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Periodontal Regeneration Dentistry Treatment

Periodontal regeneration means restoring the bone and supporting tissues adjacent to teeth with advanced bone loss. Frequently, periodontal regeneration treatment will prolong the use of the involved teeth. A periodontist or dentist will diagnose the problem by taking a careful medical and dental history.

The tissues adjacent to the teeth will be gently probed with a calibrated, ruler-like instrument. These measurements, together with a dental X-ray, will help determine the appropriate treatment for the involved teeth.

There are many regenerative techniques and methods. Bone purchased from bone banks has been used effectively as a regenerative material for over 30 years. This bone is procured from healthy individuals, is carefully processed, and has been proven safe. Treatment consists of carefully moving the gum tissue away from the involved teeth and removing tarter (calculus) deposits from the root surfaces.

The bony defect is gently filled with the bone bank material (allogenic bone) or other synthetic materials. The gums are then replaced around the neck of the teeth with small sutures. The sutures are removed within five to seven days, and gentle tooth brushing can resume.

Synthetic bone substitutes have been developed to simulate natural bone. These materials are safe, and may help support the involved teeth. Such substitutes are implanted through periodontal surgery. Recently, cow bone, which is carefully prepared, sterilized, and safe, has been used to repair defects next to teeth. This bone is porous, allowing bone from the patient to grow into the pores. New technologies have developed porcine (pig) proteins, which, when painted onto teeth, allow for natural regeneration of tooth cementum and bone. These materials have demonstrated early promising clinical results.

The use of barrier membranes to protect and isolate bony defects has been used for over 15 years. These are made from synthetic, non-dissolvable materials, dissolvable materials, or bovine collagen (cow collagen). Membranes are frequently used either with synthetic graft materials or with bone purchased from bone banks. Recently, proteins have been joined to synthetic bone.

This material enhances cell attachment to root surfaces and may provide an effective method for periodontal regeneration. In the future, proteins that stimulate bone formation and enhance formation of new root cementum will make periodontal regeneration a simple, effective method to save teeth with advanced disease.

The materials discussed above have been published in dental journals, are safe, and generally result in tooth retention with bone fill of the treated bony defects. Articles relating to periodontal regeneration can be researched from PubMed using the following key words: "periodontal," "regeneration," "allogenic bone," "synthetic bone grafting," and "barrier membranes."

By William Becker, DDS

Dental Procedure For Dental Recession

Dental recession is a displacement of the gum around the teeth that results in greater tooth exposure and a longer looking tooth. As the gum that protects the root surface of the tooth is lost, not only does it create an esthetic deformity, it makes the tooth more sensitive to changes in temperature (hot and cold), touch, and to proper oral hygiene techniques. The exposed root surfaces also are more susceptible to cavities. Causes of dental recession include:

• Periodontal disease: The bacteria that cause gingivitis can release toxins that injure the gum tissues and create gum recession. Once the gum is affected by gingivitis (see article "Gingivitis"), it is even more susceptible to further dental recession and bone loss. So if the gum is red, swollen, or bleeds when probed, it is more likely to continue receding. Eventually, there may not be enough healthy gum and bone left to protect the tooth and the tooth may need to be removed. If there is less than 2 mm of healthy gum in an area of recession, a dentist may recommend a gum graft to help prevent further receding gums and help protect the tooth.
• Trauma: Medium or hard bristle toothbrushes, brushing too hard, or brushing inappropriately can damage the teeth and the gums. It is very important to use a soft bristle toothbrush when cleaning the teeth, and to follow proper technique. Mechanical trauma to the gums also can be caused by improperly fitting dental restorations or dentures. Fillings that are rough or dentures that are loose or poorly designed can injure the gums and cause them to recede.

Gums also may recede as a result of orthodontic treatment or from manipulation during restorative procedures. To prevent this from occurring, a dentist may recommend gum grafting before orthodontics or restorative treatment.

Gum grafts are indicated if an individual has root sensitivity to touch or temperature changes, if new restorative work will be done in the area of the dental recession, if the roots are susceptible to cavities, or if an individual is having problems following proper plaque control procedures. In addition, gum grafts are cosmetic periodontal procedures that can be performed to enhance smiles if recession has created esthetic problems such as long teeth or exposed roots.

By Laura Minsk, DMD