Practical Periodontal Treatment

The extent of periodontal disease (PD) can vary from patient to patient and even from tooth to tooth in the same patient. It is critical to fully evaluate the extent of attachment loss to initially ‘stage’ the tooth, but also to determine appropriate therapy options. In teeth with stage 1-2 periodontal disease, it is an easy decision to clean and treat those teeth to maintain them in a healthy periodontal state. Mild to moderate suprabony pockets require excellent management of the subgingival surfaces, including curettage. Perioceutical materials may be considered for use, but only have the cleaning is complete. Minor gingivoplasty may be appropriate in some cases.
Stage 4 PD teeth also lead to an easy decision to treat. In the great majority of cases, extraction is the best option, though considerations in teeth with F3 furcation involvement (theoretically in stage 4), we may have some alternatives.
When it comes to stage 3 periodontal disease, many factors must be taken into account to determine appropriate therapy. If it is a strategic tooth (canine and carnassial teeth), additional effort may be afforded, depending on the level and character of attachment loss, including alveolar bone. Assessment of adjacent teeth can often provide superior access to the strategic tooth by extracting the smaller tooth and proper soft tissue management keeping the goal of periodontal treatment in mind. Newer products are available to assist in the management of periodontal disease, even when furcation exposure is involved.
The patient status is also important when making a decision to provide advanced periodontal care. Due to the potentially longer anesthetic times, and likely more frequent anesthetic procedures to maintain periodontal health, a patient with systemic issue may benefit more from extraction and removal of the chronic inflammation. Even the client should be considered: while they might want to ‘save all the teeth’, will they be willing to provide adequate home care and regular professional therapy?
Our periodontal therapy options may range from non-surgical pocket curettage and perioceutics to minor gingivoplasty. With large or infrabony pockets, surgical intervention is needed with gingval flaps (+/- adacent tooth extraction) for adequate exposure. Regenerative procedures, particularly with infrabony pockets, is often considered and will be discussed briefly. Resection procedures are just as important when pocket depth involves more soft tissue, or non-harmonious osseous levels are found. Particularly with mandibular canines, deep pockets may be present, but extraction of adjacent incisors with soft (and bone) tissue management can remove proliferative, redundant or diseased tissue around the canine, partnered with appropriate alveoloplasty, to improve the situation of the tissues of the periodontium and overall periodontal health.
Recent advances in products that help provide scaffolding to enhance the healing of the cells of the periodontium