Our goal is to provide you with the highest quality of care in a compassionate and safe environment. In order to do this, we use the most current periodontal procedures, instruments, medications, and sterilization techniques.
Every procedure is done with your comfort and safety in mind. We work closely with your general dentist to ensure you get the best possible care. We want you to be completely informed of your condition and encourage you to ask any questions you may have regarding your treatment and care. Please feel free to ask questions before, during, or after any of these procedures.
Basic Periodontal Treatment
Periodontal disease is an infection that gets under the gums and causes inflammation. It then starts dissolving the jawbone which supports your teeth. Periodontal inflammation leads to tooth loss and contributes to other medical conditions. This infection must be removed and the area given a chance to heal.
There are generally two accepted treatments for this condition depending on the severity of your infection:
Sub-gingival Scaling and Root Planing
Sub-gingival scaling and root planing is a non-surgical procedure in which the therapist removes calculus (tartar) on the roots of the teeth below the gum line that causes periodontal infection. Scaling and planing effectively remove upper level periodontal infections where the pockets around your gums are not too deep. Tooth root surfaces below the gum line are cleaned of calculus (tartar) and smoothed with specially designed instruments. This removes the calculus (tartar) and bacteria under the gums, smooths the tooth roots, and makes it more difficult for bacteria to grow under the gums in the future.
Sub-gingival scaling and root planing is usually done an area of the mouth at a time using local anesthesia (novocaine) and are quite different from the routine dental cleaning.
If pockets are small, sub-gingival scaling and root planning may be the only treatment required. If pockets are deep, sub-gingival scaling and root planning may be an initial procedure done to remove some calculus (tartar) and reduce the periodontal infection temporarily in order to provide healthier gum tissue to allow pocket reduction surgery (described below) to be done.
Above is a photograph of what calculus (tartar) looks like that causes periodontal infection. The tooth on the left has the calculus following the area where the bottom of the gum pocket attaches to the tooth. The tooth on the right has bone loss approaching the bottom of the tooth root.
This patient has substantial amounts of sub-gingival calculus (tartar under the gum line) that causes gum disease. Note the darkish gum line of this upper cuspid on the left photo. On the right photo you see a scaling instrument teasing back the gum tissue exposing the underlying calculus on the root surface.
The above photos show the sub-gingival calculus being removed from the root of this tooth. Usually this is done with local anesthesia (Novocaine) and is called sub-gingival scaling and root planing.
Pocket Depth Reduction
If the pockets around your teeth are too deep to thoroughly clean with scaling and root planing, then a minor surgical procedure must be performed to pull back the gums and remove the lower levels of infection. Your periodontist pulls back the gum tissue and removes the disease-causing bacteria before securing the tissue into place.
The above photos are of a section of upper back teeth with deep pockets and bone loss.
A periodontal probe (a dental instrument with millimeter markings) is inserted between the gum and tooth to measure how deep the "periodontal pocket" is. In this case it extends 7mm deep into the "periodontal pocket" and the gums bleed on gentle probing, indicating the gums are "infected" with periodontal disease.
These are photos of the post-operative result. Since deep pockets are difficult to impossible to clean adequately, bacteria that builds up under the gum line in the pockets "infects" the gum tissue, leading to a slow deterioration of the bone that holds the teeth in. With pocket reduction surgery, also known as periodontal osseous surgery, the deep pockets are reduced by removing the "infected" gum, and any "diseased" bone defects that will inhibit reducing the gum pockets are reshaped. These photos show the post-operative result with the pockets reduced, making the teeth and gums manageable to clean every day. This greatly reduces the likelihood of further infected gums, thus greatly reducing the likelihood of loosing teeth due to periodontal disease.
It can not be overemphasized, it is far more predictable to obtain an excellent long-term post-operative result when the "periodontal pockets" are 6 to 7mm deep than 8 or 9mm deep. Once pockets get to double digits (10mm or more), with few exceptions, a definitive surgical correction can not be obtained. Early diagnosis and early treatment of periodontal disease and periodontal gum pockets usually equals a good long-term result. Advanced periodontal disease and excessively deep pockets are not as predictable.
In some cases, irregular surfaces of the damaged tooth root are smoothed to limit areas where disease-causing bacteria can grow. This allows the gum tissue to better reattach to healthy tooth roots, and it can help reduce the depth of the pockets around your teeth.
With today's newer techniques (e.g. bone regeneration ) it may be possible to "grow" some bone back in certain instances where it has been lost due to periodontal disease. Dr.
Sebastian has special training in these techniques and will be happy to explain all your options for treatment.
Periodontal disease is never cured but only controlled. Maintenance, or supportive periodontal therapy, is an ongoing program designed to keep periodontal disease under control in patients who have undergone periodontal treatment. This ongoing phase of treatment allows your periodontist to assess your periodontal health and ensure your infection stays under control.
During maintenance therapy, you will receive an oral examination and accumulations of new infection will be removed. If necessary, your teeth are polished and your bite is checked. Your dentist or periodontist will recommend a schedule that is best tailored to protect your periodontal health. Depending upon the severity of your original periodontal problem, you may need to receive maintenance therapy every 3 months or more often.
Your jawbone is what supports your teeth and gums. Unfortunately, periodontal disease dissolves parts of your jawbone. This causes bone loss and eventual loss of teeth. The first step is to remove the periodontal disease which halts the bone loss. Then we repair the damage that has occurred. In some isolated instances, various bone grafting techniques can be used to grow back some of the jawbone that was lost.
Dr. Sebastian has advanced training in the placement of bone regeneration materials such as Gortex™ Periodontal Material and Gore Resolut Regenerative Membrane.
Procedure: The periodontist administers a local anesthetic and opens the area, removes the periodontal disease, repairs the bone damage, cleans the effected tooth root(s) with scaling instruments and medication (PrefGel), and covers the area with a barrier, such as GoreTex Periodontal Material or Gore Resolut Regenerative Membrane, and sutures the area closed.
In many cases, however, bone regeneration is not an option. Dr. Sebastian will review your options with you and will let you know if you are a good candidate for this procedure.
Below is an example of a case where GoreTex™ Periodontal Material was used effectively to heal significant bone loss. If this procedure hadn't been done, the patient most likely would have lost the tooth.