Periodontal disease treatment
Periodontal disease is often called gum recession in everyday speech. It is a wider inflammation involving the gums, bone and periodontal ligaments around the teeth.
It develops slowly, with few early complaints — many patients come to us already at an advanced stage. Symptoms include bleeding, swelling and pain of the periodontium, discharge, food packing and cervical sensitivity.
Periodontal disease is more common than you might think.
Since 2010 it has been listed as the world’s 6th most common disease, affecting more than 700 million people. In Hungary eight in ten adults are affected in some form — and periodontal disease accounts for most tooth loss.
I. Causes
- 1Acquired causes: Poor oral hygiene, plaque and tartar are the most common. Over-vigorous brushing can scrape the gum off healthy teeth.
- 2Local irritants: Ill-fitting restorations, overhanging crowns and fillings damage the periodontal tissues.
- 3External factors: Certain heart medicines (calcium-channel blockers), epilepsy drugs, contraceptives and immunosuppressants after organ transplant can harm the periodontium.
- 4Hereditary factors: Some gene polymorphisms can reduce the periodontium’s natural defence against infection.
II. Classification
Diagnosis follows an internationally agreed classification. The 1999 scheme was replaced in 2018 by a system developed by AAP and EFP working groups.
The current grouping no longer distinguishes chronic and aggressive forms. Staging (1–4) and grading (A–C) run from mildest to most severe, slowest to fastest progression, and take smoking and conditions such as diabetes into account.
Source: J Clin Periodontol. 2018;45(Suppl 20):S1–S8.
Links with general disease
Bacteria entering the bloodstream via the periodontium can contribute to several conditions. Literature links periodontal disease with type II diabetes, cardiovascular disease, late-life dementia, premature birth and lower birth weight.
Cardiovascular disease and periodontitis are both common, chronic, non-communicable conditions that increase with age. Periodontal inflammation raises the risk of heart attack, heart failure and stroke.
Smoking, stress, obesity, diabetes and unhealthy diet worsen both. Early diagnosis and dentist–physician cooperation improve the chances of recovery.
Preparation, instruction, motivation
Careful daily care and a proper brushing technique are fundamental, plus special cleaning aids and six-monthly hygienist visits with tartar removal.
Microbiological sampling and full-mouth disinfection
We clean according to protocol. If culture from the pockets is positive for periodontopathogens, we run a full-mouth disinfection: targeted antibiotics plus professional cleaning and curettage under local anaesthesia with sterile Gracey instruments.
All diseased pockets are cleaned in a short window so they are not recolonised. The patient adds chlorhexidine rinses and tongue cleaning. After one month we reassess and enter a recall programme.
Closed curettage
Subgingival cleaning: inflamed tissue, pocket wall and infected root cementum are removed with Gracey instruments.
Evaluation
3–4 weeks after disinfection or closed curettage we remeasure pockets, assess healing and hygiene, and choose the next strategy — including correcting overhangs, polishing rough fillings, replacing faulty restorations or occlusal adjustment.
Splinting
Temporary or permanent splints at various stages help teeth stabilise. We bond glass-fibre tape and aesthetic flowable composite on the inner surface. Often needed before regenerative surgery.
Open-flap curettage
Deep, poorly accessible pockets are cleaned under direct vision. We use flap surgery with microsurgical methods under local anaesthesia, close with sutures and remove them after a week. Bio-materials (hyaDENT BG™, Emdogain™) can support regeneration.
Re-evaluation
The watershed of the periodontal plan. We remeasure pockets and bleeding, check inflammation-free gums and hygiene. Surgery is only possible after proper preparation and patient partnership.
- Is pocket surgery needed?
- How committed is the patient to keeping the teeth?
- Can an adequate hygiene level be established?
Risk assessment, supportive care and maintenance
At the end of treatment a multi-factor risk analysis sets how often you return for check-ups and professional cleaning. Based on the Bern risk assessment we recall every 3, 4 or 6 months. Maintenance has run as a recall system for 15 years.
Recall means we do not say goodbye after a treatment series; we analyse risk by type and condition (Bern: perio-tools.com/pra).
After implants yearly, after advanced periodontitis every six months, and with serious systemic disease every four months we perform professional hygiene.
IV. Regenerative periodontal surgery
Periodontal regeneration is possible within narrow limits. The aim is to restore bone, periodontal ligament, cementum and collagen fibres, using growth factors and membranes that protect the bone crater from rapid gingival ingrowth.
We combine materials according to defect shape, depth and angle, using only premium, well-evidenced biomaterials.
Basic requirements for regenerative surgery:
- cause-related therapy has succeeded; inflammation is absent
- the disease is inactive
- the patient maintains excellent home care
- the bony defect has a suitable shape and angle
- the patient does not smoke
- general health is adequate; no surgical contraindication
