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Periodontitis treatment: methods, procedure, effectiveness

by Josephine Andrews
Published: Last Updated on 233 views

Periodontitis treatment (colloquially: periodontosis treatment) includes various dental measures. However, the patient himself can contribute a great deal to the success of the therapy. Read everything you need to know about periodontitis therapy here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

K04 K05

Periodontal treatment in stages

The aim of periodontitis treatment is to free the periodontium from the inflammation and to prevent (further) degradation. If periodontitis is discovered early, basic treatment is often sufficient to combat the inflammation. However, if this does not work or the periodontitis is already more advanced, additional surgical interventions are necessary. In both cases, periodontitis patients need permanent follow-up care by the dentist afterwards.

Controlling risk factors, which include smoking and diabetes in particular, is important for successful periodontitis treatment. For example, periodontitis patients should avoid smoking and have existing diabetes well under control with medical help.

Phase 1: basic treatment

Good oral hygiene is a prerequisite for the success of periodontitis treatment . In a comprehensive consultation and instruction, the dentist (or a specially trained professional) explains to the patient how to use the (electric) toothbrush, dental floss and interdental brushes (interdental brushes) correctly. As a demonstration, plaque is often made visible with tooth staining tablets before the dentist removes it.

” Subgingival instrumentation ” is also very important, i.e. the removal of bacterial plaque and tartar below the gum line, on the tooth necks and exposed tooth roots. This is also referred to as “closed” periodontitis treatment because the gums are not cut open. The dentist cleans the periodontal pockets under local anesthetic , usually with thin instruments (curettes or scalers), an ultrasonic device or rotary instruments. Alternatively, subgingival instrumentation with an erbium-YAG laser can be considered.

The dentist also smooths out accessible surfaces of the tooth roots to prevent bacteria from re-adhering . The edges of any protruding crowns and fillings are also smoothed out .

As part of the basic periodontitis treatment, the patient can also opt for a professional tooth cleaning ( PZR ): In short, the teeth are cleaned, polished and (usually) fluoridated. Patients usually have to pay for a PZR out of their own pocket.

Possibly antibiotics

The basic treatment is often sufficient to stop the inflammation underlying the periodontitis. In severe cases, however, additional antibiotic therapy may be necessary. Patients are usually prescribed antibiotic tablets for this. Sometimes antibiotics are also applied locally by being introduced directly into a periodontal pocket as a gel or ointment. In order to select a suitable antibiotic, it can make sense to first conduct laboratory tests to determine which bacteria are in the patient’s periodontal pockets.

Phase 2: Surgical interventions

Surgical periodontitis treatment (formerly open periodontitis treatment) includes cleaning deep gum pockets, regeneration of the periodontium and plastic surgery to restore the gums, as required.

Cleaning deep gum pockets

To do this, the dentist opens the pockets with a small incision under local anesthesia. This makes it easier to access the bacterially infected areas. Now the dentist cleans the exposed root areas and removes diseased tissue. Finally, he sews up the incision so that the gums are tight against the tooth again. This procedure is intended to allow the gums to adhere better and the pockets to be eliminated (gum pocket elimination).

Regeneration of the periodontium

It becomes necessary when long-lasting or aggressive periodontitis has already destroyed so much connective tissue and bone that the teeth are losing their grip. The following methods are available, which can be used individually or in combination:

Guided Tissue Regeneration (GTR)

This periodontitis treatment aims to stimulate new formation (regeneration) of connective tissue fibers and jawbones and thus promote the healing process of the attacked periodontium. To do this, the dentist inserts a special membrane (a kind of thin film made of material that can be broken down by the body) between the gums and the bone. It is intended to prevent the faster-growing gums from growing uncontrollably, so that the other, slower-growing parts of the periodontium (such as bone, cementum) have time and space to regenerate.

Introducing growth agents

With this method of surgical periodontitis treatment, active ingredients are applied to the cleaned root surface, which enable new bone formation and the regression of periodontal pockets – so-called enamel matrix proteins (“growth proteins”).

Insertion of bone or bone substitute material

Bone tissue degraded by periodontitis can be at least partially rebuilt by a bone transplant. The body’s own bone tissue is usually used as a transplant ( autologous bone transplant ). The dentist removes it from the patient in a small operation from the rear jaw area and transplants it to the defective area (bone pocket).

Alternatively, demineralized, freeze-dried bone tissue from another person can be transplanted: the dentist obtains such allogeneic bone transplants from tissue banks. After all organic components have been removed, bone tissue from other species (e.g. cattle, pigs or corals) can also be transplanted ( xenogeneic bone transplants ). In addition, calcium phosphate and glass ceramics can serve as artificial bone replacement material.

The transplants can only improve the existing bone structure – a complete regeneration is not yet possible.

regeneration of the gums

Under certain circumstances, as a result of periodontitis, so much gum is destroyed that tooth necks or tooth root sections are exposed. This has two disadvantages: On the one hand, the exposed areas on the tooth are often difficult to clean, which makes them susceptible to renewed inflammation and tooth decay (root caries). On the other hand, visible tooth necks and roots are an aesthetic problem for many of those affected. The gums can then be rebuilt in a plastic operation. There are two ways to do this:

  • free mucosal graft
  • sliding tabs

With a free mucosal transplant , the hard palate of the patient serves as donor tissue: the dentist cuts out a piece of mucosa of the required size from the palate, then places it on the exposed tooth areas and sews it up. The wounds in the donor area usually heal well after several weeks. The transplant itself healed after about four months.

For a so-called advancement flap , the dentist makes an incision in the healthy gums near the exposed tooth. He pushes the flap of tissue obtained in this way onto the exposed tooth root and sews it up. A distinction is made between lateral (laterally displaced) and coronal advancement flaps. With coronal flaps, the gum is incised below the diseased area and pulled up (in the lower jaw ) or down (in the upper jaw ) against the exposed teeth.

Sometimes free mucosal grafts and advancement flaps are combined to achieve more cosmetically pleasing results.

Phase 3: The aftercare

Since periodontitis is a chronic disease, good follow-up care is required over the long term – especially if there is already receding gums . Because then the tooth necks and roots are exposed and are therefore much more susceptible to caries, since they are not – like the teeth – protected by a layer of enamel. Aftercare consists of:

  • consistent oral hygiene
  • regular check-ups at the dentist
  • Regular professional teeth cleaning (possibly several times a year)

Dentists often recommend structured aftercare for their periodontitis patients – called ” supportive periodontitis therapy ” (UPT). It includes check-ups at the dentist every three to a maximum of 12 months (depending on the degree of periodontitis). At these appointments, the dentist checks the success of the periodontitis treatment so far, checks oral hygiene and cleans the teeth. The elements of this structured aftercare are not paid for by health insurance companies.

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