*Gum grafts -Gingival Recession and root cover -Free graft
*Guided tissue regeneration
Brushing techniques
The best way to prevent cavities and periodontal disease is having an adequate brushing technique, also the use of dental floss, and do not forget that you should visit your dentist each 8 month for an overhaul and cleaning. Unfortunately, although one has a good hygiene, there are patients that can develop periodontal disease, once it is detected the periodontist must avoid that this disease keep on increasing.
There are several brushing techniques, some are complicated, but in this section we think that we must expose an easy and practical one that explain how we must brush our teeth and what we must not do.
To start, It is good to rest the brush on the gum and then pass to the teeth face, massage the gum stimulating blood circulation, in addition we drain the gingival sulcus (space left between the tooth and the gum, it is not stuck to the gum, and it forms a bottom bag where there is plaque and food left-overs)
On patients with periodontal disease, it is indicated, the one that for many is the best brushing technique, (sweeping technique).
It is based on eliminating sub gingival bacterial plaque; it is the one that is inside the gingival sulcus. It can be done by any brush, but the best and more advisable are the named sulculars or periodontics (2 or 3 filament rows)
The brush is placed 45 degrees from the tooth’s axis inside gingival sulcus, a vibration movement is done, do not displace the filaments, it is as they move without hardly varying the position of the filament edge. Approximately we do movements during 10 seconds on each group of each group of 2 teeth.
Brushing technique
Prophylaxis
Although the patient had a good oral hygiene, the dental calculus or tartar is going to be formed around teeth. The prophylaxis is the dental cleaning performed in the dentist’s office; the objective is to eliminate tartar, also to polish teeth to get an smoother surface of dental enamel. This dental cleaning is performed by instruments that are in an ultrasound apparatus, it works by vibrations and this way, we can eliminate tartar more effectively and with no pain. To eliminate the pigmentations caused by food, drinks, tobacco, offee, etc. we use equipment that releases abrasive particles with water in pressure that eliminates any kind of of pigmentations and it leaves a polished surface.
In a healthy mouth the gum goes attached to teeth. As we mentioned before, the periodontal disease is caused by bacteria that introduces themselves through the time between gum and tooth, this causes gums to bleed, irritate and become inflamed. If this infection extends, gum separates from the tooth causing an space between the tooth and the gum, these are called periodontal pockets. As this infection keep on growing, gum and bone support, that surround our teeth, are being destroyed causing dental mobility and as a consequence the loss of teeth.
Scaling and root planning is a no surgical technique to remove dentobacterian plaque and tartar, that are inside gums as soon as infection begins and we do not present great bone destruction yet, the root surface is scrapped and cleaned by special designed instruments for this procedure called “curettage“. We counted on instruments placed on an ultrasonic apparatus to facilitate and to make procedure more effective.
Normally This procedure is performed under local anesthesia that is why it is not painful. After having done this procedure; bad breath, bleeding, inflammation and gum redness disappear and the gum adheres back around teeth.
Curette for tartar elimination
Ultrasonic instrument for cleaning
Open curettage
When we present moderate or severe periodontitis it is when this technique is performed, when bone that surrounds teeth is highly destroyed due to the advance of the periodontal disease this type of surgical procedure is frequently performed, it consists on opening the gum to eliminate all infected tissue and to take tartar, that is strongly attached to teeth, out. This procedure allows us to have greater visibility to locate the tartar adhered to the teeth roots in their entire surface and eliminate it. After this procedure the patient will note a better breath, inflammation of the gums lessen and getting a coral rose color, bleeding is eliminated from gums and mobility of teeth diminish remarkably, as we eliminate this tartar, gum adheres back to root surface.
Periodontitis. Note bone destruction where the measuring instrument gets in.
X-ray that shows the great destruction of the bone around the root, caused by periodontal disease.
Frenotomy-Frenectomy
The frenum are muscular insertions which join gum with cheeks and lips, sometimes they limit cheeks, lips and tongue movements. An abnormal frenum can cause a periodontal affection like retraction or recession of gums, also they can cause diastemas (spaces) between teeth and as we said, they can limit lip’s and tongue’s movements. Frenoctomy consists on a small surgery where lingual or labial frenum is replaced in upper maxilla so that this anatomic structure does not interfere with the right position of the teeth, the most common is that when the upper labial frenum has a too low insertion or it is very fibrous and it causes an space between two central teeth called distema, if a frenoctomy is not done, even the teeth that are joined by orthodontics, the space will open again.
Here we can observe the central teeth separation caused by frenum
The frenum was eliminated, it kept the orthodontic treatment on and the space between teeth was closed.
Gingivectomy-Gingivoplasty
This surgical procedure is performed when gum covers the teeth, this gum enlargement can be light or sometimes it can cover the whole teeth.
This enlargement can be caused by several factors;Like dentobacterian plaque, drugs used by patients with ephilepsy, hypertension and patients that have received some transplant of an organ. Also can be presented in patients under orthodontics treatment. On these patients, oral hygiene is too difficult to perform because braces difficult cleaning, they retain plaque causing inflammation and gum’s enlargement. What we search with this technique is to reshape gums so that it returns to its normal level, also to improve the aesthetics.
Demarcation of the line where the incision will be made by a periodontal measuring instrumental
Crown enlargement
It is a periodontal treatment performed to create a space to one or several restorations (crowns) and in other occasions to enlarge front teeth aesthetics, when they are covered under too much gum. Crown enlargement is a surgical procedure that shapes gums and sometimes the bone that surrounds one or more teeth. The aim of this is to obtain a proper quantity of exposed healthy teeth. This procedure is performed in general when there isn’t enough dental surface to retain a crown.
Reshaped bone to give space to the gum for inserting back
Gum grafts
-Gingival recessions and root covering.
When the root is exposed, sometimes a tooth is antiaesthetic and can caused dental sensitivity. That means, this sensitivity can appear from cold, hot or with sweet food. This exposure of the tooth root surface is caused by a bad brushing technique (traumatic brushing) or by using brushes with hard bristles, Nowadays it is not recommended to use dental brushes with hard bristles, we must use dental brushes with soft or medium bristles, though they are still sold in the market.
To cover the tooth root, recently “it is not” indicated to place resins over the radicular surface, unless deep cavities exist in the root.
There are different techniques for radicular covering; the periodontist will indicate you which are the best for you.
Gingival Recession
It is not indicated to place resins or amalgams over the radicular surface to cover it.
- Free graft and subepithelial connective tissue graft
The most common technique we use is to take a gum portion from the palate and place it on the root of the exposed teeth.
To take a portion of palate gum out do not cause any kind of deformation in the gum that covers the palate. This gum regenerates itself 100%in a month after performing this surgery. In the zone where roots were exposed we will obtain the cover of this root and a good gum thickness to avoid the aesthetic damage or dental sensitivity. It is necessary to clarify that in this like any other type of procedure, there are indications where it can be done, if we have a great bone loss around the teeth with recession, this procedure can not be perform.
Graft obtained from palate to cover the exposed surfaces of the root.
Before Gingival recessions
After Note the root from both teeth covered by the gum graft.
-Guided Tissular Regeneration
The regeneration is a biological process where the architecture and function of lost tissues are completely recovered. When we present moderate to severe periodontitis, great bone decay is presented, now, by fortune we already counted on graft materials which can be placed surrounding teeth to give them grater support and lessen their mobility. However, it is important to mention that placing these type of grafts around teeth is indicated in a very few cases. It is impossible to regenerate 100% of lost bone when the patient presents a moderated or severe periodontitis.
Treated Tooth with conventional open curettage without regeneration.
Treated tooth with regeneration where bone will be shaped to its original height.
