Periodontics is the part of dentistry that studies the pathology of the tissues which surround the teeth: the gums, the periodontal ligament and bone.
Periodontal tissues can undergo periodontal diseases, which some years ago were known as “pyorrhoea”, and mucogingival defects which prelude the loss of gingiva and root exposure. Besides the gingival tissues can present different morphological alterations which have their specific treatments.
Periodontal disease is a chronic infectious disease that has as a consequence the loss of the bone that supports the teeth, and it can cause its loss due to mobility. Its first stage is gingivitis, which is the inflammation of the gums. In this phase, if the patient receives the adequate treatment, it can be completely reverted and can heal. Nevertheless, if the gingivitis becomes chronic or if the patient has genetic predisposition to develop a periodontal disease, the problem evolves and becomes periodontitis, where bone loss cannot be recuperated. In this case, with the indicated treatment, the disease can be stabilised.
The cause of periodontal disease is the presence of biofilm, which is an accumulation of more or less pathogen bacteria on the surface of the tooth and, especially, in the gingival sulcus, which is the union between the gingiva and the tooth. The presence of this bacteria excess is usually due to a bad oral hygiene technique. For this reason, it is very important to stablish correct brushing techniques and oral hygiene habits. This is the base of any periodontal treatment. In Clínica Dental Padrós-Creus Muntaner we stress the importance of a good oral hygiene, because the periodontal patient needs to perfectly understand that his or her discipline will be the key of the stabilization of the disease.
We should point out that there are some cases of aggressive periodontitis that have a genetic factor in its base. They are patients who are susceptible or have a great predisposition to develop periodontal disease; their immunity in front of the periodontal pathogens has decreased. Today, if it is required, we can perform genetic tests to know this susceptibility pattern and decide the ideal precautions to defeat it.
The type of bacteria that coexist in the mouth is another determinant factor. There are microorganisms that are more virulent than others, and for this reason it is also interesting to perform microbiological tests which will exactly determine the existent microorganisms. Depending on the detected typology, sometimes we may need antibiotic techniques combined with probiotics, etc.
The periodontogram is the basic element for the diagnosis of periodontal disease. It includes the taking of a series of measurements with a periodontal probe, that is, periodontal probing; the probe is softly introduced in the union between the gingiva and the tooth. This will allow us to know how much the probe penetrates in the space. We can consider that the more the probe enters, the worse the bone defect is. The periodontogram is like a map of the bony situation of the patient, and lets us know, together with the required x rays the prognosis of the disease.
In Clínica Dental Padrós-Creus Muntaner we have the Florida Probe system, which allows us to perform the periodontogram with a computer and compare the evolution over time.
The basic treatment of the periodontal disease is root planning, polishing and scaling. The objective is to thoroughly clean all the mouth, trying to reach the bottom of the deep pockets, eliminating the biofilm, the tartar and looking for the disinflammation of the tissues and their cicatrisation. Once the scaling sessions have finished, a new periodontogram is done to reevaluate the case, and we compare it with the initial one. This way we can determine if other treatments are needed.
If there are still very deep pockets, periodontal surgery will be indicated, especially if with it we are able to achieve a better prognosis of the affected tooth in the long term. The periodontal surgery will allow to reach the bottom of the bone defects, the remodelling of the altered bone anatomy, and even to apply regenerative techniques, like the different techniques that have been described.
Recently, we have seen great advancements in the tissue regeneration through the use of membranes, artificial absorbable bone, enamel proteins (Emdogain), growth factors, etc…
Once the doctor can dismiss the patient, the personalized protocol of periodontal maintenance will be established. We will determine how often the controls should be performed, in a protocol of “deep periodontal hygiene”. Usually, a periodontal patient that has been controlled comes to the office every 6 months.
When somebody smiles and shows too much gingival tissue, it may be an aesthetic problem that can be enhanced. What is most important is to perform a good diagnosis and detect the cause. If the problem is a gingival excess what covers the dental crown, we can re-touch It with a simple surgical procedure, with a minimal post-surgical period, and the patient’s smile extraordinarily improves.