Our primary goal at Norwich Periodontal Associates is to provide you with the most advanced care possible in a comfortable relaxed environment. To achieve these results, we use the most current periodontal procedures, instruments, medications, and sterilization techniques. Every procedure is completed with your comfort and safety in mind. We always work closely with your general dentist to ensure that you get the best possible care. We also make certain that you are completely informed of your dental needs, and encourage you to ask questions before, during, or after any procedure completed in our office. After treatment, home care and medication instructions will be thoroughly explained. For your convenience, you will also be given printed post treatment instructions, which will include emergency phone numbers, if necessary.
Procedures
The Most Advanced Periodontal Care PossibleNON-SURGICAL PERIODONTAL TREATMENT
For most patients, the initial stage of periodontal therapy will include non-surgical treatment. If periodontal disease is detected in the early stage, often the non-surgical treatment will be sufficient to eliminate the present infection and prevent the spread of the disease.
Here are some reasons why scaling and root planing may be recommended:
Tooth Protection – Periodontal disease is the number one cause of tooth loss in the developed world. When tissue pockets exceed 3 mm in depth, there is a greater risk of periodontal disease. As pockets deepen, they tend to house more colonies of dangerous bacteria. Eventually, a chronic inflammatory response by the body begins to destroy gingival and bone tissue which may lead to tooth loss.
Disease Prevention – The oral bacteria which cause periodontal infections can travel via the bloodstream to other parts of the body. Research has shown that lung infection and heart disease have been linked to periodontal bacteria. Scaling and root planing remove bacteria and halts periodontal disease from progressing, thus preventing the bacteria from traveling to other parts of the body.
Fresher Breath – One of the most common signs of periodontal disease is bad breath. Food particles and bacteria can cause persistent bad odor in the oral cavity which are alleviated with deep cleaning procedures such as scaling and root planing.
Non-surgical periodontal treatment primarily consists of a procedure called scaling and root planing. Often completed under local anesthetic, this procedure entails smoothing the tooth roots to allow the gum tissue to heal and reattach to the tooth. In some cases, systemic antibiotics or site specific antibiotics may also be included in the non-surgical phase of treatment. These antibiotics will further reduce the harmful bacteria which cause periodontitis.
Finally, studies have clearly demonstrated that long term periodontal treatment success heavily depends upon a patient’s ability to properly brush and floss. Dr. Trailor and his staff will provide the proper education and modification needed to obtain a level of plaque control consistent with long term periodontal health.
Dental Implants
Dental implants are designed to provide a foundation for replacement of teeth that look, feel, and function like natural teeth. The person who has lost teeth regains the ability to comfortably eat and smile with confidence, knowing that their teeth will appear natural and their facial contours will be preserved. The implants themselves are titanium posts which are placed into the jawbone where teeth are missing. The bone bonds to the titanium, creating a strong foundation for artificial teeth. In addition, implants can help preserve facial structure preventing bone deterioration that occurs when teeth are missing. Finally, implants can also be used to significantly improve the tension and stability of both partial and complete dentures.
There are several indications for utilizing dental implants:
- Replace one or more missing teeth without damaging adjacent healthy teeth.
- Restore a patient’s confident smile.
- Improve a patients chewing, speech, and digestive function.
- Improve the retention and stability of complete and partial dentures creating a more secure and comfortable appliance.
The dental implant procedure includes surgically placing the implant fixture into the jawbone. After an appropriate healing period, you will be referred to your restorative dentist for the final implant bridge work or implant supported denture fabrication. During this period, temporary dentures or temporary teeth will be fabricated to provide aesthetics and function during implant treatment. In some cases, implant fixtures may be temporarily restored immediately after placement.
Overall, implant treatment is quite predictable and successful. Most longitudinal studies have shown a 90% to 95% success rate over a five year period; however, a small percentage of implants do not properly heal. It has been Dr. Trailor’s office policy to guarantee a successful outcome with implant treatment. If your implant does not heal properly within the first year, it has been Dr. Trailor’s policy to replace the implant at no cost, or simply refund the full amount charged for your implant surgery. Historically, our office has experienced a 2% failure rate when placing dental implants.
If implant dentistry is a choice for you, we would ask that you undergo a clinical and radiographic examination. During this consultation visit, Dr. Trailor will address your specific implant needs. Your questions and concerns are important to us and our team will work with you very closely to help make your procedure a success. At this visit, procedures, fees and insurance coverage will be reviewed and, if necessary, a payment plan arranged.
Soft Tissue Grafting
Soft tissue grafting is often necessary to combat gingival recession. Periodontal disease, overzealous tooth brushing, trauma, and poor tooth positioning are the leading causes of gingival recession which can lead to tooth/root exposure in severe cases. When the roots of the teeth become exposed, eating hot and cold foods can be uncomfortable, decay is more prevalent and the aesthetic appearance of the smile is altered. The main goal of soft tissue grafting is to either cover the exposed root or to thicken the existing gum tissue in order to halt further tissue loss.
There are several reasons for soft tissue grafting. Recent developments in dental technology have made soft tissue grafting more predictable and less intrusive.
Here are some of the main benefits associated with the soft tissue grafting treatment:
Increase Comfort – Root exposure can cause substantial pain and discomfort. Eating hot, cold or even warm foods can cause severe discomfort. Soft tissue grafts cover the exposed root, decreasing sensitivity and restore good health to the gum area.
Improve Aesthetics – Gum recession due to periodontal disease can cause a smile to look “toothy”, or the teeth appear to be uneven in size. Soft tissue grafting can be used as a cosmetic procedure to re-augment the gums, and make the smile appear more symmetrical.
Improved Gum Health – Periodontal disease is a progressive condition that can destroy soft tissue very rapidly. When used in combination with deep cleaning procedures, soft tissue grafting can halt tissue and bone loss and protect roots from further complications.
The grafting procedure itself is generally performed under local anesthetic. A small incision will be made at recipient site in order to create a small pocket. Donor tissue obtained from a second surgical site is then placed and sutured into the recipient’s site. Finally, the wound site will be sutured to prevent shifting, and surgical dressing will be placed to protect the sensitive area.
Pocket Reduction Surgery
Pocket reduction surgery is a collective term for a series of several different surgical procedures aimed at gaining access to the roots of the teeth in order to remove bacteria and tarter. Periodontal infections cause a chronic inflammatory response in the body that literally destroys bone and gum tissues once they invade the subgingival area. Periodontal pockets form and deepen between the gums and teeth as the tissue continues to be destroyed. Periodontal disease is a chronic condition which, if left untreated, causes massive bacteria colonization in pathologic pockets which eventually lead to loss of teeth. Pocket reduction surgery is an attempt to alleviate this destructive cycle, and reduce the depth of bacteria-harboring pockets.
There are many reasons for pocket reduction periodontal surgery. Pocket reduction surgery is a common periodontal procedure which has proven effective at eliminating bacteria, reducing inflammation and saving teeth. The goals of pocket reduction surgery are:
Halting bone loss – The chronic inflammatory response induced by the oral bacteria leads the body to destroy bone tissue. As the jawbone becomes infected by periodontal disease, the teeth loose their rigid anchor. When the teeth become too loose, they may require extraction.
Facilitate home care – As the periodontal pockets become progressively deeper, they become incredibly difficult to clean by the patient. The toothbrush and dental floss simply cannot reach the bottom of the pockets, thus increasing the risk of further periodontal breakdown.
Reducing bacterial spread – oral bacteria has been connected to many other serious conditions such as diabetes, heart disease and stroke. Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize. It is important to decrease the bacteria in the mouth in order to reduce the risk of secondary infection.
Pocket reduction surgical treatment is performed under local or general anesthetic, depending upon the preference of the patient. The gingival tissue will be pulled back from the teeth and bacteria and tarter will be removed. Scaling and root planing will be completed to fully remove tarter from the surface of the tooth root. Further surgical measures are taken to eliminate all diseased hard and soft tissues. The gingival tissue is then sutured with stitches that are left in place for 7-10 days. In some cases, a patient may experience temperature sensitivity immediately following this procedure. However, this sensitivity will decrease with time and a patient will experience a significant reduction in pocket depths and a vast improvement in their overall periodontal health.
Crown Lengthening
Crown lengthening is generally performed in order to improve the health of the gingival tissue, or to prepare the mouth for restorative or cosmetic procedures. This procedure can also be used to correct a “gummy” smile, where teeth are covered with excess gingival tissue. Crown lengthening exposes more of the natural tooth by reshaping or recontouring adjacent bone and gingival tissue. This treatment can be performed on single or many teeth prior to prosthetic or restorative dental treatment.
Reasons for Crown Lengthening
Crown lengthening is a versatile and common procedure that has many effective uses and benefits. The vast majority of patients who have undergone this type of surgery are delighted with the results.
Here are some common reasons for crown lengthening:
Restoration of damaged teeth – When teeth have been broken beneath the gingival tissue, or have experienced decay which extends beneath the gingival tissue, crown lengthening can be used to prepare the tooth for a new restoration.
Cosmetic uses – Extragingival tissue can make teeth look unnaturally short. Removing excess gingival tissue can restore a balanced, healthier look and thus, improve the aesthetic appearance of the smile.
Dental crowns – Crown lengthening serves to provide more space between the supporting jawbone and the new dental crown. This prevents the crown from damaging gingival tissues and supporting bone once it has been placed.
Crown lengthening is normally performed under local anesthetic. The amount of time this procedure requires will largely depend on how many teeth are involved and the extent of any bone removal required. The crown lengthening procedure entails a series of small incisions around the soft tissue in order to separate the gingival tissue from the teeth. Even if only one tooth requires crown lengthening, neighboring teeth are usually treated to provide a more even reshaping. Separating the gingival tissue allows access to the roots of the teeth and the underlying bone. In some cases, the removal of a small amount of gingival tissue will provide adequate tooth structure for restorative or prosthetic treatment. In other cases, a small amount of bone will need to be removed in order to properly expose a sufficient amount of tooth structure. When an adequate amount of tooth structure has been exposed, the gingival tissues will be sutured. The teeth will look noticeably longer immediately following the crown lengthening procedure because the gingival tissue has been repositioned. A surgical dressing is usually placed and prescriptions for pain medication will be provided. The surgically treated teeth will be ready for restorative or prosthetic treatment in approximately four to six weeks.
Maintenance
It only takes 24 hours for plaque that is not removed from your teeth to turn into tartar. Daily home cleaning helps control plaque and tartar formation, but those hard-to-reach areas will always need special attention. Once your periodontal treatment has been completed, it will be recommended that you have regular maintenance cleanings (periodontal cleanings), usually three to four times a year. At these cleaning appointments, the pocket depths will be carefully checked to insure that they are healthy.
In addition to your periodontal cleaning and evaluation, maintenance visits will also include:
Examination of diagnostic x-rays (radiographs) – Updated dental x-rays of diagnostic quality are essential for the detection of cavities, periodontal bone loss, and various other dental pathologies. The frequency of obtaining x-rays will heavily depend upon each patient’s overall dental condition.
Examination of existing restorations and tooth decay – During maintenance visits, all teeth will be checked for defective restorations and the presence of new decay. If restorative or prosthetic issues are detected, patients will be referred to their restorative dentist for proper treatment.
Oral cancer screening – All patients will undergo a cancer screening of the face, neck, lips, tongue, throat, and gingival tissue.
Oral hygiene recommendations – During maintenance visits, the patient’s ability to adequately remove plaque throughout their dentition will be evaluated. Patients will be educated and motivated to effectively remove the plaque, which forms on a daily basis.
Teeth polishing – The removal of stain that is not otherwise removed during tooth brushing and scaling will also be removed during a maintenance visit.
Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control. The literature clearly states that even patients with advanced periodontal breakdown can maintain their teeth for decades with a strong commitment to maintenance care.