Periodontology

Periodontology refers to the medical practice that deals with the diagnosis and treatment of patients experiencing various ailments related to the gums and the supporting structures surrounding the teeth. Patients can seek advice, diagnosis, and a second opinion, subject to meeting the qualifying criteria, and may receive appropriate treatment. (1)

Definition and Overview

According to the European Federation of Periodontology, the field of periodontology is concerned with the examination of the distinctive system of soft and hard tissues that provide support to the teeth and preserve their position within the jaw. 

The periodontium is an apparatus that firmly connects the teeth to the jaw and plays a crucial role in maintaining their stable position. It also acts as a shock absorber during biting and chewing, thus preventing damage to the teeth. The periodontium consists of several structures, including the tooth socket, cementum, and periodontal ligament. 

The tooth socket refers to the bony cavity in the jaw that accommodates the tooth, while the cementum is a layer that covers the roots of the teeth. 

The periodontal ligament is a complex arrangement of tiny fibers that hold the tooth in place, similar to a sling, between the root cementum and the tooth socket. Since the periodontium is composed of living tissues, it can adjust to changes in the mouth over time, making minor changes in shape and thickness to maintain the position of the teeth. (2)

Procedures

In cases where a dentist has identified the presence of periodontal disease, a wide range of treatments are available to control and manage the condition. Here are the most common periodontal procedures.

• Gum Disease Information

Gum disease is usually not very obvious, its symptoms are silent. That is, symptoms may not appear until advanced stages. The types of gum disease are Periodontitis and Gingivitis.

• Comprehensive Periodontal Evaluation

CPE evaluates the patient's periodontal health and identifies any conditions, such as periodontal disease, that may require further treatment.

• Surgical Procedures

In some serious situations, a periodontist may need to perform a surgical procedure to treat periodontal disease and any damage it may cause. Some of the most common types of surgical procedures are Gum Graft Surgery, Regenerative Procedures, Dental Crown Extension, and Periodontal Pocket Procedures.

• Non-Surgical Procedures

Depending on the specific characteristics of the patient's condition, non-surgical periodontal treatment may be a suitable option. The most common non-surgical procedures are Laser Treatment, Scaling and Root Planing, and Tray Delivery Systems.

• Dental Implants

A dental implant is an artificial tooth root placed in the jaw to hold a bridge or prosthetic tooth. Types of dental implants are Endosteal (in the bone) and Subperiosteal (in the bone). Periodontist develops a personalized treatment strategy based on the patient's circumstances and the implant option selected. This personalized treatment may encompass a variety of options such as Single Tooth Dental Implants, Multiple Tooth Dental Implants, Sinus Augmentation, and Ridge Modification, tailored to the patient's needs and the nature of condition.

• Cosmetic Procedures

In periodontology, cosmetic procedures include Gummy Smile or Uneven Gum Line treatment, Long Teeth or Exposed Roots treatment, and Correction of Indentations in the Gums and Jawbone. (3)

Candidates

The candidates for periodontology treatments may include individuals with

• BPE/CPITN scores 3, 4 (indicating pockets >5.5mm), 
• medical conditions affecting the periodontium, 
• acute problems like desquamative gingivitis and necrotizing gingivitis, 
• aggressive/advancing forms of periodontal diseases like periodontitis stage III/IV with grade B/C, 
• non-responding patients with periodontal probing depths >5.5mm, 
• mucogingival problems including ridge enhancement, 
• requires intraoral/minor grafting and/or socket preservation procedures while preparing for implant treatment, 
• peri-mucositis or peri-implantitis around dental implants, 
• multidisciplinary care interfacing across other disciplines such as orthodontics, restorative, systemic, 
• advanced periodontal problems that require integrated care and/or are associated with systemic diseases.

In order to recommend the most suitable periodontal disease treatment, periodontists must carefully examine the patient's dental and medical history. They must also take into account the patient's lifestyle and identify any habits that could exacerbate gum disease, such as smoking. It is worth noting that certain medications can hinder periodontal treatment. (4)

Risks and Side Effects

Complications that arise after periodontal surgery can be classified as follows.

General Complications after periodontal surgery

• Bleeding, 
• Swelling, 
• Postoperative pain, 
• Root hypersensitivity, 
• Increased tooth mobility
• Delayed wound healing
• Trismus
• Postoperative bacteremia
• Taste changes
• Bruising

Complications related to the surgical procedure applied

• Local anesthesia related
• Flap related
• GTR related
• Suture related
• Graft related
• Periodontal pack related (5)

Post-Procedure and Follow-up

Effective postoperative management is a crucial element in obtaining desirable postoperative outcomes. Patients who fail to comprehend or comply with appropriate post-surgical guidelines are vulnerable to adverse consequences. The periodontist responsible for administering the periodontal treatment must provide written and verbal instructions to the patient prior to discharge to prevent any procedure-related complications. The patient's adherence to all post-operative instructions is crucial in minimizing the risk of complications. (6)

Recovery

Normal postoperative pain following surgery typically subsides as the recovery process progresses, particularly within the first three days. Local anesthesia wearing off and extensive surgical procedures can contribute to postoperative discomfort. Pain levels tend to diminish significantly on the first day following surgery and gradually decrease thereafter. A minority of patients may experience severe pain that cannot be alleviated with mild analgesics. Consequently, initiating analgesic therapy before the surgery is preferable, as prevention of pain is generally easier than its removal. (7)

Results

It is crucial to recognize that the postoperative care required can differ among patients and depends on various factors such as the type of surgery, wound healing, and the patient's capacity to achieve satisfactory oral hygiene. By adhering to these principles, satisfactory healing and desired outcomes can be attained. (8)