Local Dental Care - Gum Problems

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 Disease And Ridge Augmentation

Whether a tooth has been lost to periodontal disease, tooth decay, or trauma, one may be left with a cleft, an indentation, or uneven gum margins. This happens because after a tooth is removed, the bone that was encasing it disintegrates and the gum around it collapses. If this occurs in the front of the mouth, it can result in an esthetic problem. No matter how well designed the replacement teeth are, they may appear to be too long and unattractive. To have a pleasing smile, the shape, color, and texture of the gums is just as important as that of the teeth they frame.

Ridge augmentation is a cosmetic periodontal procedure that may include gum and/or bone grafting. A dentist will determine which option is better suited to a patient's esthetic needs. Regardless of what treatment method a dentist chooses, ridge augmentation is a very predictable procedure with long-lasting results.

What to Expect from Periodontal Ridge Augmentation

Ridge augmentation is a surgical procedure that is done in the dentist's office with local anesthesia (lidocaine). Stitches (sutures) are placed to aid in healing. Post-surgical discomfort can last a few days and is usually minimal. It can be easily managed with commonly available over-the-counter medications such as aspirin, acetaminophen, or ibuprofen. Patients can expect to follow their normal routine the day after oral surgery. The dentist will provide special instructions related to diet, exercise and medications.

To ensure more esthetic results, ridge augmentation procedures should always be done before new crowns are made. Although a temporary (provisional) tooth replacement can be made at the time of tooth loss, the final restoration should not be fabricated until after six to eight weeks of gum healing.

Alternatives periodontal treatments

It is possible to help prevent collapse of the gum tissue by doing a bone grafting procedure or by placing an implant at the time of extraction. Although sometimes it may still be necessary to do further periodontal plastic surgery procedures, these treatments can help maintain the space that was previously occupied by the tooth and prevent bone loss. If this was not feasible, ridge augmentation can be done to improve esthetics after tooth extraction.

Ridge augmentation should be considered as part of an individual's cosmetic dentistry options when there are uneven gum contours, clefts, or indentations on the gums. The most beautiful teeth will not look natural if the gum surrounding them is not cosmetically pleasing. Talk to a dentist about esthetic concerns and the possibility of incorporating cosmetic periodontal procedures as part of a "smile lift."

By Laura Minsk, DMD