All treatment will entitle the removal of plaque and calculus. This cleaning may vary from the removal of the plaque above the gum margin (supragingival plaque) by routine brushing and flossing by the patient, to scaling performed by the oral hygienist and dentist, to also the removal of deeper deposits that the patient cannot reach below the gum margin (subgingival plaque), to open surgical curettages. Debridement can be done by means of sharp hand instruments such as curettes and ultrasonic scalers. The deeper subgingival scaling and root planing is usually performed under local anaesthetic. The aim is to decontaminate the root surface by removal of the soft and hard deposits with its associated bacterial endotoxins. The pocket spaces are cleansed up to the base of the pockets up to the margin of the supportive bone. After debriding all the root surfaces and ensuring that the patient is maintaining an appropriate standard of plaque control, the periodontal status will be re-evaluated in conjunction with the radiological findings. The deep cleaning and root planing phase may clear up most of the symptoms, but more advanced cases of periodontal disease may require surgical invention.
The gum will then be gently lifted away from the neck of the teeth to expose the bony margin. Deep pockets will be eliminated by contouring the gum and the infected bone will be reshaped and any bony ledges will be smoothed that may lead to food and plaque entrapment. In the areas of severe bone loss, bone regenerative procedures will be performed to try and augment to a certain extent the lost structures. Bone substitute materials and/or liophylized freeze-dried bony sugar will be used as bone regenerative material. This not only serves as a filler material for the bony defects, but also serves as a scavot or type of framework for the new bone to grow. After surgery the gum is repositioned and sutured to hold it in place until it heals. Laser assisted bio stimulation of the periodontium may also be utilised as a treatment modality. Supplement to mechanical plaque removal, adjuvants such as anti-bacterial mouth rinses may also aid in maintaining acceptable levels of plaque control.
Treatment is not done for cosmetic reasons, but to restore proper function and comfort of chewing in the long term and to try and keep the teeth for as long as possible. The teeth may be a little bit longer after surgery and there may be a passing sensitivity for cold or sweet. The choice however remains: either a little bit longer teeth than no teeth any longer! As soon as the foundation of your teeth (gums, fibre attachment and supportive bone) has healed and stabilized (usually 2 to 3 months after surgery), any aesthetic compromised areas such as long teeth and unsightly open spaces between the teeth, if any, can be rectified by means of selective crown and bridge work. At this stage any missing teeth can also be replaced by implants if suited and indicated.
