Treatment Sequence

Periodontitis, like any other chronic disease (i.e. heart disease), will progress if untreated or inadequately treated. Moreover, it will recur if given the chance. Thus, it is very important to complete all the steps of the recommended treatment, from beginning to end.

The goals of the treatment are to control the cause (bacterial plaque) and the risk factors, repair the damage present (pockets) and restore and maintain a healthy environment. In order to attain these objectives, there are 5 main steps:

1.      Periodontal examination and Treatment Planning

2.      Initial Therapy or Hygienic Phase

3.      Reevaluation Phase

4.      Surgical Treatment

5.      Maintenance

Periodontal exam, diagnosis and Treatment Planning

During the consultation appointment, we will complete the following:

• Complete or limited periodontal examination
• evaluation of the risk factors
• establish a treatment plan and cost estimate
• prescribe the relevant radiographs (x-rays)

A precise diagnosis is necessary in order to elaborate a treatment plan with predictable and long term results. If required, the radiographs necessary for a complete evaluation will be recommended and used to complement those taken by your dentist.

A detailed written report and a copy of the radiographs will be sent to your dentist.

Initial or Hygienic Phase of Treatment:

Deep cleaning (root planing)

This first step is to reduce the gingival inflammation and thus allow the supporting bone to partially recover. For an optimal result, the oral hygiene must be excellent. This step includes the following

• Personalized oral hygiene instructions using techniques and tools adapted to your needs.
• Scaling and root planing (deep cleaning) to remove the plaque and tartar buildup which adheres to the root surface below the gum line.

This procedure is not a surgery, but rather a very thorough cleaning (compared to the habitual more superficial cleanings). It is done mainly under local anesthesia (numbing) and usually requires 2 to 4 appointments.

Special instruments are used below the gum line to remove soft and hard deposits from the tooth surface. Deep cleaning does not eliminate deep pockets and may have to be redone periodically.

Control of risk factors

Several risk factors, although incapable of starting periodontal disease on their own, can speed up its evolution and render it unstable when in the presence of inflammation. In an effort to eliminate these factors, some of the following treatments may be required :

• Making of a bite plane to control the trauma caused by teeth grinding (bruxism)
• Occlusal adjustment
• Splinting of weakened adjacent teeth
• Extraction of untreatable teeth
• Antibiotics
• Smoking cessation

Reevaluation

Between 4 and 12 weeks after the hygienic  phase is completed, Dr. Madi will reexamine your gums in order to evaluate the healing that has occurred, determine if additional treatment is recommended and plan the latter.

Treatment may consist in corrective periodontal surgery, non surgical treatment and preventive maintenance visits. This important phase confirms the short term improvement in your periodontal condition and determines the long term potential that can be obtained with further treatment.

Surgical Phase of treatment:

Periodontal surgery will be recommended if it is likely to improve the long term stability of the gum condition. The objectives of the surgical phase are:

• Removal of the plaque and calculus buildup (surgical techniques allow better access to deep calculus deposits)
• Correction of the gingival and bony deformities
• Reduction or elimination of the residual pockets to allow proper access for an efficient daily home care regimen.
• To regenerate the supporting bone if possible.

Two surgical approaches are possible :

1. The resective approach
   It consists in reducing the pocket depth by reducing the thickness of the gingiva (gums) and recontouring the bone to promote stable periodontal health.
2. The regenerative approach
   It consists in regenerating (rebuilding) the bony support and gum attachment to the tooth root. Although this technique is preferable to the resective approach since it restores what the disease has taken away, it requires several prerequisites that are seldom present. Furthermore, its outcome is less predictable.

Maintenance Phase of treatment:

In order to maintain the high level of periodontal health obtained with the treatment rendered thus far, it is of utmost importance to meticulously follow the recommended home care instructions daily.

A maintenance recall frequency will be recommended, depending on your specific needs. The preventive maintenance appointments allow us to determine the stability of your periodontal health and intercept any minor problems before they become major ones. When treated and maintained properly, long lasting and predictable results are expected.

Initially the maintenance phase often consists of supportive hygiene therapy every 3 months for 1 or 2 years.