Periodontal disease is a chronic inflammation in the supporting tissues of the teeth that causes recession and loss of gums and jawbone. About half of all American adults suffer from periodontal disease and the disease incidence increases with age.
Periodontal disease is multifactorial and no one specific reason can justify why you might have it. The factor that you are most in control of is managing your home oral hygiene with daily toothbrushing and flossing to minimize bacteria, plaque, and calculus buildup on your teeth.
If identified and treated early enough, periodontal disease’s destruction can be kept to a minimum and teeth can be maintained both in the short and long term. If your general dentist or hygienist is recommending a “deep cleaning,” it is the first step in treating periodontal disease. However, more severe forms of periodontal disease can result in more extensive procedures, including periodontal surgeries that require referral to a periodontist. When disease is most severe, teeth may require extraction and eventual replacement with options like dental implants (link).
Drs. Kyle Diehl and Colleen Leong are adept at managing all forms of periodontal disease, from mild to severe, and can recommend a treatment plan that is tailored to your oral health needs to stop the progression of periodontal disease and restore health. Our doctors are skilled at microsurgical interventions and strive to make periodontal interventions as comfortable and pain-free as possible. Explore below to learn about some of the nonsurgical and surgical therapies we use to treat periodontal disease.
Nonsurgical scaling and root planing is often the first line of treatment to treat periodontal disease. Typically half of your mouth is treated at a time. The areas treated will be numbed with local anesthesia so you will not feel any pain or sensitivity, just occasional pressure.
Ultrasonic instrumentation with water spray is used to deep clean in the gum pocketing around your teeth followed by hand instrumentation with thin, highly specialized scalers and curettes. Sometimes, in particular cases, laser light may be used to decontaminate the pocket and encourage clotting and healing. Some specific cases also may call for the adjunctive usage of a concentrated antibiotic placed directly into the gum pocket. Your provider will inform you if you qualify for these additional, adjunctive treatments.
For our post-operative instructions after non-surgical periodontal therapy, click here.
Osseous surgery is often recommended when you do not respond to nonsurgical scaling and root planing or, when the bacteria have penetrated so deep into your gum and bone, exposing the full extent of the diseased area and recontouring the underlying bone and overlying tissue is necessary to encourage healing and restoration of health.
Also called pocket reduction surgery, osseous surgery is a procedure in which the region treated is numbed and the gums are pushed back to expose the root surfaces and bone with microsurgical instruments. A surgical cleaning is performed and all diseased tissue, bacteria, and calculus is removed with a combination of ultrasonic and hand instrumentation, or sometimes laser therapy.
After the teeth and bone are cleaned, the bone is reshaped to recreate “positive bony architecture” to allow the overlying gum tissue flap to be laid over and pocket resolution and healing to occur. Stitches will be placed to hold the gum tissue in place during the initial healing period.
For our post-operative instructions after hard tissue periodontal therapy, click here.
Like osseous surgery, guided tissue regeneration is often recommended when you do not respond to nonsurgical scaling and root planing. However, unlike osseous surgery, which is a resective means to treat periodontal disease, guided tissue regeneration is a regenerative means to treat periodontal disease. However, not all bony defects produced by periodontal disease can be treated with guided tissue regeneration.
Also like osseous surgery, the region treated is numbed and the gums are pushed back to expose the root surfaces and bone with microsurgical instruments. A surgical cleaning is performed and all diseased tissue, bacteria, and calculus is removed with a combination of ultrasonic and hand instrumentation, or sometimes laser therapy.
But with guided tissue regeneration, only certain areas of the bone may be conservatively reshaped and bone graft material is packed into the bony defect. Sometimes the bone graft is mixed with a biologic material like Platelet-Rich Fibrin. A membrane can be trimmed and shaped to match the size of the defect and draped over the bone graft to hold the particulates in place. Finally, the overlying gum tissue flap is laid over and stitches placed to hold the tissue in place during the initial healing period.
For our post-operative instructions after hard tissue periodontal therapy, click here.
The Fotona LightWalker® laser can offer a minimally invasive treatment of periodontal disease with the TwinLight® protocol. TwinLight® periodontal surgery is fast, simple, highly effective, and can result in fast healing and excellent results in treating certain cases of periodontal disease. TwinLight® is an FDA-cleared protocol for laser-assisted new attachment procedure resulting in periodontal regeneration of the cementum (root surface), periodontal ligament, and bone.
During TwinLight® periodontal surgery, a thin laser fiber will be inserted in the pocket between the tooth and gums. The pulsed Nd:YAG laser light removes diseased tissues while simultaneously improving access to the root surface. The Er:YAG laser is used to kill bacteria and remove microbial biofilm and calculus from the root surface. Finally, the Nd:YAG laser is. Used again to coagulate and promote the formation of a stable fibrin clot to promote healing of the soft tissue.
The use of both Er:YAG and Nd:YAG laser wavelengths in one treatment harnesses the optimum wavelength of each laser. In combination, TwinLight® therapy can maximize laser-assisted surgical treatments with maximum safety and efficacy without scalpels or stitches.
You will be re-evaluated for improvements in your pocketing in 4-6 weeks after completion of your TwinLight® periodontal surgery. Typically, patients improve significantly with pocket reduction of 2-3 mm. Many patients find laser-assisted periodontal therapy to be more comfortable than traditional periodontal treatments, however, not all patients will be candidates.
Click here to learn more about laser periodontal therapy.