Periodontal treatment

As a preparatory treatment, we use ultrasonic tartar removal above and below the gum.

Then comes curettage, i.e. cleaning below the gum, which removes the inflamed tissues and the infected root cementum layer. This practically destroys most of the bacteria. Curettage is performed under local anesthesia, so the procedure is painless. It is performed with specially trained, sterile Gracey hand instruments, which are able to mechanically clean the surface of the tooth root with their sharp ends, and with their rounded parts, they carefully remove the diseased soft tissues from the pocket, which maintain the tissue reaction by releasing inflammatory factors.

The essence of the procedure is to clean all the diseased gingival pockets within a short period of two days, thus preventing the cleaned pockets from becoming re-infected from other pockets in the mouth. At the end of the treatment, an antiseptic medicine is placed in the gingival pockets. This prevents the bacteria from re-establishing themselves to a certain extent and for a period of time. Pain is not typical after the procedure, but it may occur. In such cases, we recommend taking over-the-counter painkillers.

A check-up is performed 3-4 weeks after the curettage. At this time, we evaluate the extent of healing and the effectiveness of individual oral hygiene. If further causal treatment is necessary, e.g.: correction of protruding filling edges, polishing rough fillings, replacement of defective restorations, this is done at this stage. Grinding of the teeth may be necessary if the teeth transmit unfavorable forces to each other when chewing. Since this puts a strain on the supporting tissues of the teeth, it is important to correct such a deviation. Grinding of the teeth is done in a spot-by-spot manner and only where absolutely necessary. Orthodontic treatment may also be necessary to correct the contact of the teeth.

Splinting helps to strengthen the teeth, as it does not allow the teeth to move. Splinting of mobile teeth can be done using fiberglass bands, which can be attached to the inside of the teeth with a liquid, tooth-colored filling material. This connects the teeth stably and is also aesthetic. It increases the patient’s comfort, as eating is easier with stronger teeth. Splinting can be done at different stages of the treatment, and can be both temporary and permanent. This is the dentist’s job to decide.

Repeating the closed curettage is usually necessary every 3-4 weeks. In some cases, traditional subgingival cleaning also solves the problem.

With open curettage, deep, inaccessible pockets are cleaned, which cannot be controlled with closed curettage. In such cases, open curettage, flap pocket surgery, is used. This procedure is also performed under local anesthesia and with the help of hand instruments. The difference is that we make incisions in the gum along the gum line on the outer and inner sides of the tooth in order to expose the defect, to better see the area under the gum, and thus to clean it more effectively. At the end of the procedure, the wound is closed with sutures, which are removed after a week.

After that, a medical check-up is required every two weeks. In the meantime, your task is to maintain the most effective oral hygiene possible, using a toothbrush, interdental brush and mouthwash containing chlorhexidine. It is important to mention that once the inflammation has subsided, the reduction in the depth of the gum pockets is accompanied by a certain degree of gum recession. This does not indicate a failure of the treatment, but quite the opposite: a sign of healing! With the closed and open method of cleaning under the gum, it is usually possible to eliminate the inflammation and make the pockets disappear. This creates a condition that can be maintained with proper oral care and regular check-ups and does not worsen. If we are dealing with chronic periodontal disease, this can practically mean the end of the treatment.

Rarely, it may be necessary – if the pocket wall has thickened excessively – to remove the pocket wall with a small operation. This operation is called gingivectomy. This is a relatively minor procedure performed under local anesthesia. The surface of the gum facing the tooth, i.e. the pocket wall, is carefully excised from the gum edge. The pocket is cleaned, then the gum is placed back between the teeth and fixed with stitches. If the course of the gum is not aesthetic after the causal treatment, i.e. the elimination of the inflammation, gingivoplasty is also possible. This is a small correction, a minor intervention, and is not burdensome due to the amazingly fast healing tendency of the gums. We also recommend it to those whose gums have enlarged due to taking medication or a hereditary predisposition.

If the treatment is completed with the above, there is nothing left but to maintain the achieved results. This also requires attention, since those who have developed periodontal disease once have a much higher chance of developing it again. That is why we take care of our patients, call them back every 3-6 months, and check them. During the control visits, we assess the condition of the periodontal tissue and provide personalized advice to help maintain a healthy state. At such times, we also perform ultrasonic cleaning to help ensure complete tartar and plaque removal. Periodontal disease treatment lasts a lifetime. Our dentists will do everything they can to ensure that you can keep your teeth for life!

There are forms of periodontal disease that are associated with crater-like destruction of the bone. In such cases, the so-called vertical bone pocket develops. Bone can also be destroyed between the roots of multi-rooted teeth. In some cases, it is possible to repair such defects, i.e. regenerate the periodontal tissue. This is what regenerative surgeries are for. During regeneration, the destroyed tissues are replaced with tissues of the same type and function as the original. This surgery can only be performed in certain cases. With the regenerative technique, we can often save teeth that would not solidify sufficiently after traditional subgingival cleaning because there is not enough bone around them. Often, the lack of bone does not allow for tooth implantation, and in certain cases, the regenerative technique can be used here as well. Some gum problems can also be remedied with such methods, but the main area of ​​application remains the saving of teeth weakened by advanced periodontal disease.