Periodontics
Periodontics is a dental specialty that manages diseases of the gum and tissues surrounding teeth in addition to dental implants.
What is gingivitis?
Gingivitis is a term used to describe inflammation of the gums which typically presents as gum bleeding, redness and irritation. It is a common condition and usually appears as a result of plaque accumulation.
What is periodontal disease (periodontitis)?
Periodontal disease is one of the most common chronic diseases in the human race which affects the gum and tissues around teeth. There are different types of periodontal disease with chronic periodontitis being the most common one. It usually appears in the mouth as gingival recession (loss of gum tissues and exposure of larger part of the tooth), deep pockets and/or secretions of yellow/white fluids in-between and around teeth.
There are several factors which contribute to periodontal disease. Plaque and calculus are the most common as they provide a reservoir for bad bacteria to live in and damage the gum and tissues surrounding teeth. Other factors such as smoking, uncontrolled diabetes and family history of periodontal disease are major contributors as well.
Management of periodontal disease is usually tailored for each patient based on the severity and extension of the disease. Treatment options include deep scaling and root planning (deep and meticulous cleaning around teeth and within surrounding tissues), localized and systemic antibiotic therapy and surgical options as a last resort (including surgical cleaning of periodontal tissues, bone shaping or building of lost bone). Longstanding periodontal disease without treatment may lead to teeth mobility and eventually teeth loos.
Examination of the periodontal tissues and looking for periodontal pockets using a periodontal probe.
What are dental implants?
Dental implants are dental screws made from the inert metal of titanium. They have been invented decades ago and modified over the years to become one of the most predictable and successful treatment options to replace missing tooth/teeth. It consists of two parts, the screw and crown/bridge on top to restore function.
Once you decide to receive a dental implant, your dentist will discuss the procedure with you which is typically done in the dental office and under local anesthesia. Your dentist will create small cut in the gingiva and then place the dental implant inside the jaw bone and suture over it to conclude the surgical step. Afterward, you will have to wait around 3 months before starting the restorative step to construct the crown/bridge on the top of the implant. This waiting time of 3-months represents the time needed for the implant to heal and become glued to your jawbone. Once the dental implant “screw” has healed and stable, your dentist will construct the crown/bridge on top which may take 2-3 weeks (including lab processing time) to conclude the restorative phase.
Often times, your dentist may suggest having a bone graft procedure prior to or during implant placement in order to increase the success rate of the treatment and decrease the risk of any future complications. Bone grafting is a separate procedure and your dentist will charge you extra fee for it.
Who can get dental implants?
In general, everyone is eligible to receive dental implants. Patients with specific medical conditions and/or medication may have to consult with their treating medical team prior to placing the implant. Some of these patients may end up starting or discontinuing certain medications in order to receive dental implants or wait until their active medical condition is controlled such as diabetes.
Is there any risk associated with dental implants?
Placement of dental implants is a surgical procedure with minimal risk which may include but not limited to post-operative pain, bleeding, and infection
What is the success rate of dental implants? And how long does it last for?
Dental implants were developed as a permeant treatment option to replace missing teeth. The available literature reports a very high success rate for dental implants ranging between 95-98% for healthy patients.
What is the difference between dental implant types?
There are many companies which make dental implants around the world with a wide price range. In general, all dental implants are made of the inert material of titanium. However, the surface treatment and implant design differ which may affect the success rate of the implant. Several dental implant brands have been in use since the 20th century (e.g. Straumann®, Nobel Biocare®, 3I®, Biohorizon®, Astra®, Dentsply®) and have been studied extensively providing solid evidence for their compatibility with the human tissues and high success rate. Other implant companies may exist in the dental market without enough evidence for their longevity. Make sure to ask your dentist about the type of implant you are going to receive before the surgery.
Gingival pigmentation
What is gingival pigmentation?
Similar to skin color, human gum may present with dark pigmentation (e.g. pale or dark brown or black) embedded within the regular pink color. In general, there is no clinical or functional significance for such pigmentation and usually considered a variation from normal. However, it presents an esthetic concern for many people especially when bigger part of the gum is visual upon smiling (gummy smile).
Gingival depigmentation is a term used to describe the procedure to remove the darker pigmentation from the gums. This procedure is typically completed under local anesthesia on the dental chair and using either a scalpel or a laser machine. Both techniques are painless and result in comparable outcome. However, gingival de-pigmentation using laser approach tends to be less technique sensitive with slightly faster healing.
Papilla loss “black triangles”
Black triangle is a term used to describe the triangular space in-between teeth, especially the frontal area, as a result of a loss of bone and gum which is usually filled with part of the gum known as papillae. Due to the limited available light inside the mouth, these triangles appear black in color; thus named black triangles.
Black triangle is an acquired esthetic concern for the public in which they seek treatment for in most of times. It doesn’t necessarily represent gum disease as risk factors include habits, traumatic brushing or flossing techniques and extensive orthodontic (braces) treatment.
How do we treat black triangles?
Crown lengthening procedure
What is Esthetic Crown Lengthening procedure?
Esthetic crown lengthening is a minimal surgical procedure typically performed to serve different purposes including removal of excessive showing gums and surrounding bone to improve esthetics as well as getting frontal teeth ready to receive crowns or thin-layered veneers. It is a technique-sensitive surgical procedure to remove as minimum as possible of tissues and achieve optimum dimensions of gum beauty.
Before
After
Platelet-rich plasma (PRP)
PRP is a procedure in which a specific amount of blood is collected from the patient himself/herself and processed in a centrifuge in order to extract certain growth factors to help with bone and gum healing and regeneration. In general, it is a safe procedure and your dentist may suggest it based on a case-by-case selection. Evidence from studies has supported the role of using PRP to help with bone and soft tissue growth and regeneration.
