Scaling and root planning is the most effective non-surgical method of treating gum disease. Ultrasonic and hand scaler instruments are used to remove dental plaque and dental calculus from beneath the gums in order to eliminate the cause of periodontitis.
Scaling and root planning is normally done by using anesthesia in order to provide you with a total comfortable experience. Most patients can return to their regular activities following the scaling procedure. If you're still worried about pain, we can always prescribe something for post-treatment discomfort.
As with any dental procedure, patients should discuss their medical history and medications with us to avoid complications.
Root planing and scaling can introduce harmful bacteria into the bloodstream. Normally, we prescribe antibiotics before and after surgery. It is also important for you to tell us if you have a condition that puts you at high risk for developing a severe infection, such as:
- Damaged or artificial heart valves.
- A congenital heart defect.
- An impaired immune system.
- Liver disease (cirrhosis).
- An artificial joint, such as a hip replacement.
- A history of bacterial endocarditis.
Keeping it Healthy
Once scaling is complete, preventative care is necessary to keep gums healthy. Plaque can return and build-up on your teeth as
soon as 8 hours after the procedure is completed. Brushing and flossing daily will help fight the dental plaque that is constantly forming around teeth. Regular dental visits are also required to remove the dental calculus you've missed. We recommend that all patients who are treated with scaling return every 4 months for follow-up care. We will most likely change your daily brushing and flossing routines
and we always recommend interdental cleaners, such as plastic toothpicks.
SURGICAL APPROACHES TO GUM PROBLEMS
Periodontal surgery may be necessary when we determine that the tissue around your teeth are unhealthy and cannot be repaired with non-surgical treatment, such as scaling and root planing. There are 3 types of surgical treatments most commonly prescribed in our office:
- Gingival Flap surgery
- Gingivectomy
- Crown Lengthening
Gingival Flap Surgery
In most patients, the nonsurgical procedure of scaling and root planing is all that is needed to treat gum diseases. However, surgery
may be required when the tissue around your teeth is unhealthy and cannot be repaired with nonsurgical options.
Your bone and gum tissue fit snugly around your teeth, sort of like a turtleneck around your neck. When you have periodontal disease, the supporting tissue and bone is destroyed, forming "pockets" around the teeth.
Over time, these pockets become deeper, providing a larger space for bacteria to live. The bacteria set off a focal point of infection resulting in bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.
Reducing pocket depth and eliminating existing bacteria are the basic reasons for any gum disease treatment. However, eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult to clean. Scaling, alone, may
not be able to correct these advanced problems.
Gingival flap surgery can be done along with scaling and root planning, or it may be recommended as a separate procedure, normally
3 months after scaling is completed. We strive to always limit the number of procedures a patient requires and always strive to complete all periodontal treatments in the fewest number of visits. For the majority of our patients, we will complete scaling, root planning, and
flap surgery all in one visit. This avoids more treatment and costs down the road and it normally does not decrease the outcome of care.
 |
The gum is lifted from the tooth so the diseased tissue can be removed. The bone may also be reshaped.
After surgery, the gum is repositioned and often sutured in place. |
First, we remove all plaque and tartar (calculus) from around your teeth by scaling and root planning. Then, we separate the gums away from the teeth in order to allow us to reach the root of the tooth and the bone. We continue to remove any remaining tartar from the root surfaces and then we perform osseous recontouring, a procedure which smoothes the edges of the bone. Files or rotating burs are normally used to smooth the bone and provide the optimal architecture which is required to fit the bone, gums, and teeth back into harmony. After these procedures are completed, the gums will be placed back against the teeth and anchored in place using stitches. Antibiotic gels or surgical packs may also be used to decrease discomfort and eliminate the infection more rapidly. Antibiotics are usually prescribed and may be recommended for an extended period of time in order to effectively eradicate all remaining areas of infections in your jaw bones.
Crown Lengthening
Is a sub-division of gingival flap procedures and it is normally done on 1 or 2 teeth to expose a natural, broad smile . During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. We may also recommend crown lengthening to make a restorative or cosmetic dental procedure possible. Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so we can restore it properly.
Gingivectomy
A less intrusive method of correcting pocket depths is done via reduction of excess gum tissue, without opening the gums. Gingivectomy can also be used to lay the groundwork for restorative and cosmetic dentistry and/or to improve the esthetics of your gum line. The following tab below shows a case that included gingivectomy procedures…
 |
 |
Occlusal Bite Rehabilitation
(Click blue tab to open or close panel) |
Aesthetic Correction & Gummy Smile Treatment Planning
| Best Treatment Outline |
|
|
|
|
| Before |
After |
No More Gummy Smile!
As tooth structures wear down with age, the physical properties of our bite also change. Left untreated for an extended time, the bite collapses (a natural aging phenomenon.)
As a result of this “aging process” patients can experience TMJ pain, increased wear on front teeth, changes in facial features, difficulty smiling, and can even cause us to look older than our real age (granny mouth).
Our patient, an attractive 30 something year old male had the beginning stages of dental problems that typically don't occur, as a natural phenomenon, until a person is in their late forties or fifties.
As can be seen in the above photographs, our patient had an extremely gummy smile, small upper teeth, and severe wear to the biting surfaces.
Our patient had several goals that needed to be attained:
1. Fix the gummy smile
2. Halt and reverse the wear and tear
Many other dentists had given this young man their opinions, which included "all at once" bite adjustments and cosmetic reconstruction. We helped him understand that occlusion/bite modifications for his jaw structures needed to be changed incrementally, through a step by step process to assure natural repositioning of the upper and lower jaws. Corrections made too quickly usually result in worsening jaw relationships.
Best Treatment Outline
Selective gum shaping and recontouring was used as needed to create harmony across the new gingival arches on the treated teeth.Davinci Veneers were used selectively to resize the anterior teeth, to the cosmetic specifications made by the client.
The anterior resizing required the need for onlays and inlays on the posterior teeth…the bite was going to be in the beginning stages
of
"re-opening." Interestingly, our treatment cost was less than half of what other doctors recommended.
|
