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Treatment of periodontitis always begins with a non-surgical phase. Non-surgical treatment includes learning of correct hygiene practices, removal of supragingival and subgingival tartar and, if necessary, extraction of teeth with hopeless prognosis. Diagnostics helps us identify the extent and severity of the disease. Based on this information, we plan deep cleaning of teeth during 2, 4 or 6 visits. If there is a large build-up of tartar and plaque, the extensive layers should be cleaned off first to ensure decreased gum bleeding, better visibility and control over teeth surfaces during the deep cleaning procedure. We perform deep cleaning of tartar under anaesthetic and the aim of the procedure is to remove supragingival and subgingival tartar to achieve clean teeth surfaces. We use ultrasonic scalers and curettes.
Before and after
If the patient suffers from a severe and aggressive periodontitis, we use more intensive non-surgical treatment methods. To reduce the bacterial load in the oral cavity, we conduct a deep cleaning in the entire mouth during 2 long visits within 24 hours so that bacteria cannot colonise the already cleaned areas again. We support this cleaning process with anti-microbial agents (mouthwash containing chlorhexidine at home and gum pocket rinse with gel after cleaning at the dentist’s practice) and a week-long systemic antibiotic treatment. The outcome of this treatment is usually a radical reduction in gum pockets and bleeding and receding of gums. The conventional deep cleaning of gum pockets is often necessary (during 2, 4, or 6 visits) after this treatment.
Laser use in adjunctive therapy
In recent years, many studies have been conducted to find out whether laser therapy could replace the conventional periodontitis treatment in future. At the moment there is little proof that lasers with Nd:YAG and Er:YAG wavelength could have an effective impact in the treatment of chronic periodontitis. This proof is minimal and presently more attention is paid to finding out whether using a laser for cleaning root surfaces in addition to traditional cleaning may have a positive additional effect.
Check-up after non-surgical treatment
After the end of the initial non-surgical treatment, a follow-up check should be conducted during which the condition of the gums will be assessed (bleeding, plaque, depth of pockets, recession of gums, furcation defects, mobility of teeth). Necessary caries and root treatment should have been completed by this time. A follow-up check will be performed 1.5–2 months after the end of the initial non-surgical treatment. The gum pockets will be measured and pictures of the pockets will be taken.
Based on this information it is decided whether corrective treatment should be undertaken, i.e. the problems that have developed during the inflammatory process should be corrected. This is especially important in case of patients that have a moderate or severe periodontitis. Only patients whose bleeding and plaque percentage has dropped below 20% (as a result of certain treatment methods even <10%) can begin the corrective treatment phase. If this has not been achieved, non-surgical treatment and appropriate hygiene practices at home should be continued until these requirements are met. Scientific research has found that if surgical treatment is used on patients whose indicators of inflammation are higher than allowed, the conditions of the attachment apparatus may deteriorate even more.
The corrective treatment phase may include surgical, orthodontic and prosthetic treatment of periodontitis. In this phase, an interdisciplinary treatment plan must be prepared by professionals specialised in different areas of dentistry.