PERIODONTAL SERVICES

 

SUPPORTIVE PERIODONTAL THERAPY

Also known as:​

  • Non-Surgical Periodontal Treatment

  • Maintenance Therapy

  • Dental prophylaxis

  • Teeth Cleaning


Scaling and root planing (SRP) is the least invasive and most cost-effective manner in which we can maintain periodontal health, or healthy gums and teeth. This treatment involves careful cleaning of the root surfaces to remove trapped plaque and calculus (tartar) from within the pockets. Local anesthetic may be administered, when indicated, in order to allow the procedure to be as comfortable and pain-free as possible, and to allow the dental cleaning instrument, or curette, to access the deepest part of each pocket (Figures 1-4). The majority of disease-causing bacteria are removed with this treatment. In certain cases, a Periodontist may recommend further cleansing of pocket immediately after with a local antimicrobial solution such as Chlorhexidine (Peridex™). In other cases, this same solution may be prescribed as a mouth rinse for a 2-week period, and in combination with a 1-week oral antibiotic regimen.


Although very effective, SRP treatment does have its limitations. The prevalence of periodontal disease among people 30 years of age or older is 47.2% with 8.7% having mild, 30% having moderate, and 8.5% having severe disease.1 When the disease is far-progressed, the pockets around our teeth become too deep to allow effective treatment with SRP alone. In these cases, a Periodontist may offer surgery in order to help restore periodontal health.


Continuous maintenance therapy on a 6-month recall is sufficient to sustain gum health for most patients. For patients with periodontal disease, a 4-month or 3-month recall may be recommended until the periodontal condition is stabilized. After a consultation with Dr. Valentin Dabuleanu, a tailor-made treatment plan will be made that best suits your specific needs.


Why is Scaling and Root Planing so important?


The main cause of gum disease is bacterial plaque, an adherent whitish film that continuously reforms on our teeth. The bacteria in this plaque produce toxins that constantly attack our teeth and gums (Figures 1-2). Unless plaque is removed, it will harden into a rough crystal-like deposit called calculus, also known as tartar. Thorough daily brushing and flossing techniques are effective in minimizing the formation of calculus, but they will not completely prevent it.


Regardless of how effective we are at brushing and flossing, bacterial plaque will cause a recurrence of gum disease 2-4 months after the last SRP. Periodontal disease is the most common cause of tooth loss in adults. Your natural teeth can be kept for a lifetime by carefully following the guidelines of a maintenance program recommended by Dr. Valentin Dabuleanu. You will be able to keep dental costs down by preventing future problems if you stick to a recommended SRP schedule. This commitment will help you maintain better oral health for a lifetime.


Reference

  1. Genco R, et al. Risk factors for periodontal disease. Periodontology 2000. 2013; 62: 59-94.

 

CROWN LENGTHENING TO EXPOSE CARIES

Crown lengthening may be indicated in order to make a restorative dental procedure possible, such as a dental filling. A tooth may sometimes be decayed below the gum line. Crown lengthening may be indicated in order to adjust the gum and bone level to expose the entire extent of the decay so it can be restored (Figures 1-3). This allows the dentist to apply a well-adapted restoration, so that the tooth does not experience repeat decay in the future. This procedure also allows the patient to clean the edge of the restoration, with regular brushing and flossing, in order to help prevent repeat decay from occurring in the future.


A crown lengthening procedure takes approximately one hour. It may be done with local anaesthetic alone, or in combination with sedation (see “Sedation”). Most patients are back at work one day after having had crown lengthening. The majority of healing takes place during the first week, and patients may then resume most of their normal eating and oral hygiene practices (see “Post-Operative Instructions”). The tissue underneath continues to mature however, and full healing of the gums takes 4-6 weeks. The tooth or teeth receiving treatment will look noticeably longer afterwards (Figures 4-6). Dr. Valentin Dabuleanu will see you for a 1-week and 6-week post-operative check before your dentist places the final dental restoration.

 

CROWN LENGTHENING TO EXPOSE NATURAL TOOTH STRUCTURE

Crown lengthening may be indicated in order to make a restorative dental procedure possible, such as a dental crown. A tooth may sometimes be broken below the gum line, or it may have insufficient sound tooth structure for a restoration, such as a crown or bridge. Crown lengthening may be indicated in order to adjust the gum and bone level to expose more of the natural tooth so it can be restored. This helps to prevent the restoration or crown from becoming loose in the future. This procedure also allows the patient to clean the edge of the restoration, with regular brushing and flossing, in order to help prevent decay and gum disease from occurring in the future (Figures 1-3).


A crown lengthening procedure takes approximately one hour. It may be done with local anaesthetic alone, or in combination with sedation (see “Sedation”). Most patients are back at work one day after having had crown lengthening. The majority of healing takes place during the first week, and patients may then resume most of their normal eating and oral hygiene practices (see “Post-Operative Instructions”). The tissue underneath continues to mature however, and full healing of the gums takes 4-6 weeks. The tooth or teeth receiving treatment will look noticeably longer afterwards. Dr. Valentin Dabuleanu will see you for a 1-week and 6-week post-operative check before your dentist places the final crown.

 

CROWN LENGTHENING FOR ESTHETICS

Patients may sometimes report that they have a “gummy smile” because they feel their teeth appear short. Other times, they may notice unevenness between the heights of 2 adjacent teeth. Dr. Valentin Dabuleanu will be able to assess whether the teeth involved are in fact the proper length, but just covered by too much natural gum tissue. This unevenness may be corrected with a crown lengthening procedure. During the procedure excess gum and bone tissue is reshaped to expose more of the natural tooth that is visible. This can be done on either one or several teeth as needed to re-create harmony to the smile line.


A crown lengthening procedure takes approximately one hour. It may be done with local anaesthetic alone, or in combination with sedation (see “Sedation”). Most patients are back at work one day after having had crown lengthening. The majority of healing takes place during the first week, and patients may then resume most of their normal eating and oral hygiene practices (see “Post-Operative Instructions”). The tissue underneath continues to mature however, and full healing of the gums takes 4-6 weeks. The tooth or teeth receiving treatment will look noticeably longer afterwards. Dr. Valentin Dabuleanu will see you for a 1-week and 6-week post-operative check before your dentist places the final dental restoration or crown.

 

OSSEOUS SURGERY

Our bone and gum tissue should fit snugly around our teeth, the same as when we wear a turtleneck sweater around our necks. When periodontal disease is advanced, however, this supporting tissue and bone is destroyed, resulting in loosening of the gum and bone attachment, and the formation of deep pockets. Periodontal disease is the most common cause of tooth loss in adults.


A periodontal pocket reduction procedure may sometimes be recommended if your pockets are too deep to clean with daily home oral hygiene and a professional hygiene maintenance care (Figure 1). During this procedure the gum tissue is folded back, and deeply trapped plaque and calculus containing disease-causing bacteria are removed (Figure 2).  The 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 (Figure 3). The gum tissue is then secured into place (Figure 4).


Osseous surgery may be indicated for those affected by severe periodontal disease. The specific goals of this treatment are:

  1. To reduce of eliminate the pockets that cause periodontal disease

  2. To reduce bacterial spread – bacteria from the mouth have the potential to spread throughout the body and cause other life-threatening conditions such as cardiovascular disease and lung cancer (see The Mouth-Body Relationship)

  3. To prevent bone loss – the recontouring of damaged bone helps to prevent the bone loss around teeth from progressing

  4. To facilitate home care – as the pocket deepens, it becomes nearly impossible to effectively clean with brushing and flossing, and even with professional dental cleanings. Osseous surgery will reduce the pocket, making it easier to maintain, thereby preventing further disease


A pocket reduction procedure takes approximately one hour. It may be done with local anaesthetic alone, or in combination with sedation (see “Sedation”). Most patients are back at work one day after having had pocket reduction. The majority of healing takes place during the first week, and patients may then resume most of their normal eating and oral hygiene practices (see “Post-Operative Instructions”). The tissue underneath continues to mature however, and full healing of the gums takes 4-6 weeks. You will be seen for a 1-week and 6-week post-operative check.


Patients who receive osseous surgery to help keep their teeth may notice the following:

  1. Teeth may look and feel longer

  2. There may be more spaces (embrasures) between teeth, underneath the contact area (Figures 5-6)

  3. Teeth may be sensitive for a period of about 1-month. Sensitivity fades over time, and can be managed with desensitizing toothpastes such as Sensodyne© ProNamel© (https://www.pronamel.ca)

  4. Teeth may feel slightly loose (mobile) for a period of about 1-month. This is temporary, as they firm up again during the healing process


Reduced pockets and a combination of daily home oral hygiene as well as professional hygiene maintenance care will help those affected by severe disease to keep their natural teeth.

 

GINGIVECTOMY

The gum tissue may sometimes become overgrown and thicken to the point that it covers the tooth surface, making the tooth itself look short. Certain medications can cause this condition. It may also be caused by inflammation due to gum disease.


A gingivectomy may be offered to eliminate this excess gum tissue. The following are indications for a gingivectomy:

  1. Cosmetics – Teeth are normal in size and shape, however there is too much overlying gum. Adjusting the gum line will make the teeth look longer, and more proportional

  2. Function – Drug-induced gingival overgrowth may occur after taking the following classes of medications. The excess gum tissue creates deep pockets that harbor periodontal disease-causing bacteria:

    1. Anti-seizure

    2. Organ transplant

    3. High blood pressure – specific types only


A gingivectomy procedure takes approximately one hour. It may be done with local anaesthetic alone, or in combination with sedation (see “Sedation”). Most patients are back at work one day after having had gingivectomy. The majority of healing takes place during the first week, and patients may then resume most of their normal eating and oral hygiene practices (see “Post-Operative Instructions”). The tissue underneath continues to mature however, and full healing of the gums takes 4-6 weeks. Dr. Valentin Dabuleanu will see you for a 1-week and 6-week post-operative check.

 

FRENECTOMY

We have naturally occurring muscle attachments in our mouths, which connect our upper and lower jaws to the muscles of speech and eating. These muscle attachments are located on both the outer and inner aspect of our jaws.


A prominent lingual muscle attachment, or frenum, can occur between the under-surface of the tongue and the inner aspect of the gum of the lower front teeth. This condition is commonly known as a “tongue-tie” (Figure 1). It will significantly restrict movement of the tongue and can affect speech. It can even make basic home oral hygiene techniques such as brushing and flossing more challenging. A frenectomy may be indicated in order to eliminate this prominent frenum. Tongue posture, tongue mobility, oral functions, and communication are all dramatically improved following this procedure, as the tongue is immediately allowed a wider range of motion (Figure 2).


A prominent labial muscle attachment, or frenum can occur between the gum of the upper or lower front teeth, on the facial aspect – and the inner aspect of the lip (Figure 3). It has the potential to exaggerate muscle pull on the gum, resulting in gum recession. This frenum may also prevent the teeth from coming together, resulting in a gap (diastema). A frenectomy may be indicated in order to help release this muscle attachment from the gum (Figure 4). When orthodontic treatment is planned, the removal of a prominent frenum may increase the stability and improve the success of the final orthodontic outcome.


This is a short procedure. Patients usually resume most of their normal eating and oral hygiene practices within 1-2 days (see “Post-Operative Instructions”). The majority of healing takes place during the first week.

 

CONNECTIVE TISSUE GRAFT

Please refer to the “Receding Gums” section for a description of the causes of gingival recession. Our gingiva serves as a natural defence system that protects against both trauma as well as bacterial invasion. Cases of minor gingival recession do not require any treatment, as the remaining healthy gingiva may be enough to help protect the tooth. The adoption of atraumatic brushing and flossing techniques (see “General Gum Care”) will help prevent the recession from progressing in the future.


When the recession is advanced, however, the remaining gingival tissue will no longer serve as a healthy defense system against bacterial invasion as well as trauma. Roots may become sensitive to hot and cold foods. The exposed root surface may not only have an unsightly appearance, but it also has a higher chance of experiencing dental decay than enamel, as it is softer. Dr. Valentin Dabuleanu may offer soft tissue grafting in order to reconstruct this missing tissue, and to help protect your teeth. There are two types of graft procedures:


  1. Root coverage – connective tissue graft

  2. Gingival augmentation – free gingival graft (see below)


The root coverage graft, or a connective tissue graft, is indicated when there are esthetic or cosmetic demands, and when exposed root surfaces cause sensitivity. A root coverage graft will increase the thickness of the band of protective keratinized gingival tissue, which is the non-moving gum that sits next to the tooth. In many cases, it will also help to completely reverse the recession.


The root coverage graft involves taking a thin piece of tissue from the roof of the mouth, and is inserting it into a pouch that is created at the recipient tooth (Figures 1-3). The procedure takes approximately one hour. It may be done with local anaesthetic alone, or in combination with sedation (see “Sedation”). Most patients are back at work two days after having had a root coverage graft. The majority of healing takes place during the first two weeks, and patients may then resume most of their normal eating and oral hygiene practices (see “Post-Operative Instructions”). You will be seen for 1-week, 2-week and 4-week post-operative checks.


The root coverage graft is a highly effective and esthetic treatment that helps to eliminate the recession. The graft will also prevent the recession from reoccurring in the future, as long as patients thereafter commit to an atraumatic brushing and flossing technique (Figures 4-7).


For more information on the causes of and treatment for gingival recession, please visit the following link to an article published in Oral Health, one of our national dental journals, written by Dr. Valentin Dabuleanu

 

FREE GINGIVAL GRAFT

There are two types of graft procedures:

  1. Root coverage – connective tissue graft (see above)

  2. Gingival augmentation – free gingival graft


The gingival augmentation graft, or free gingival graft, is indicated when recession is progressing with time, when there is discomfort during chewing or tooth brushing, and when orthodontic treatment is planned and it is expected that a particular tooth movement may result in recession. A free gingival graft will widen the zone of protective keratinized tissue, which is the non-moving gum that sits next to the tooth. This graft also deepens the vestibule and relieves muscle tension, which helps to prevent the recession from reoccurring.


The free gingival graft involves taking a thin piece of tissue from the roof of the mouth, and attaching it along the root surface of the recipient tooth where the gum tissue is lacking (Figures 1-3). The procedure takes approximately one hour. It may be done with local anaesthetic alone, or in combination with sedation (see “Sedation”). Most patients are back at work two days after having had a free gingival graft. The majority of healing takes place during the first two weeks, and patients may then resume most of their normal eating and oral hygiene practices (see “Post-Operative Instructions”). You will be seen for a 1-week, 2-week and 4-week post-operative check.


The free gingival graft is a highly predictable treatment that helps to widen the zone of protective keratinized tissue around the tooth (Figures 4-5). The graft will also prevent the recession from reoccurring in the future, as long as patients thereafter commit to an atraumatic brushing and flossing technique.

 

IMPACTED CANINE EXPOSURE

An impacted tooth is one that fails to erupt in a normal fashion, or one that only erupts partway into the mouth. Canine teeth are the second most common teeth to become impacted, following third molars. A canine tooth may become impacted on either the facial or palatal aspect. Palatal impactions are more common. The overall incidence of a maxillary canine tooth impaction is about 1%.


If left untreated, an impacted canine tooth may cause neighbouring teeth to erupt either facially or palatally. Neighbouring teeth may also suffer from root resorption. Infections are a rare occurrence.


Surgical exposure followed by orthodontics to bring the previously impacted tooth into proper alignment is the recommended treatment. In many cases a Cone Beam CT scan will provide information on the precise location of the impacted tooth, as well as its proximity to neighbouring teeth (Figures 4-6).


Impacted canine exposure surgery involves creating a small access point directly over the crown of the hidden tooth, and bonding an orthodontic bracket and chain. The chain is attached to a fixed orthodontic appliance, or braces (Figures 1-3). The procedure takes approximately one hour. It may be done with local anaesthetic alone, or in combination with sedation (see “Sedation”). Most patients are back to their usual routine two days after having had a canine exposure surgery. The majority of healing takes place during the first two weeks, and patients may then resume most of their normal eating and oral hygiene practices (see “Post-Operative Instructions”). You will be seen for a 2-week and 4-week post-operative check.

 

PERIODONTAL REGENERATION

Also known as: guided tissue regeneration


As periodontal disease progresses, pockets deepen and promote the growth of bacteria as well as the spread of infection (see Periodontitis). The supporting bone may begin to degenerate. Regeneration procedures are used to restore lost supporting hard and soft tissue, and can reverse some of the damage caused by periodontal disease. This is in contrast with repair of periodontal tissue, also known as osseous surgery, which was the staple of periodontal treatment for decades (see Osseous Surgery). Dr. Valentin Dabuleanu will help you determine if periodontal regeneration surgery is right for you.


This procedure involves the reflection of the gingival tissue and removal of the majority of disease-causing bacteria within the pocket. This is achieved through a very thorough cleaning of the pocket. Membranes (filters), bone grafts, and tissue-stimulating proteins are then used to encourage the body's natural ability to regenerate bone and soft tissue (Figures 1-4). The procedure takes approximately one hour. It may be done with local anaesthetic alone, or in combination with sedation (see “Sedation”). Most patients are back at work two days after having had periodontal regeneration surgery. The majority of healing takes place during the first two weeks, and patients may then resume most of their normal eating and oral hygiene practices (see “Post-Operative Instructions”). You will be seen for a 1-week and 4-week post-operative check.


This treatment, when indicated and when combined with a combination of daily home oral hygiene and professional hygiene maintenance care, will result in a significant increase in the chances of keeping your natural teeth (Figure 5). Furthermore, when periodontal disease is arrested, your chances of having other health problems that associated with periodontal disease are decreased (see The Mouth-Body Relationship).

Link to Video on Periodontal Regeneration


For more information on periodontal regeneration surgery, please visit the following link to an article published in Oral Health, one of our national dental journals, written by both Dr. Valentin Dabuleanu and Dr. Mary Dabuleanu:

 

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