Illustrations Of Periodontal Procedures

What is periodontal diseases?
Millions of people have periodontal disease and don't know it. The word periodontal literally means "around the tooth." Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.(AAP)

To diagnose periodontal disease, a periodontist will examine several things:
Color and condition of the gum line
Pocket depth measurements
Bone line as revealed by x-rays
Mobility of teeth
Amount of calculus
These findings determine the periodontal stage and therefore determine the appropriate treatment plan.

Non-Surgical Therapy:
Non-surgical therapy includes plaque control, supra- and subgingival scaling, root planing, and the adjunctive use of chemical agents.

Scaling is the process by which plaque and tartar ( aka. calculus - calcified deposits on teeth ) are removed from tooth surfaces above and below the gum tissue.
Root Planing is the process by which residual embedded tartar ( aka. calculus ) and portions of cementum ( the surface layer of the tooth root ) are removed from the roots to produce a smooth, hard and clean surface.
The primary objective of scaling and root planing is to restore gingival health by removing inflammation inducing substances from the tooth surface.

Surgical Therapy:
Periodontal surgery is any surgical procedure used to treat periodontal disease or to modify the morphology of the periodontium. It's goal is to restore health and function to the periodontium.

A gingivectomy is a periodontal surgical procedure which includes the removal of a portion of the gingiva ( gum tissue ); performed to reduce the soft tissue wall of a periodontal pocket.

Gingivoplasty is a surgical reshaping of the gingiva ( gum tissue ).

An illustration of flap design- a surgical blade is used to cut gum tissue and an elevator ( a periodontal instrument ) is used to reflect it exposing the root surface and the bone around the teeth
( Note the bone defect caused by periodontal disease indicated by the dark spot next to the third tooth from the left )
Flap closure indicated in the lower right illustration

An illustration of the classification of intrabony defects which can be addressed by flap curettage, removal of the osseous defect and/or regeneration (bone grafting/membrane)

Osseous surgery is a periodontal surgery involving modification of the bony support of the teeth. It creates a bony architecture which is compatible with the maintenance of a physiologic gingival ( gum ) architecture.
In this series of illustrations bone irregularities caused by periodontal disease ( top and lower left ) are corrected ( lower right )

Osseous grafting uses bone to replace a damaged or missing anatomical part of the alveolus ( bone supporting the teeth aka. socket ). It can eliminate pockets and regenerate the functional attachment apparatus, stabilizing a periodontally compromised tooth or group of teeth.

When a tooth needs to be extracted and you want a dental implant placed in that spot, one of the options is to extract the tooth, place a bone graft, and wait 4 to 6 months for the graft to heal before placing the implant. This is called "socket preservation".

Guided tissue regeneration ( GTR ) attempts to regenerate lost periodontal structure using a barrier under the gum tissue and over the remaining bone. GTR and the osseous grafting procedure may be performed at the same time.

In this illustration a bone defect is covered by a membrane

Crown lengthening is a periodontal surgical procedure performed to expose a greater height of tooth structure in order to properly restore a tooth.

A frenectomy ( aka. frenulectomy or frenotomy ) is the removal of a frenulum, a small fold of tissue.
The labial frenulum often attaches to the center of the upper lip and between the upper two front teeth. It can also attach to the lower lip and between the lower two front teeth. This can cause a large gap and gum recession. A labial frenectomy removes the labial frenulum.
A series of illustrations of a labial frenectomy procedure ( upper lip reflected back in front of nose )

This periodontal surgery procedure corrects defects in the morphology, position and/or the amount of gingiva ( gum tissue ).
A series of illustrations showing one type of mucogingival surgery using connective tissue ( upper left lateral and canine )

Another before and after picture of a mucogingival surgery using connective tissue ( upper right lateral incisor )

A dental implant is an artificial tooth root that a periodontist places into your jaw to hold a replacement tooth or bridge. Dental implants are natural looking. They are more tooth-saving than traditional bridgework, since neighboring teeth are not altered or necessary for support. Endosteal (in the bone) implants are the most commonly used type ( see illustrations below ). Dental implants are a viable option in the treatment of partial and full edentulism. The ideal candidate for a dental implant is in good general and oral health. They are considered an excellent option for tooth replacement.

Single Missing Tooth Dental Implant Placement
1. Missing Tooth x-ray and examination of empty space and jawbone for dental implant placement	2. Implant Placement surgical installation of implant to fuse and integrate with jawbone for crown fitting	3. Crown Fitting permanent ceramic crown placement fitted to function as a normal new tooth	4. New Tooth new tooth looks and functions like a natural tooth

Multiple Missing Teeth Partial Arch Fixed Bridge Placement on Dental Implants
1. Missing Teeth x-ray and examination of empty space and jawbone for dental implants placement	2. Implant Placements surgical installation of implants to fuse and integrate with jawbone for bridge fitting	3. Bridge Fitting permanent ceramic bridge placement fitted to function as normal new teeth	4. New Teeth new teeth look and function like natural teeth

All Missing Teeth Full Arch Fixed Bridge Placement on Dental Implants
1. Missing Teeth x-ray and examination of gums and jawbone for dental implants placement	2. Implant Placements surgical installation of implants to fuse and integrate with jawbone for bridge fitting	3. Bridge Fitting permanent ceramic bridge placement fitted to function as normal new teeth	4. New Teeth new teeth look and function like natural teeth

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