Periodontitis is a chronical bacterial infection affecting tooth-supporting tissues, jawbone and tooth root. Along with the dental caries this is the most frequent disease and it is believed that 90% of population has some kind of periodontitis.

The first symptoms of the disease are the inflammation of gums that bleed easily and are swollen and painful. Bad breath can also be present. If the gum inflammation is not treated, the disease can spread and affect the tooth supporting structure and jawbone eventually causing typical periodontal pockets, loss of bone around the tooth, dislocation and ultimately loss of one or more teeth.

The therapy is long and complex. The periodontitis cannot be completely cured, but further progression of the disease can be stopped or slowed down. The therapy is determined and implemented according to the stage of the disease. It is necessary to do a thorough examination, RTG analysis and determine a prognosis for each tooth. The teeth with the poor prognosis have to be extracted, whereas teeth with the good prognosis should be treated so they can perform their function in the oral cavity as long as possible. The therapy can be conservative, surgical, prothetic and it is usually combined.

Inflammation of gums – gingivitis

The inflammation of gums occurs due to the accumulation of plaque on the teeth, gums, crowns, bridges and dentures. Over time the plaque is inhabited by bacteria causing the inflammation of gums. Gingivitis is treated by removing hard and soft deposits and the patient is instructed how to appropriately maintain oral hygiene. Dental tartar and soft deposits are removed twice a year. With more persistent forms of disease laser treatment is used as an addition to the basic therapy.

Initial stages of periodontitis

If inflammation of gums is treated, bacteria move from the gums to the jawbone and supporting tooth structure and eventually result in their decay. At this stage, the formation of distinctive periodontal pockets occurs.

In addition to the removal of hard and soft deposits, it is also necessary to perform a causal stage of periodontal treatment. This involves the treatment of periodontal pockets. Infected pocket content is cleared using special periodontal curettes, under local anesthesia, and concrements from the root is removed. Best results are achieved when, in addition to the basic therapy, we perform a laser therapy.

Advanced stage of periodontitis

If periodontitis is not stopped at the beginning, the disease advances and destroys the bones and supporting tooth structure. In the final stage, pockets reach the top of the tooth root, teeth become loose, they change position and fall out.

In addition to conservative treatments, advanced stage of periodontitis must also be treated surgically. The surgical intervention is performed under local anesthesia and is completely painless. It should provide direct access to periodontal pockets and enable the removal of infected tissue from the pockets and from the top of the tooth root thus eliminating the pockets or decreasing their depth. In some cases it is possible to replace the lost bone by adding the artificial bone. More efficient cleaning of pockets, elimination of infected tissue and better healing is achieved with laser in the surgical treatment.

Gingival recession – receding gums

Gingival recessions are mucogingival anomaly caused by inappropriate, too aggressive brushing of teeth, inappropriate position of teeth in the jawbone or teeth grinding – bruxism. It is possible to stop further progression of gum recession or bring the gums back to their initial position by surgical treatment. A free gingival graft is commonly applied on the lower jaw. Using the soft tissue transplant, this technique stops further recession of the gums, wider zone of attached gingiva and greater depth of the oral vestibule are obtained, thus enabling more efficient oral hygiene. In the upper jaw we opted for coronally repositioned flap therapy in combination with connective tissue transplant. As a result, the gums return to their original position, further recession is prevented and significant aesthetic results are achieved.

These interventions are performed in local anesthesia and are completely painless.

Clinical crown lengthening

In cases when gums above teeth are not symmetrical or when they are excessively displayed (gummy smile), the surgical procedure called clinical crown lengthening is applied. Most commonly this procedure is performed together with pre-prosthetic surgery, prior to teeth grinding for permanent prosthetic restorations (crowns or veneers), but it can also be done on natural teeth. In some situations, laser or classical surgery may be performed, but in both cases it is done under local anesthesia and is completely painless.

Boris Navratil DDS
periodontal surgery specialist