Periodontics

What is periodontal disease?

Periodontitis is the outcome from infection that is resulting from a complex interplay between bacterial infection and host response, often modified by behavioral factors.

Epidemiology of periodontal diseases:

Documentation reveals 5-15% of any population suffers from severe generalised periodontitis, even though moderate disease affects majority of adults. The adult population suffers from chronic periodontitis with mild attachment loss.

Chronic Periodontitis:

Chronic periodontitis is an infectious disease resulting in inflammation within the supporting tissues of the teeth, with progressive attachment and bone loss.

Risk Factors and determinants associated with chronic periodontitis:

  • Plaque,poor oral hygiene
  • Tobacco
  • Genetic predisposition
  • Psychosocial stress
  • Diabetes
  • Systemic disease

Diagnosis: is based on the following-

  • Bleeding on probing,probing depth and clinical attachment loss
  • Testing teeth for mobility
  • Radiographic examination(vertical bitewings and periapical view)

Treatment includes:

  • Scaling and root planning
  • Pharmacological therapy
  • Surgical therapy
  • Occlusal adjustment

 

Pocketing/Gingival and Periodontal Pockets:

A periodontal pocket is a pathologically deepened gingival sulcus and is an important feature of periodontal disease.

Gingival Pocket:

These are pseudo pockets due to gingival enlargement with the pocket epithelium at or above the cemento-enamel junction.

Periodontal pockets:

These are either supra-bony or infra-bony pockets. This is due to the apical migration of junctional epithelium beyond the cement-enamel junction.

Pocket contents:

Periodontal pockets contain debris consisting principally of micro-organisms and their products.

Pocket Depths:

The pocket depths are measured from the gingival margins to the estimated base of the pocket. The clinical attachment levels are however,more precise indicators of disease. They are measured from a fixed reference point: the cemento-enamel junction to the base of the pocket.

Instruments used:

Periodontal probes and gingival curettes

Probing Variables:

The depth of penetration depends on the following:

  • Type of probe
  • Amount of pressure used
  • Degree of inflammation

In the presence of inflammation, a probe tip can pass through the inflamed tissues until it reaches the most coronal dentogingival fibres, about 0.5mm apical to the apical extent of the junctional epithelium.The amount of penetration into the tissues varies directly with the degree of inflammation,so that, following resolution of inflammation, an underestimate of attachment levels can be given.

Diagnostic Tests and monitoring at Smileoracles Multispeciality Dental Clinics:

The diagnosis and classification of the diseases associated with the periodontium is still based on traditional clinical assessment.

Even though bleeding on probing has traditionally been the most useful indicator in disease activity, only 30% of sites that bleed will lose attachment.

Traditional approach to diagnosis:

  • Presence or absence of clinical signs of inflammation
  • Probing depths
  • Extent and pattern of clinical attachment and bone
  • Patient’s medical and dental history
  • Presence or absence of miscellaneous signs and symptoms.

Advances in traditional diagnostics methods:     

  • Instruments have been developed that measure the temperature in the gingival tissue.
  • Repeatability values that are comparable have been obtained with computer-linked, controlled-force electronic periodontal probes.
  • Electronic probes have the control of insertion forces and automatically recording clinical information into the computer.
  • Advances in direct digital radiographic and computed tomographic techniques have been staged.
  • Intra oral radiographs

Acute Periodontal disease:                                       

Gingival abscess

 

Periodontal abscess

Necrotizing Periodontal disease

Herpetic Gingivostomatitis

Pericoronal abscess

Combined periodontal/endodontic lesions

At Smileoracles Multispeciality Dental Clnics we lay emphasis on the diagnosis of an acute condition that would help us attain best treatment planning and subsequent results.

 

Periodontitis in children and adolesents:

  • Localised aggressive periodontitis
  • Generalised aggressive periodontitis
  • Periodontitis as a manifestation of systemic disease

 

Treatment for the above conditions:

Surgical mechanical debridement

Non surgical mechanical debridement

Anti-microbial therapy

 

 

Prevention of periodontal disease:

Oral hygiene instructions

Tooth brushing

Interdental cleaning

 

Professional preventive techniques at Smileoracles Multispeciality Dental Clinics:

A periodic examination for periodontal disease, is essential. This includes:

  • Complete oral examination
  • 3 months follow uo check up
  • Routine scaling and polishing
  • Intensive education and motivation of the patient
  • Elimination and prevention of iatrogenic problems like overhanging restorations, ill fitting crowns,poorly designed appliances are mandatory.

                                                                                    Principles of treatment at Smileoracles Multispeciality Dental Clinics:

  • Establish a diagnosis
  • Daily plaque control
  • Aims of corrective techniques such as scaling, root planning, periodontal surgery ,restorative works, endodontics, occlusal adjustment etc
  • Eliminating pathological periodontal pockets
  • Improving alveolar bone support and arresting loss
  • Creating an oral environment that is relatively simple for patient to maintain plaque-free.

The 3-phases of Periodontal Therapy:

1.Initial Phase-Control/Eliminate

2.Corrective Phase-Restoration of function

3.Maintenance Phase-Supportive phase

  • Nonsurgical Therapy
  • Local delivery of medicaments like Tetracycline fibres(actisite),Chlorhexidine chips(Periochip),doxycycline gels(atridox),minocycline microspheres(arestin),metronidazole gel
  • Minimal Invasive therapy with scaling and root planning and modified Widmann flap.
  • Periodontal surgeries-gingivectomy,apically repositioned flap,osseous surgeries
  • Regenerative techniques
  • Role of occlusion
  • Tooth mobility
  • Analysis and treatment of Perio-endo lesions with our specialists.