root surfaces are softer than enamel). Soft tissue grafts can be used to predictably cover exposed roots and to restore a natural and esthetic tooth length This procedure can also thicken thin soft tissue structures in order to reduce or eliminate tooth sensitivity, and to protect the roots against decay.
A different type of soft tissue graft may be used to enhance the width or the height of tissues under fixed bridges prior to their replacement or to improve the appearance of the existing prosthesis.
When teeth are extracted, there is frequently a loss of bone dimension by about 30% of the jaw width and height if the tooth socket is not augmented at the time of the extraction. Once the loss has occurred, it is much harder to regain what was lost. Socket preservation involves bone graft placement when the tooth is extracted. It forms a scaffold on which the bone heals and protects the height and width of the area. The net result is an area that can be restored with either an implant or fixed prosthesis with more nearly ideal cosmetic results. Sometimes, socket preservation is combined with immediate implant placement in the extraction socket.
Tooth loss can result in a "dent" in the gums and jawbone. There can also be such an indentation where teeth have failed to develop. Either way, it presents a problem to have a cosmetically pleasing restoration placed. The replacement would look long and unnatural in comparison to the adjacent teeth. Ridge augmentation with either hard and/or soft tissue can fill in these depressions and reestablish a natural contour. After a period of healing, the area can be restored with a tooth of the proper length and contour.
In order to place implants, adequate bone is necessary. Sometimes in the posterior upper jaw, there is not enough bone due to previous tooth loss or periodontal disease. Sinus augmentation consists of methods by which the floor of the maxillary (upper) sinus can be raised and the site developed for implant placement. One procedure is to begin the treatment for implant placement and lift the sinus membrane in conjunction with implant placement. In order for this procedure to be considered, there must be enough bone at the outset to stabilize the implant. When there is not enough bone for such initial stabilization, a different type of sinus augmentation is performed through the side of wall of the sinus. In this latter instance, 6-8 months of healing must elapse prior to implant placement. Sinus augmentation makes placement of dental implants possible. Only a few of years ago a removable partial denture would have been the only solution to replace lost teeth in the posterior upper jaw.
