The Most Common Periodontic Procedures

Before we dive right into the most common types of periodontal procedures, let’s clarify exactly what’s meant by periodontics.

What is Periodontics?
Periodontics is the subset of dentistry that’s concerned with everything that supports and surrounds the teeth. This includes the gums, jaw, and all the surrounding tissue.

How is Periodontics Different From Other Dental Procedures?
The primary difference between periodontal procedures and other dental procedures is defined by the tools and training of the care provider. It’s also defined by the area of the mouth the care is focusing on.

When Does a Patient Need a Periodontal Procedure?
Periodontics procedures typically become necessary when two types of oral diseases are left untreated until the diseases reach an advanced stage: Gingivitis and Periodontitis.

What is Gingivitis?
According to the Mayo Clinic, “Gingivitis is a common and mild form of gum disease (periodontal disease) that causes irritation, redness and swelling (inflammation) of your gingiva, the part of your gum around the base of your teeth.”

When a patient suffers from an untreated case of gingivitis for an extended period of time, the disease can lead to “gum disease that spreads to underlying tissue and bone (periodontitis), a much more serious condition that can lead to tooth loss”.

What is Periodontitis?
According to the Mayo Clinc, “Periodontitis (per-e-o-don-TIE-tis), also called gum disease, is a serious gum infection that damages the soft tissue and, without treatment, can destroy the bone that supports your teeth. Periodontitis can cause teeth to loosen or lead to tooth loss.”

Left untreated, periodontitis causes “pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. In time, these pockets become deeper, filling with more bacteria. If not treated, these deep infections cause a loss of tissue and bone, and ultimately you may lose one or more teeth. Also, ongoing chronic inflammation can put a strain on your immune system.”

For both types of disease, the recommended course of prevention is good oral hygiene and regular dentist visits. Also, it’s best if a patient can identify symptoms early and seek treatment immediately.

The Most Common Periodontics Procedures
Should you experience an advanced case of either gingivitis or periodontitis, here are the most common types of periodontal procedures you may have to undergo.

Scaling and Root Planing
The point of this procedure is to eliminate a buildup of plaque that inflames your gums, causing your gums to pull away from your teeth and form pockets for more plaque to lodge in areas that can’t be removed by flossing or brushing.

Scaling and root planning is a two-part procedure. Scaling involves using specialized equipment to remove excess plaque above and below the gumline. Then root planing is performed to smooth out the base of the teeth for the roots and gums to reattach themselves naturally. This procedure may need to be completed over multiple dentist visits.

Periodontics Tray Delivery Systems
Sometimes the gum inflammation is too severe or the infection is in a difficult spot to reach with mechanical devices. In this situation, a dental professional may use a Periodontics Tray Delivery System to help reduce pain, inflammation, and symptoms from the infection. The try looks like a typical mouthguard with internal seals where a dentist can inject medication. When the patient wears the tray as prescribed, a set amount of medication is slowly but continually delivered to the infected area over an extended period of time until the inflammation and infection are reduced enough for additional treatment.

Dental Implants
When dental disease progresses far enough, the result can be tooth loss. Dental implants are used to replace missing teeth when conventional dentures are not an option or not preferred. Dental implants come in two varieties: Endosteal and Subperiosteal.

Endosteal Implants
Endosteal implants are replacement teeth that are attached by drilling a base directly into the jaw bone to hold a prosthetic tooth.

Subperiosteal Implants
Subperiosteal implants are another type of artificial tooth that attaches to a metal framework bonded on top of the jaw bone. This type of implant is available for patients whose jawbone is not strong enough or tall enough to support an endosteal implant.

Soft Tissue Grafting
When a patient is diagnosed with receding gums as a result of either gingivitis or periodontitis, that means the gum has shrunk away from the tooth, potentially exposing the roots. Left untreated, the roots are exposed to bacteria that can cause infection and eventually tooth loss or jaw bone damage. Your dentist may recommend soft tissue grafting to replace the receded gum tissue and restore the soft tissue protection of the roots. Soft tissue grafting comes in three varieties: Connective-tissue grafts, free gingival grafts, and pedicle grafts.

Connective-Tissue Grafts
According to WebMD.com, a connective-tissue graft procedure involves cutting a flap of skin from the “roof of your mouth (palate) and tissue from under the flap, called subepithelial connective tissue, is removed and then stitched to the gum tissue surrounding the exposed root. After the connective tissue — the graft — has been removed from under the palatal flap, the flap is stitched back down.”

Free Gingival Grafts
Free gingival grafts are similar to connective-tissue grafts in that they both take soft tissue from the mouth roof. “But instead of making a flap and removing tissue under the top layer of flesh, a small amount of tissue is removed directly from the roof of the mouth and then attached to the gum area being treated. This method is used most often in people who have thin gums, to begin with and need additional tissue to enlarge the gums.”

Pedicle Grafts
Pedicle grafts vary from the previous two procedures by taking soft tissue from the “gum around or near the tooth needing repair. The flap, called a pedicle, is only partially cut away so that one edge remains attached. The gum is then pulled over or down to cover the exposed root and sewn into place. This procedure can only be done in people who have plenty of gum tissue near the tooth.”

Gingivectomy
When the gums pull away from one or more teeth and become infected, a common course of treatment is simply to remove the diseased gum tissue. A gingivectomy involves numbing the infected area and surgically removing the dead tissue, allowing the remaining, healthy tissue to heal naturally.

Flap Procedure (also known as Periodontal Pocket Reduction)
The flap procedure is designed to address mild amounts of bone damage occurring near the root of a tooth. The dentist will cut a section of gum near the base of the damaged tooth and peel back the “flap” to expose the roots and bone. The specialist then smoothes the bone area to remove damage and prevent plaque from depositing in pockets and sews the gum area back in place.

How to Prevent the Need for Periodontics Procedures
Of course, prevention is the best medicine. Both periodontitis and gingivitis can be minimized or prevented by taking the following measures.

Brush your teeth twice a day and floss before bedtime
Schedule regular checkups with your dentist for cleanings and maintenance
If you smoke, quit immediately

If you stick to these preventative measures indefinitely, your chances of avoiding the need for a periodontal procedure rise dramatically.