I. Periodontal treatment:
Preparation, oral hygiene instruction, motivation:
We can teach you proper oral hygiene and effective tooth brushing techniques. We also teach you how to incorporate special cleaning devices and methods into your daily oral hygiene practice, and offer regular check-ups and professional tartar removal by our dental technician every six month.
Screening for periodontal disease, microbiological testing and full mouth disinfection
If you have gum disease we follow a special cleaning protocol. There is scientific evidence that gum disease is caused by special bacteria. If your symptoms suggest aggressive periodontitis, we take tissue samples from the pockets around your teeth and send it to the lab to be examined. If the test confirms the presence of bacteria in your mouth, we start a full mouth disinfection protocol (Quirynen protocol). Non-surgical treatment of periodontitis usually involves a series of appointments on a weekly basis. We will give you oral antibiotics targeted at the type of bacteria found in your mouth and perform professional dental cleaning to remove bacteria deposited in tartar on your teeth. The cleaning protocol also involves a curettage, in which we remove inflamed tissue from under the gum and infected tooth material from around the root. This procedure is performed under local anaesthesia, which means we make the gum numb and you won’t feel any pain. We will use a special sterile instrument (Gracey hand piece) which has a sharp edge to scrape the surface of the root and a rounded tip to gently remove the diseased tissue responsible for the inflammation in the gums from the pockets.
The purpose of this treatment is to clean all pockets in your mouth, which together with the use of oral antibiotics can prevent the recurrence of bacterial infection. Regular use of Chlorhexidine rinse and daily brushing of your tongue is also part of the treatment. As part of our so called Recall Program, you will be asked to come back for a check-up in one month.
Closed curettage: cleaning under the gum in which we remove inflamed tissue and pocket lining, as well as infected tooth material from the root with special Gracey instruments.
You will be asked to come back in 3-4 weeks for a follow-up examination of your gum and the pockets so that we can check the recovery process and the effectivity of your oral hygiene. We can also decide about further treatment. If it is required we will correct faulty edges of fillings, polish rough surfaces or replace unsound fillings in order to eliminate further causes of gum disease. It might also be necessary to grind your teeth to balance the forces that exert pressure on your teeth when you are chewing.
Splinting may be required at various stages of your treatment. You may require temporary or permanent splints. Splints prevent the mobility of your teeth, therefore they facilitate the healing process. Splinting involves attaching glass fibre strips on the back surfaces of your teeth using aesthetic liquid bonding materials. Such splints can fix the position of your teeth aesthetically. Splints are also required before regenerative surgical interventions.
Open flap debridement:
Pockets that are deep or cannot be accessed by closed curettage are cleaned under direct visualisation, which means that we perform open surgery. We do it under local anaesthesia (numbing) using state-of-the-art dental instruments. We make little cuts in the gum on the external and internal sides of your teeth (flapping) to see under the gum and clean the area thoroughly. We close the site of the operation with stitches which we clean regularly and remove after one week.
Re-evaluation: This phase is very important because we can monitor how your gum responds to the treatment and decide what further treatment is necessary. We measure pocket depth, look for the presence of bleeding and signs of inflammation, and check your oral hygiene. Finally, we do single tooth risk assessment again. With this careful approach we can find the most beneficial treatment for you so that you can retain your teeth in the long run.
Single tooth risk assessment:
We evaluate each tooth and classify them according to the expected prognosis. Tooth risk assessment means evaluation of tooth position within the dental arch and testing the furcation involvement of teeth with multiple roots, as well as assessment of iatrogenic factors, residual periodontal support and mobility.
II. Regenerative periodontal therapy
Several new regenerative methods have been found effective. We apply these methods to save teeth with a poor prognosis.
Regenerative techniques aim at restoring natural tissues (bone, root membrane, cement, collagen fibres). Regenerative restoration requires the presence of growth factors comprised of bone and blood, and a special layer that covers the defect in the bone and prevents the protrusion of the gum into the defect.
For this purpose special membranes have been devised: they are perfect to seal the defect allowing time for the bone to regenerate.
Depending on the nature, shape and depth of the defect, we apply several combinations of regenerative materials: Bioss® (Gseitlich) bone replacement granules of various sizes, collagen membranes: Bio Guide® (Gseitlich), Janson®, enamel matrix protein products: Emdogaint® (Straumann), and, of course, your own bone material and soft tissue from the roof of the mouth.
Requirements for regenerative periodontal therapy:
- Successful periodontal treatment, no signs of gum inflammation
- Inactive periodontal disease
- Proper oral hygiene
- The shape of the defect is suitable for such interventions
- Non-smoking patient
- Good general health
II/1. Open flap debridement with Emdogain®
Open flap debridement is a common procedure in conservative periodontal surgery. This procedure involves minimal exposure of the affected area. We detach only a small part of the gum and remove the inflamed tissues from the root surface through this small cut. The intervention can reduce the extent of gum recession after surgery. The purpose of the intervention is to eliminate the inflammation by removing granulation tissue.
At Dentoplant Clinic we perform open flap debridement applying innovative reconstructive surgical approaches. In selected cases following the indications we can insert a regenerative material called Emdogain® (Straumann). The purpose of Emdogain® application in periodontal surgery is to decrease pockets and regenerate deeper tissue. This process is carefully balanced in order to achieve maximal regeneration and elimination of pockets. Emdogain® application results in root surface modification (1.,2.,5.), new cement and fibre development, and direct targeted collagen development in the attached gingiva.
Depending on the extent of the damage, the procedure takes about one hour. We apply local anaesthesia and place Emdogain®, a chemically purified protein, on the root surface. We use this procedure to treat minor abnormalities. The procedure has several benefits: there is no significant alteration in the original structure, there is minimal gum recession and normal wound healing. By applying Emdogain® we can stabilise the periodontal structures and achieve slight regeneration (3.,4.,5.).
(1.)L.Hammarström: Enamel matrix, cementum development and regeneration J.Clin Periodontol 1997;24:658-668
(2.)L.Heijl, G.Heden, G. Svardström, A. Östgren: Enamel matrix derivative in the treatment of Intrabony periodontal defects.J.Clin. Periodontol 1997;24:705-714
(3)R.H.Heard, J.T.Melloning, M.A.Brunsvold, D.J.Lasho, R.M.Meffert, D.L.Cochran: Clinical evaluation of wound healing following multiple Exposuers to EMD is the treatment of intrabony Defects J.Periodontol 2000;71:1715-1721
(4)G.Heden, J.L.Wennström:Five-Year Follow Up of regenerative periodontal therapy with EMD at sites with angular bone defect.J.Periodontol 2006;77:295-301
(5)Dr. Anton Sculean, Dr. Péter Windisch,Dr. Ferenc Döri, Dr. Tibor Keglevich, Dr. Balint Molnár, Dr. István Gera: Emdogain® in Regenerative Periodontal Therapy, A Review of the Literature Stomatologia Hungarica 100. évfolyam 5. sz. 2007. október 220.
II/2. Open flap periodontal surgery with bone augmentation:
Another periodontal reconstructive approach is bone augmentation around the teeth. After careful preparation we can reconstruct the tissues around the teeth by rebuilding the bone using bone substitutes, your own bone and membranes. This approach allows us to restore bone mass, but it requires careful execution and perfect oral hygiene.
III. Periodontal plastic surgery – Recession coverage surgery
Intact gums indicate good periodontal health and make your smile attractive and aesthetic.
There are several types of mucogingival (gum) conditions that can cause aesthetic problems:
- small amount of gingiva around the teeth
- single gingival recession (receding gum)
- multiple gingival recession
- asymmetric gingiva
- gum smile
- interdental craters, negative papilla
- insufficient edentulous mandibular ridge
- gingival correction after implant opening
Patients often visit us because of problems and fears caused by receding gums. The most common complaints include:
- sensitivity of the neck of the tooth
- aesthetic problems: the receding gum makes the teeth longer and results in unattractive smile
- fear of losing the tooth
Most of these conditions can be corrected with periodontal reconstructive surgery. There are several surgical methods which need great expertise. Periodontal reconstruction involves two things: an adequate surgical technique and a material to increase gum mass. The most advanced surgical method nowadays is the so called tunnel technique. This technique does not require cutting through the gum. We use various types of this technique at our clinic. The materials we use to increase gum mass include: free palatal flap, graft from the area around the upper molars, and Mucograft® by Geistlich®.
Single recession coverage:
Below you can see the case of a patient with 5 mm gum recession around the right upper canine tooth. Gingival reconstruction is always preceded by careful evaluation and preparation. The only possible way to restore your gum is periodontal plastic surgery. In this case we used coronally advanced flap (CAF) procedure with a free palatal graft. The procedure was carried out with periodontal plastic microsurgical techniques and tools.
Multiple recession coverage:
In many cases gum recession affects more than one tooth. It is particularly important to restore the gum in the aesthetic zone of the mouth, when the front teeth are affected or sensitive. In the following case we also reconstructed the gum using a periodontal microsurgical technique, but this time we used tunnel technique. We prepared a tunnel in the gum, inserted a free palatal flap and positioned the gum with special surgical stitches. This case is really unique, because we can show you the one-year outcome, as well as the seven year follow-up. After seven years the coverage is nearly 100%, which is an outstanding achievement not only in Hungary, but also abroad.
At Dentoplant Clinic gingival reconstruction is always preceded by a careful oral hygiene protocol. Gingival reconstruction can only be successful if you yourself take responsibility for the outcome of the surgery by maintaining proper oral hygiene.