Periodontitis: treatment

Pretreatment (initial periodontitis treatment)

At the first appointment of the periodontitis treatment, the tooth surfaces are cleaned, polished and fluoridated (Professional Teeth Cleaning, PZR). Fluoride is administered by the dentist as a gel or varnish directly on the affected tooth. They help to store important minerals and thereby strengthen the tooth. In addition, bacterial plaque (biofilm) and tartar (plaque) are removed as well as any irritants such as supernatant fillings and crowns eliminated.

In addition, a comprehensive consultation of the patient is part of the periodontal treatment: the person concerned receives tips and advice on the right brushing teeth. Those who have problems with the handling of a conventional toothbrush due to rheumatism should get an electric version. In addition, those affected will be advised on the right care products for periodontitis treatment such as toothpaste, rinsing solutions or dental floss. With special tooth-dye tablets, periodontitis patients can independently check the success of their oral care.

Removal of biofilm (closed periodontitis treatment)

In this step of periodontal therapy, the bacterial biofilm in the periodontal pockets is eliminated. For this the dentist uses thin instruments (curettes), if necessary with ultrasound. Also, any deposits on the necks and root surfaces are removed. Laser periodontitis treatment can also be used. Laser beams not only remove tissue, they also have an antibacterial effect and can stop bleeding.

Often these therapeutic measures are enough to stop the progression of the disease and relieve the symptoms. In many cases, one way to cure a periodontitis in this way.

Operation (open periodontitis treatment)

A surgical treatment of periodontitis is necessary if the first therapeutic measures have shown no success or the inflammation is already well advanced. Under local anesthesia, the periodontal pockets are opened by a small incision. This makes the affected areas more accessible. Then the dentist cleans the now visible root areas and removes diseased tissue. Even with a not yet visible defect in the root division (furcation involvement), this surgical procedure is recommended. Finally, the gums are applied to the teeth again and the cut stitched together. Through this procedure, the gums should adhere better, and the pockets are eliminated (gingival pocket elimination).

grafts

Under certain circumstances, so much gum is destroyed that tissue grafting is necessary. There are two options for this:

• free mucous membrane graft
• flap

At a free mucosal graft serves the hard palate of the patient as donor tissue. Using a cut tin foil, the required piece of mucous membrane is cut out. Then it is placed on the exposed tooth areas and sewn there. The wounds in the donor area usually heal well after several weeks. The graft itself heals after about four months.

In a so-called flap the gums are cut in a healthy place. The tissue flap thus obtained is pushed onto the nearby diseased jaw area and there exposed tooth roots and sewn. A distinction is made between lateral (laterally displaced) and coronal sliding lobes. In the case of coronal flaps, the gums are incised underneath and pulled up (in the lower jaw) or down (in the upper jaw) against the exposed teeth. There, the tissue is attached with a seam that wraps around the tooth.

Frequently, free grafts and sliding lobes are combined in order to achieve cosmetically more beautiful results.

Bone substitute material

In case of two- or three-walled bone pockets, it may be necessary to replace the degraded bone with real or artificial material. One uses either bone tissue of the patient (autogenous bone grafts) or those from bone banks. These offer demineralized, freeze-dried bone (allogeneic bone grafts). When all organic matter is removed, the tissue of cattle, swine or coral can also be used (xenogeneic bone grafts). In addition, calcium phosphate and glass ceramics can replace the bone defects.

Tooth extraction and root tip resection

This step of a periodontitis therapy is especially necessary if the tooth is clearly damaged and its conservation therefore makes no sense. Pulling the tooth (tooth extraction) or surgically removing its root tips (apicectomy) is the treatment of choice for apical periodontitis. Here, the inflammation is usually too deep to be successful with conventional treatments. Individual gaps due to lost teeth can be closed by bridges, for example. If several teeth are missing in succession, the partial function can be restored by means of a partial denture.

Controlled tissue regeneration

In this periodontal treatment, a special membrane is cuffed around a bony pocket. This is to prevent gum tissue from growing into the original site of the periodontium. Cells of the periodontal can now colonize the tooth root surface. The long-term goal of this periodontitis treatment is the rebuilding of the periodontium.

Some dentists also recommend therapy with so-called enamel matrix proteins. These are growth proteins that also play a role in the development of the masticatory apparatus. This is to promote the restoration of the tooth retention structures.

antibiotics

To treat advanced and aggressive periodontitis, the dentist prescribes antibiotics. They reduce the number of harmful bacteria in the mouth. So that these antibacterial drugs can specifically combat the periodontitis pathogens, the respective bacterial types are previously determined (bacterial test). To do this, the dentist removes plaque from the periodontal pockets and has them examined microbiologically.

Antibiotics are also urgently needed if the patient already complains of general complaints such as fever.

If you want to avoid antibiotics, locally acting essential oils are a good alternative. A so-called antibiogram is used to test which oils have a promising effect. In a pharmacy, the remedies for Periodontal treatment compiled.