This is the first part of your periodontal treatment. With this procedure, you will reduce the inflammation of your gingival (gums) and make the rest of the treatment a success.
These instructions are add-ons to your current brushing technique. We recommend that you perform this once a day, preferably in the evening when you have more time.
DISCLOSING: Prior to brushing, take one disclosing tablet (pink) and chew until dissolved. Rinse with water. Using the mouth mirror provided, look along the gumline, the plaque will appear RED. At this point, you should time yourself to determine how long it will take you to completely remove all plaque (stained in RED.)
- Place bristles along the gumline at a 45° Bristles should contact both the tooth surfaces and the gumline.Gently brush the outer tooth surface using a circular motion until the red stain disappears. Then complete brushing the outer teeth surfaces.
- Repeat the above steps for the inner teeth surfaces. Or you can use an up-down motion which will also brush and penetrate the gumline.
- Tilt brush vertically behind the front teeth. Make several up/down strokes using the front half of the brush.
- Place the brush against the biting surface of the teeth and use a gentle back and forth scrubbing motion.
FLOSSING: Flossing should be done at least once a day, in the evening, when you have more time.
- Take an “elbow length” of floss. Wrap the floss around middle fingers of each hand. Pinch floss between thumbs and index fingers, leaving a short distance in between.
- Gently guide floss between the teeth; once you hit the gums, STOP. Wrap floss around the tooth in a “C” shape. Slide floss up and down against the tooth surface 5-10 times until clean.
Floss threaders are designed to help pass the floss under a fixed bridge or orthodontic appliance.
Proxabrushes are for cleaning between teeth which have more space or gum recession. Coming from the outer side, insert the proxabrush between the teeth and brush in a back-and-forth motion. Repeat this step coming from the inside.
End Tuft brushes are small, single ended soft toothbrushes, which are designed to clean the gumline of hard-to-reach areas.
SCALING AND ROOT PLANING
Scaling root planing is performed in order to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar. The root of the tooth is literally smoothed, which promotes healing, and also helps prevent bacteria from easily colonizing in the future. When deep pockets between teeth and gums are present, it is difficult for Drs. Gantes and Costandi to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health.
Root planing along with good oral hygiene will reduce inflammation. Two things will happen after root planing. First, the gingiva will be less inflamed and therefore will reduce in size and volume. This is good for the disease control but it will induce gingival recession therefore displaying a portion of the root previously covered by the inflamed gingiva. As a rule of thumb, the deeper the pocket the larger the recession will be. The second thing happening is the re-adaptation (not reattachment) of the gingiva on the root towards the bottom of the pocket.
The anterior teeth which are cylindrical shape in nature are easier to root plane and will respond usually very well to root planing. This means that additional surgical treatment may not be needed on anterior teeth.
Root planing is not as effective on the posterior teeth, mainly because of more difficult access for instrumentation but also for daily oral hygiene. To make it more difficult, posterior teeth have multiple roots which created embrasures and grooves which are impossible to clean during the root planing.
This is the main reason why Drs. Gantes and Costandi will schedule you a few weeks after root planing to reassess your pocket depths. During that time Drs. Gantes and Costandi will be able to differentiate between the teeth which a) have recovered, b) will continue to recover, c) have recovered slightly but will go downhill again and c) have not recovered. If all your teeth have recovered, you will be placed in a periodontal maintenance program alternated or not between your referral dentist and our office.
Based on the number of teeth in each category, Drs. Gantes and Costandi may recommend additional therapy including localized osseous surgery, extraction, implant replacement or prosthetic replacement. After this second treatment phase, you will be placed into the maintenance program as well.
Osseous surgery, sometimes referred to as pocket reduction surgery, refers to a number of different surgeries aimed at gaining access to the tooth roots to remove tartar and disease-causing bacteria.
Osseous surgery is used to reshape deformities and remove pockets in the alveolar bone surrounding the teeth. It is a common necessity in effective treatment of more advanced periodontal diseases. The ultimate goal of osseous surgery is to reduce the periodontal pockets that cause periodontal disease. Despite the word surgery the procedure is reported to feel more like a thorough cleaning. By surgically exposing the roots, Drs. Gantes and Costandi will be able to clean and debride the roots from any residual debris. Bone contours may be rounded to facilitate gingiva repositioning. Resorbable suture will be used to lock the gingiva in place.
In some specific areas in your mouth Drs. Gantes and Costandi will perform a regenerative procedure. It is best achieved with a combination of root conditioning, placement along the root of a blood clot stabilizer such as bone graft or collagen sponge as well as a resorbable membrane to protect the wound. The gingiva may be loosened to wrap the tooth better for wound protection purposes. Best results are obtained when the area can remain undisturbed for a few weeks in order to give a chance for the wound to mature slowly into bone and periodontal fibers.
ROOT COVERAGE WITH GINGIVAL GRAFTING
Gingival recession is not a disease, it is a state. It can be the scar of periodontal disease treatment (surgical or non-surgical) but can also be encountered in patients who were born with smaller jaws. The teeth can be planted outside of the jaw boundary (instead of within) and the gingiva undergoes recession as a normal remodeling. Recession can be minor or major. It can be isolated or generalized on the entire dentition. Based on your cosmetic or hygienic requirements, Drs. Gantes and Costandi will recommend gingival grafting.
The procedure consists of harvesting in your palate a thin piece of tissue and gently insert it in to the recipient area which is prepared like an envelope (or a pita bread). The graft is micro-sutured in place using resorbable suture material.
The gingival graft procedure is highly predictable and results in a stable esthetically pleasing appearance.
ESTHETIC CROWN LENGTHENING
Esthetic Crown lengthening is usually performed to improve the health of the gum tissue, prepare the mouth for a procedure, or correct a gummy smile. A gummy smile is used to describe an instance where teeth are covered with excess gum tissue resulting in a less esthetically-pleasing smile. The procedure involves reshaping or re-contouring the gum tissue and bone around the tooth in question to create a new gum-to-tooth relationship. Crown lengthening can be performed on a single tooth, many teeth, or the entire gum line.
SMILE LINE CORRECTION
As you can see from previous example above, gingival contours can be altered. The additive or subtractive alterations are based on the “Golden Rules of Oral Harmony”. This patient’s smile demonstrate what we are trying to achieve in regards to measurements. Each smile is unique but the human brain labels a smile “attractive” when the golden rules of oral harmony are present.
We base our SMILE LINE CORRECTIONS on the following measurements:
|Upper lip||Vermillion border 0-2mm above gingival margin of central incisors|
|Lower lip||Curvature coincident with incisal edge of maxillary incisors|
|Upper central incisors # 8, 9||1. Incisal edge levelled with cuspids
2. Gingival edge levelled with upper lip
|Upper lateral incisors # 7, 10||1. Incisal edge shorter than central incisors
2. Gingival edge 2 mm away from upper lip
|Upper cuspids # 6, 11||1. Incisal edge levelled with central incisors
2. Gingival edge levelled with upper lip
PROPHYLAXIS (TEETH CLEANING)
A dental prophylaxis is an appointment to monitor your gingival health. I starts with probing measurement as well as assessment of marginal gingival inflammation and residual dental plaque left behind in spite of your efforts in oral hygiene. Our Hygiene team member will thoroughly clean your teeth and gums, polish your roots and crown, assess possible cavity or restorative issues and guide you to maintain or improve your oral hygiene performance.
An ideal case scenario would be that your hygienist discovers after probing that you are doing so well that only a polishing is required. Remember that the more work your hygienist does the less stable you are.
We recommend that prophylaxis be performed at least twice annually as a preventative measure, but should be completed every 3-4 months for diagnosed periodontal patients. It should be noted that gum disease cannot be completely reversed, but prophylaxis is one of the tools Drs. Gantes and Costandi can use to effectively halt its progression.
EXTRACTION WITH SOCKET PRESERVATION FOR A FUTURE DENTAL IMPLANT
The best results are achieved without bone graft. It is a bit contra-intuitive but your body will fill up the socket with your own bone when a collagen sponge is grafted in the socket and secured with a suture and an optional advanced gum tissue. Your own bone as evidence by X-Ray will be back as soon as two months. To the contrary, if your place a bone graft, your body has to resorb it before replacing it with your own bone. This takes place over a period of time of eight to twelve months. In this case x-Ray are meaningless since bone grafting and your bone can’t be differentiated.