The Benefits of Periodontal Treatment

Periodontal treatment is an investment in your health. Treating periodontal problems will help you achieve a healthy mouth and help prevent tooth loss. In fact, with prompt treatment, proper home care, and regular dental visits, a great majority of patients can keep their teeth for a lifetime.

What Is The Treatment For Periodontal Diseases?

After evaluating your periodontal health, Dr. Packman will work with you to determine the treatment options that best meet your needs.

If periodontal disease is your problem, the treatment can vary widely depending on how far the diseases have progressed. If caught in the early stages, simple procedures are done that will remove the plaque and calculus from below the gum line and disrupt the infection-causing bacteria. If these diseases have advanced to the point where the periodontal pockets are deep and the supporting bone is lost, further treatment might be necessary.

Scaling and Root Planing (Deep Cleaning)

Scaling and root planing or what some people call a "Deep Cleaning". It is a step above a "regular" cleaning that you might receive at your general dentist’s office and a step below laser or surgical procedure. It is a non-surgical technique that removes plaque and calculus below the gum line.

Note how the red, puffy gums have resolved following an improvement in the patients daily homecare and several "deep cleaning" visits.

Tooth root surfaces are cleaned and smoothed with specially designed instruments. This procedure will generally arrest periodontal infection that is limited to the gum tissue and not yet advanced into the bone.

Atridox Treatment

Atridox is a conservative, non-surgical way to treat pockets of infection caused by periodontal disease. It is used either in conjunction with scaling and root planing, or may be used if scaling does not effectively eliminate the bacteria .

Atridox is a commonly used antibiotic, doxycycline, in high concentration , which is placed directly into the pockets as a gel . It is slowly released from the gel over a period of 7 to 14 days , and effectively eliminates the bacteria deep in the pockets, and even within the gum tissue itself.

This mode of direct therapy is much more effective than taking the medication by mouth.

We use Atridox treatment both in the initial phase of treatment, and also during maintenance, if pockets recur.

Research has shown significant reduction in pocket depths, as well as reduction in disease activity, and we are very excited by the clinical results we see in our practice.

Laser Treatment

Our office is one of the very few periodontal specialty offices that has a dental laser. In fact, we have 3. The laser is used to treat gum pockets that might not need surgery, or to assist with the surgery.

Laser treatment does not require stitches, and there is virtually no bleeding, and minimal discomfort afterwards.

Some procedures, such as Frenectomy, are best done with a laser.

To learn more about Lasers click here: Dental Laser.

Surgical Treatments

There are a variety of surgical treatments that can be used to resolve your particular needs. If surgery is required, rest assured that Dr. Packman and his entire team will make certain that you are always comfortable not only during the surgical procedure but postoperatively as well.

Surgery To Eliminate Bone Infections and To Regenerate Lost Bone

If your periodontal disease has progressed into the bone around your teeth, it is likely that a surgical procedure will be necessary to eliminate the infection. In the past, these procedures sometimes removed gum tissue and resulted in longer teeth. Today newer procedures are used that are not only more effective but also more esthetic. These minor surgical procedures eliminate the infection that has invaded the bone and often times the lost bone can be regenerated through a variety of bone grafting techniques. Dr. Packman will carefully review your options and answer any questions you might have.

Cosmetic Periodontal Procedures

Start Smiling! If you are not happy with your smile, there are cosmetic periodontal and dental procedures available to help you achieve the look you desire.Cosmetic procedures are one of Dr. Packman’s special interests. If you have a cosmetic concern you are at the right place-ask for a smile consultation. Together you and Dr. Packman can talk about your gum line, the amount of tooth you would like to show in your smile and any other cosmetic concerns you might have. Our office offers a full range of treatments to help you achieve the look you want.

Gummy Smile or Uneven Gum Line

  

If you feel your teeth are too short and you show too much gum when you smile or that your gum line is uneven, Dr. Packman may have the cosmetic treatment that will solve your problem.

Your teeth are probably not "too short". More than likely they are the perfect length, but you simply have too much gum tissue covering your teeth and hiding your smile .

Cosmetic procedures can sculpt your gum line, often with use of our Dental Laser, removing excess gum tissue giving you the proper contour of your gums and teeth with just the right length. Many times this is all that needs to be done, but if restorations are needed, this procedure sets the stage, allowing your new veneers or crowns to have the correct length and shape giving you a beautiful new smile.

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Long Teeth Or Exposed Roots

  

If one or more of your teeth are too long, exposing the root surface, there are grafting procedures Dr. Packman can use to cover these roots. The old saying "long in the tooth" has become synonymous with aging. And it’s true, if your gums recede exposing roots, you do look older.

Dr. Packman can cover roots with a variety of grafting techniques.

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Depressions In The Gum Or Jawbone

  

If you lose one or more teeth, it is not uncommon to have an indentation in your gums and jawbone where the tooth used to be. This occurs because the jawbone recedes when it no longer is holding a tooth in place. Not only is this depression unnatural looking, it also causes the replacement teeth to look unnatural.

Dr. Packman can resolve this unsightly problem by filling in the indentation with a procedure called "ridge augmentation", recapturing the natural contour of your gums and jaw. A new tooth can then be created that is natural looking, easy to clean and beautiful.

This shrinkage of the gum can often be prevented when a tooth needs to be removed, with a procedure called "ridge preservation". Dr Packman can extract the tooth, and fill in the socket with a synthetic material at the same visit.

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Crown Lengthening or "Crown Exposure"

If a tooth is decayed or broken off under the gumline, it is often impossible to restore without exposing sound tooth structure. This is done with a simple surgical procedure. Your dentist will need to wait about 6 weeks after the treatment before making the permanent crown.

Dental Implants

Tooth missing, Implant placed, then the tooth replaced with crown

If you are missing one or more teeth and would like to smile, speak and eat again with comfort and confidence, there is great news! Dental implants are teeth replacements that can look and feel like your own.

A dental implant is an artificial tooth root that is placed into your jaw to hold a crown or bridge. While high-tech in design, dental implants are actually more conservative than traditional bridgework, since implants do not rely on neighboring teeth for support.

What dental implants can do for you:

Replaces missing teeth without affecting bordering teeth
Provide support for a bridge or denture

Advantages of Dental Implants

Esthetic: Implant supported crowns look and feel like your own teeth.
Teeth Saving: Adjacent teeth do not have to be reduced to crowns like they do for conventional bridges.
Confidence: Implants will allow you to eat and speak with confidence.
Reliable: Dental implants are highly predictable.

Am I A Candidate For Implants?

The best candidates for dental implants are free from periodontal diseases and have an adequate amount of bone in the jaw to support the implant. Dr. Packman will be happy to discuss your options.

What Is Treatment Like?

The best results always flow from close teamwork between you, your dentist, and Dr. Packman. Our office will work closely with your dentist to determine where, when and how your implant should be placed. This is critical because the quality of the crown or bridge that your dentist will place on the implant is directly related to the planning that occurs well before the implants are placed. The surgical procedure to insert the implants is relatively minor. It is done in the office under local anesthetic. For the week after surgery, your mouth will be sore but not painful. Medications are always prescribed to make certain you are comfortable.

Follow Up Care

Dental implants require the same daily homecare and professional cleaning that your teeth do. Dr. Packman will probably place you on an alternating cleaning and evaluation schedule between our office and your general dentist. In that way we can continually monitor the health of your teeth and implant and your dentist can make certain that your crowns and bridges are functioning as designed.

Emdogain

In Sweden a protein chemical has been isolated from developing tooth buds, which can stimulate new attachment of fibers and bone to teeth, which have been affected by periodontal disease.

This is the first of a totally new type of treatment to help save teeth which could otherwise be lost. A surgical procedure is needed to clean the roots of the affected teeth, then this chemical (Emdogain) is painted on the roots, and the gum is sutured back around the teeth.

The gums actually heal up faster than without the use of Emdogain, but the area must be left undisturbed for 2 weeks. X-rays are taken every few months to check the bone healing.

We have been successfully using Emdogain in our practice for many patients.

Keeping Your Gums and Bone Healthy (Preventive Maintenance)

Unfortunately periodontal treatment is never complete. Once the active phase of therapy is over and your disease is under control, the challenge then becomes maintaining health. The goal of maintenance therapy is to reduce or eliminate as many of the risk factors that caused your disease in the first place. Dr. Packman and his team will customize a program that will effectively meet your individual needs.

Are Maintenance Visits Worth It?

You bet! They are the cheapest insurance you can get to prevent future dental problems. They will save you dollars, time and perhaps even discomfort in the long run, even if your dental insurance will not pay for all of them. If you have dental insurance, it may pay for just one maintenance visit every six months.That doesn't mean that is all you need, it just means that is the contract your company paid for. Because of your susceptibility to periodontal disease, you need to be seen more often. Think of your dental insurance like your car insurance. It pays only for collision, not maintenance. Through proper maintenance we are trying to prevent you having that collision.

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Proper Daily Home Care

This includes effective brushing and flossing. Dr. Packman and his team will make certain that you know the best techniques especially as they relate to your unique problem.

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Frequent Professional Cleaning and Evaluation

For many periodontal patients these visits are scheduled at a three month interval, ideally alternating them with your general dentist. In this manner you will receive the expertise of both your general dentist and Dr. Packman. The actual time period between visits will be determined by the health of your gums and bone. If you are struggling to maintain health, the interval may be shortened, and on the other hand, if you historically have done well the interval may be lengthened. The reason behind the three month interval is that the bacteria that live in your mouth take three months to mature to the point that they produce the poisons that reinfect you. We cannot eliminate this bacteria but the professional cleaning disrupts, them forcing the bacteria to start the growth process all over again. Another important part of the maintenance visit is the periodontal evaluation. If you have already experienced periodontal disease, then you know that it can occur with little or no symptoms. It therefore is important to track the health of your gum and bone over time to make certain reinfection does not occur and to catch it early if it does.

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Stabilizing the Bite

When you bite, all teeth should touch evenly. If certain teeth are forced to carry more than their fair share of the load then they can become more susceptible to reinfection and can become (). This can be resolved by "buffing off high spots", a procedure called a bite adjustment. If you have a tendency to clench or grind your teeth, that too, can put you at risk for future disease and a bite guard may be prescribed.

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Bite Guards

It is not uncommon for people to clench or grind their teeth. Some people are aware of this habit but most are not. Grinding your teeth may make a noise but clenching, which is equally damaging, is silent. In either case these habits can damage your jaw joint and your teeth, and make you more susceptible for gum and bone disease. Second only to smoking, clenching and grinding is a strong risk factor for periodontal disease and must be controlled if treatment is to be successful.

Fortunately this problem can be controlled through the use of what is called a bite or night guard. This is a hard plastic retainer like appliance that is custom made for your bite. Although most people are initially resistant to the idea of wearing the guard, not only do most patients become accustomed to it, most actually end up liking it. They find they sleep better with the guard than without it.

The bite guard evenly distributes the forces created through the clenching and/or grinding and prevents them from making your disease spread more rapidly or putting you at more risk for future problems. Feel free to talk to Dr. Packman or any of his team regarding this strong risk factor.

Case Histories

Case #1 - Recession, no attached gingiva, cosmetic defect

  

Before: Patient felt as though he "had a fang". The gingival asymmetry and minimal band of attached keratinized tissue necessitated gingival augmentation.

After: A connective tissue graft resulted in root coverage, new attachment, a 2mm sulcus, good cosmetic blending, and a wide band of attached gingiva.

 

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Case #2 - Recession, no attached gingiva & cold sensitivity prior to orthodontics.

  

Before: Patient had a single tooth with root recession, cold sensitivity and minimal band of attached tissue.

After: A connective tissue graft resulted in 100% root coverage and elimination of the cold sensitivity.

 

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Case #3 - Recession exposing the crown margin in conjunction with orthodontic treatment

  

Before: Following orthodontics, the patient had 3+ mm of recession on tooth #24, with minimal attached gingiva.

After: A connective tissue graft restored the gingiva to the crown margin, and a wide band of protective gingiva.

 

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Case #4 - Recession with inflammation in lower anterior.

  

Before: Thin delicate tissue receded rapidly with inflammation.

After: A connective tissue graft restored lost tissue, with 100% root coverage, and nice blending of color.

 

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Case #5 - Recession, minimal band of attached tissue and root decay.

  

Before: Root decay and recession created sensitivity, and a cosmetic defect.

After: All the decay was removed, the root was instrumented and a connective tissue graft was placed. No restoration was needed and a good cosmetic result was achieved.

 

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Case #6 - Minimal attached tissue around implants, with chronic inflammation.

  

Before: Minimal band of attached tissue surrounding the implants.

After: Soft tissue grafts increased the band of tissue, facilitating improved home care and long-term implant success.

 

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Case #7 - Crown lengthening needed due to invasion of biologic width by old crowns

  

Before: Chronic inflammation and inadequate tooth structure for retention of new crowns.

After: Following crown lengthening (crown exposure) temporary crowns were placed, in a healthy gingival foundation. New crowns will now be made.

 

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Case #8 - Ridge defect - soft tissue

  

Before: Patient presented with missing #8, and a ridge defect due to bone collapse.

After: The ridge was augmented with a soft tissue graft, to create an ideal soft tissue profile for a bridge pontic. This improves the cosmetics of the bridge, and facilitates improved plaque control underneath the pontic.

 

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Case #9 - Bone regeneration

  

Before: A localized 12mm pocket was diagnosed with a routine x-ray: tooth #29 has deep vertical bone defect.

After: Bone regeneration utilizing bone grafting and guided tissue regeneration, saved the bridge by reducing the pocket depth and provided a maintainable environment.