Surgical periodontology. What is the resection of gum pockets? Diseases to be aware of

AT last years periodontal disease rightfully attracts increased attention dentists, since after 35 years this is the most common cause tooth loss. There are many periodontal diseases. The nature of the disease is also different, for example, dystrophic, inflammatory or tumor. It should be noted that 90-95% of periodontal diseases are inflammatory diseases, such as gingivitis or periodontitis. Periodontology is the branch of dentistry that deals with the treatment of periodontal diseases. A section of periodontology - surgical periodontology - deals with the surgical treatment of periodontal diseases. Currently, it is believed that in the moderate and severe form of periodontal disease, it is necessary to use surgical methods of treatment. Namely, resection of gum pockets, including with the use of a laser, regeneration bone tissue, elongation of the tooth crown, the use of soft tissue grafts. Let's take a closer look at some of them.

Gingival pocket resection- this is surgery, the purpose of which is the removal of gums that have exfoliated from the tooth. This is done in order to eliminate the gum pocket, which is both a consequence of periodontitis and periodontal disease, and the cause of the progression of these two diseases.

bone regeneration procedure- this is another surgical method treatment of periodontal tissue disease, in cases where bone resorption is noted. The essence of the bone tissue regeneration procedure is that a special protein is installed in the place where this bone tissue is damaged by a pathological process, which stimulates bone tissue regeneration.

bone grafting performed under local anesthesia through an incision in the gum. During the operation, the patient is performed bone reading from the affected tissues by curettage or using ultrasound. Installed in place damaged tissue protein has different goals: either it does not allow the gum to grow into the area of ​​​​absent tissue, or simply provokes the growth of bone tissue.

Tooth crown lengthening It does not consist in lengthening the tooth itself, but in lengthening the so-called clinical crown of the tooth - that part of it that is visible above the gum. This procedure is the opposite of soft tissue grafts.

And so common manipulation in periodontitis as the application of soft tissue grafts. When the gums are resorbed and can expose the tooth to the root, which makes the tooth more sensitive and the possibility of tooth loss increases. In this case, a soft tissue graft is taken, that is, a small area of ​​the sky, which is transplanted into the affected area. Thus, the tooth becomes protected from external influences.

Surgical periodontology also includes operations for the prevention of periodontal diseases, during which soft tissue plasty is performed, and aesthetic and hygienic operations (flap closure of recessions).

The main task of surgical periodontology is the struggle for each tooth, the maximum preservation of the patient's own teeth. However, patients must remember that surgery aimed at removing infected foci, as well as restoring destroyed bone tissue, makes sense only if the patient intends to maintain thorough oral hygiene.

primary goal periodontal surgery is to create conditions conducive to maintaining the patient's dentition in a healthy and functional state throughout life.

REASONS FOR SURGICAL INTERVENTIONS

Ensuring access

Surgical intervention allows the dentist to provide access to the surface of the root and alveolar bone. This access facilitates root processing and removal of hard deposits, contaminated cementum, bacteria and tissue decay products from the root surface. Removing toxic products from the root surface helps eliminate the inflammatory process. In addition, reducing the probing depth after surgery allows the patient to have better access to all tooth surfaces and thus improve the quality of self-hygiene of the oral cavity.

Periodontal restoration

In other chapters this book describes surgical methods aimed at restoring soft tissues and bones destroyed as a result of periodontal disease. Such operations mainly consist in the transplantation of bone materials and grafts.

Bone Architecture Modification

Bone defects and deformities change the physiological contour of the periodontium, which contributes to the accumulation of plaque and the development of the disease. Bone contouring to remove bone defects eliminates areas that promote plaque accumulation, and also facilitates patient access to the tooth surface for effective oral hygiene.

Elimination of periodontal pockets

It is not always possible to completely eliminate periodontal pockets, but their depth can be reduced through various resection and regenerative procedures. The main goal is to reduce the depth of periodontal pockets to an acceptable level where effective professional and self-hygiene can be carried out.

ASPECTS TO CONSIDER BEFORE THE SURGERY

Informed consent of the patient

When presenting a periodontal treatment plan to a patient, it is necessary to indicate that the operation can be part of this plan. The patient must clearly understand the benefits and possible complications associated with the intended treatment. Possible alternative therapies should be carefully explained to the patient so that the patient can make an informed decision. The result of the discussion and the consent of the patient should be documented in writing in the dental chart.

Contraindications for periodontal surgery

There are a number of contraindications for surgical intervention. If there are certain medical problems(for example, uncompensated diabetes or hypertension) surgery is not recommended. Before beginning any type of periodontal treatment, a complete medical history should be taken. Thorough removal of deposits is essential for successful periodontal surgery. Even at an early stage of treatment, the patient should be informed that surgery will not be performed if adequate self-hygiene is not carried out, and also if the patient is not able to constantly exercise good hygiene and does not understand its meaning.

It is necessary to take into account the possibility of an even greater degree of periodontal destruction than that which was already there before the operation. Intervention aimed at correcting significant periodontal destruction may result in more tissue damage rather than restoring periodontal health, comfort, and function. In many cases, tooth extraction is the most optimal way treatment (for example, in the presence of severe periodontitis).

Some patients refuse to undergo surgery, despite the fact that they were carefully explained all the benefits of surgery. In such cases, it is best to stop convincing the patient of the need for surgery and determine alternative way treatment to preserve the existing dentition for the maximum period.

A clinician should not perform periodontal surgery unless they feel comfortable performing a particular operation on a particular patient or are unsure of the ability to provide adequate supportive care for any patient. The dentist will not lose status or reputation in the eyes of the patient if, in the presence of a difficult clinical situation, he refers the patient to a more qualified specialist.

Elimination of infection / 1 stage of treatment

Activities aimed at eliminating the infection (often referred to as the initial stage or the first phase of therapy) must be completed before surgery. Eliminating the infection is the most important part of periodontal treatment. During this phase, you can do the following:

• Assess the degree of patient cooperation.
• Assess the patient's healing potential.
• Conduct additional instruction to the patient on self-hygiene.
• Reduce the need for surgery or its volume.
• To improve the condition of soft tissues, which will facilitate the work with them during the operation.

After therapy aimed at eliminating the infection, three to six weeks should pass. Then it is necessary to conduct a thorough re-examination and evaluate the changes that have occurred in order to determine a further plan for periodontal treatment. The table shows the decision-making algorithm based on clinical data and the therapy options that can be selected at this stage.

Decision algorithm

In most cases, patient anxiety can be resolved with a friendly and attentive attitude to him or her. The periodontal surgeon must inspire calmness and confidence in his ability to perform the surgical procedure. Some patients cannot be relieved of anxiety without the use of tranquilizers or sedatives. For this purpose can be used various drugs and methods. Using sedatives the clinician must be thoroughly familiar with all aspects of the application medicines, as well as with the equipment and methods necessary to eliminate unwanted side effects.

Antibiotics

Prophylactic use of antibiotics before surgery is mandatory for groups of patients with the following systemic pathology:

• Majority birth defects hearts.
• Rheumatic heart disease or other acquired valvular disease.
• Idiopathic hypertrophic subaortic stenosis.
• Mitral valve prolapse with mitral insufficiency.
• Heart valve prostheses.
• Joint prostheses.
• Pathology immune system(consultation of the attending physician).

Regarding the use of antibiotics in patients with prosthetic joints, there are different opinions. To determine the optimal mode antibiotic therapy you should consult with your orthopedic surgeon.

There is little evidence to support the concept of antibiotic prophylaxis after periodontal surgery. Use of antibiotics a wide range to suppress microorganisms and improve healing after bone grafting is considered reasonable. The concentration of tetracycline in the fluid of the gingival sulcus is 2-10 times higher than the concentration of the drug in plasma. Such high concentration in the area of ​​the gingival sulcus makes tetracycline particularly effective when using bone materials. The average dosage is 250 mg every 6 hours, starting from the day of surgery and for another 7-14 days after. Tetracycline should not be taken concomitantly with food, as this may lead to impaired absorption of the drug. In addition, such an antibiotic can cause discoloration of growing teeth, so the drug should be used with caution in pregnant women or children with developing dentition. Tetracycline is contraindicated in patients with renal and liver failure, as well as with allergies to the drug.

Asepsis

It is extremely important to carry out periodontal surgery under aseptic conditions. The oral cavity cannot be sterilized, but every effort must be made to prevent cross-contamination and the transfer of bacteria from the external environment into the oral cavity. All instruments must be sterilized and placed on a sterile operating table. The surgeon must wear a surgical cap, mask and gloves. A sterile napkin must be attached over the surgeon's uniform. The patient should be covered with sterile drapes and his/her eyes and hair can be covered with sterile towels. It is necessary to carefully avoid getting non-sterile objects into the surgical area.

Emergency conditions

The clinician must know side effects all drugs used and try to prevent their occurrence. All clinic staff should have access to resuscitation drugs and equipment and be able to use them correctly. Resuscitation equipment should be checked regularly to ensure that it is in good working order. Each clinic employee must have a valid certificate allowing them to provide resuscitation. In order to effectively deal with emergencies, it is useful to arrange regular training for all personnel.

Anesthesia

Periodontal surgery is usually performed under local anesthesia. The surgeon must use minimal amount sufficient anesthetic to ensure patient comfort during the intervention. The clinician should be aware that dosage, method of administration, and vascularity at the site of administration will affect the degree of pain relief.

The dentist must know exactly the minimum therapeutic and maximum allowable concentration of the drug used. The maximum dosage of lidocaine hydrochloride in healthy person when combined with a vasoconstrictor is 3.2 mg per pound of body. A capsule containing 1.8 ml of a 2% solution of lidocaine hydrochloride corresponds to 36 mg of lidocaine hydrochloride (20 mg per ml). Using this information, it is easy to calculate the maximum dose of lidocaine for a healthy patient. For example, 12 capsules of 2% lidocaine hydrochloride (36 mg per capsule) is maximum amount a drug that can be administered to a patient weighing 140 pounds (140 x 3.2 mg = 448 mg, i.e. 448 mg = 12.4 capsules). Usually, during periodontal surgery, it is not necessary to use anesthetics with an adrenaline concentration higher than 1:100,000 (0.01 mg/ml). The maximum dosage of epinephrine in a healthy adult is 0.2 mg of adrenaline during one visit to the dentist (10 capsules of lidocaine with an adrenaline concentration of 1:100,000). Patients with severe cardiovascular pathology do not inject more than 0.04 mg adrenaline during one visit (2 capsules of anesthetic 1.8 ml with a concentration of adrenaline 1:100,000). Caution: Any local anesthetic must be injected with an aspirating syringe and at a rate of approximately 1 ml per minute.

SURGICAL ASPECTS

Operation plan

Prior to surgery, the dentist should carefully review the patient's radiographs and information regarding the depth of periodontal pockets, the amount of attached and keratinized gingiva, and the bony contour. These data are used to select the optimal surgical intervention. While there is a need for a specific treatment plan, the clinician must be skilled enough to change the surgical plan if unexpected problems arise during the intervention. In addition, it is the clinician's responsibility to be aware of possible anatomical limitations that may affect the course of the operation.

Toolbox and flap design

Cutting tools and tools for smoothing the root surface should be sharp. Blunt instruments injure tissue, complicate treatment, and irritate the clinician. If a blunt instrument is found in the surgical kit, it must be replaced with a sharp sterile instrument before surgery. Be sure to have a few extra scalpel blades on hand. Careful control of the localization of the blade tip prevents accidental cutting off of the flap. It is necessary to work with tissues as carefully as possible during manipulation, since even a minor injury leads to the death of a large number of cells. For example, when the flap is retracted after its formation, for less trauma with the retractor, it is necessary to firmly lean on the bone, and on the underlying part of the flap.

It is necessary to avoid making laxative incisions towards the palate or along the lingual alveolar plate. mandible. In addition, when making an incision in the dorsal palate, there is a risk of damage to the palatine artery. Bleeding from it can be quite significant. Such incisions are difficult to suture, heal slowly, and cause severe discomfort in the postoperative period, especially in the lower jaw. These problems can be avoided by extending the main incision several teeth medially or distally from the surgical site. If it is necessary to perform vertical laxative incisions, they should be carried out so as not to disturb the blood supply to the flap. Vertical laxative incisions should be made tangential to the tooth surface to preserve the interdental papillae for suturing and to prevent necrosis of the wound margins. Under no circumstances should vertical incisions be made in the root projection. Using a tooth weakened by periodontal disease as a fulcrum for flap folding (especially from the palatal side) can lead to accidental extraction of such a tooth.

Rice. Incorrect execution of vertical cuts

Hemostasis control

The amount of blood loss during periodontal surgery varies. Studies have shown that blood loss can range from 16 to 592 ml per intervention. The average volume of blood loss is approximately 24 ml. Usually, in a healthy adult, symptoms of hypotension occur when more than 1 liter of blood is lost. However, a predicted loss of 500 ml of blood may require fluid replacement.

Bleeding during surgery can be stopped by simply applying pressure with a damp gauze directly to the area of ​​bleeding. While doing patchwork operation bleeding can be controlled by adapting the flap and applying pressure to it with a damp gauze pad/The pressure on the flap should be sufficient to overcome the capillary or blood pressure, but not large enough so as not to injure tissue. In many cases, significant bleeding occurs in the interproximal areas after the flap is formed. Bleeding usually stops immediately after removal of the granulomatous tissue. Bleeding from bone channels can be stopped by squeezing (chipping) the adjacent bone towards the source of bleeding with a metal instrument.

If there is no way to stop the bleeding with pressure, you can use some drugs. Thrombin-impregnated oxygenated cetacetate (Sergicel) strips can be gently placed over the bleeding area. Such strips can be installed several times as they are resorbed during short period time. Another effective hemostatic agent is microfibrillar collagen (MCH-Avitene). This material is a dry, sterile, cotton-like lump that is applied with dry tweezers to the bleeding area. Microfibrillar collagen is resorbed and does not cause any reactions from adjacent tissues.

It is not recommended to use epinephrine as a hemostatic agent. Adrenaline easily enters the patient's systemic circulation and can lead to a significant increase blood pressure, cardiac arrhythmias, and possibly ventricular fibrillation. Local application adrenaline can lead to acute life threatening states.

Bleeding must be stopped before the dressing is applied. The hemostatic effect of periodontal bandages is not very high, in addition, the bandage does not exert sufficient pressure on the tissues. Be aware of the need to create a minimal blood clot when attempting to achieve a new attachment.

This can be achieved by exerting slight pressure on the flap or graft with moistened water for 2-3 minutes. physiological saline gauze before applying periodontal dressing. When the patient leaves the operating room, there should be no bleeding in the area of ​​the operation.

Wound closure

The quality of wound closure is critical to the success of interventions aimed at achieving a new attachment or when bone materials are used. The design of the flap should be such as to facilitate maximum matching of the wound edges in the interproximal areas. It is necessary to try to preserve the interdental papillae as much as possible, which can be achieved by performing a scalloped incision. To improve the alignment of the wound edges, a limited amount of osteoplasty in the interdental areas can be performed.

Sewing is performed for:

• Ensuring adequate matching of wound edges.
• Tissue adaptations.
• Hemostasis control.
• Elimination of postoperative pain.

As stated above, close alignment of the wound edges is essential to achieve a successful outcome when attempting to create a new attachment or when performing bone grafting. In mucogingival surgery, precise suturing is essential to keep tissues in the desired position.

Suturing

When suturing, certain basic principles must be followed:

• Use the minimum number of stitches to achieve the desired result.
• When suturing, use enough tension to align the edges of the wound, but not too much, as this can lead to necrosis of the flap. Excessive tension may cause the thread to break the flap.
• If possible, suture the keratinized gingiva.
• Try to grab enough tissue with the needle to prevent tearing of the flap by the thread.

With the same success, you can use different suture materials. None of the suture materials has all the necessary characteristics. When performing periodontal operations, monofilament materials and silk are most often used. It is necessary to choose the thinnest thread suitable for the intervention. For most periodontal procedures, it is recommended to use sterile atraumatic materials (4-0 or 5-0 thickness) with a 1/2 or 3/8 back cutting or stabbing needle. One of the many suturing techniques may be preferred.

The most commonly used methods are: knotted suture, twist suture, continuous suture and mattress suture.

Dressings for the wound

Periodontal dressings are used after surgery for three main reasons.

• Wound protection.
• Ensuring patient comfort.
• Help to keep the flaps in the right position.

Two types of dressings are most commonly used: those containing zinc oxide and eugenol and those containing zinc oxide without eugenol. The eugenol-free bandage is more popular. Moreover, recently it has become quite difficult to obtain a dressing with eugenol. Many dentists believe that there is no need to use periodontal dressings after surgery at all.

There are currently on the market a large number of periodontal bandages. You need to work with them, following the manufacturer's instructions. Gloves should be lubricated prior to handling material. The bandage is rolled up in the form of small rollers, approximately corresponding to the length of the area of ​​operation. The bandage is applied over operating field to cover the apical third of the crown and the entire operation area with it. The bandage should not extend into the transitional fold or floor of the mouth. In the interdental areas, the bandage is gently pressed with a cotton applicator. Avoid getting the bandage under the flap. It is necessary to use the minimum amount of material, but sufficient to completely close the surgical field.

The bandage is left in the mouth for 1 week. After removing the dressing, the area under it is cleaned and washed warm water or a weak solution of hydrogen peroxide. Any pieces of periodontal dressing stuck in the gum or interdental spaces must be removed. All surfaces of the tooth should be carefully examined for plaque, calculus, or remaining pieces of dressing coronal to the gingival margin and removed with an adequate polishing dressing. The patient is instructed in self-hygiene. The main criteria for reapplying the dressing is to ensure the patient's comfort and his/her ability to eliminate plaque without tissue damage. Ideally, during the first month after surgery, the patient should come to the dentist every week to polish the teeth and remove plaque.

When conducting transactions with bone grafting or flap grafting, it is convenient to use gelatin-based dressings such as Stomahesive. This material has good stability and is absorbed after 24-48 hours.

POSTOPERATIVE PERIOD

Instruction after surgery

The patient must be given postoperative instructions in writing. These instructions should be carefully reviewed by the patient before he/she leaves the dental clinic. Instructions can be offered individually for each patient.

INSTRUCTIONS AFTER PERIODONTAL SURGERY

Read these instructions. Following them will reduce discomfort and the likelihood of complications.

• BLEEDING. Minor bleeding may occur during the first 24 hours after surgery, but if there is significant bleeding, please contact us immediately.
• EDEMA. Some swelling is a NORMAL consequence of surgery. You will be given an ice pack to prevent swelling. You need to apply an ice pack to the cheek in the area of ​​the operation for the next 2-3 hours for 15 minutes with breaks of 15 minutes.
• MEDICINES. Take your medications as directed by your doctor. Do not use while taking medication alcoholic drinks or others medical preparations without a doctor's permission. Take the tablets with a full glass of water or juice to avoid nausea. If you experience nausea and if there is no improvement, call us.
• LIQUID. Take plenty of fluids over the next few days. DO NOT USE A STRAW!!!
• DIET. You can eat any comfort foods, such as soups or other soft foods, for the next few days.
• ACTIVITY. Try to reduce your activity for a few days after the operation. Avoid running or strenuous activities.
• CLEANING. A clean mouth heals faster! Clean carefully, being careful not to damage the tissues in the area of ​​operation.
• RINSE OF THE MOUTH. To maintain hygiene, gently rinse your mouth with warm water after every meal. There is no need to add salt to the water. When using any mouthwash, follow the instructions.
• AVOID smoking and drinking alcohol for 72 hours after surgery or longer!
• BANDAGE. When using a periodontal dressing, it must be in the mouth for 1 week. A few pieces may break off, but this is NOT a problem. If the bandage is loose, contact your dentist.
• SEAM. If there are stitches, they are removed by the dentist during your return visit in 7-14 days.
• PROBLEMS. If you have any problems, please contact the doctor by phone.

Complications in the postoperative period

Although bleeding and loss of bandage fixation are rare, they nevertheless remain the most common complications in the postoperative period. If the patient is concerned about bleeding, the bandage should be removed. The source of bleeding is identified by carefully removing clots that may be hiding it. Usually, bleeding can be eliminated by simple pressure for 5 minutes with a gauze soaked in saline. If the bleeding does not stop, you can repeat the procedure. Injection of an anesthetic with adrenaline at a concentration of 1:50,000 into the bleeding area effectively stops the bleeding. If the above methods fail to control bleeding, oxidized glucose (Surgicel) or microfibrillar collagen (Avitene) can be used as hemostatic agents.

Uncontrolled bleeding is most likely caused by a pathology of the blood clotting system, which requires the study of clotting factors. The patient should be asked about taking aspirin. If the problem is loose bandage, then the old bandage should be removed and a new bandage applied. Significant swelling, severe soreness, suppuration and fever are symptoms infectious process, the treatment of which should be carried out as actively as possible. During periodontal surgery infectious complications rarely occur. However, if this occurs, it is necessary to prescribe an adequate antibacterial drug(penicillin, erythromycin or other).

Root hypersensitivity may occur after removal of the periodontal bandage. Most often this occurs as a result of insufficient plaque removal. Since more emphasis has recently been placed on improving self-hygiene and achieving new attachment, root hypersensitivity is rare.

LIMITATIONS OF SURGERY

Periodontal surgery is not omnipotent. With its help, it is possible to provide access to underlying tissues and restore lost periodontal tissues. Surgery is an important part of periodontal therapy only when performed by a motivated, cooperative patient by an experienced, knowledgeable clinician.

Periodontal ABC
Peter F. Fedi, Arthur R. Vernino, John L. Gray

• Surgical periodontology

Surgical periodontology

Methods of treatment in periodontology

Surgical periodontology is a branch of periodontology that deals with the surgical treatment of periodontal diseases. Currently, it is believed that in the moderate and severe form of periodontal disease, it is necessary to use surgical treatment.

Surgical treatments for periodontal disease include:

• Resection of gum pockets (including with the use of a laser),
• Bone regeneration,
• Tooth crown lengthening (gingivectomy),
• The use of soft tissue grafts.

Gingival pocket resection

Pocket resection is a surgical operation, the purpose of which is to remove the gum that has detached from the tooth. This is done in order to eliminate the gum pocket, which is both a consequence of periodontitis and periodontal disease, and the cause of the progression of these two diseases.

Usually, the gum (which is part of the periodontium) is tightly attached to the tooth. It covers the neck of the tooth from all sides. But when gingivitis occurs, the gum tissue becomes inflamed, looser, more pliable and swollen. This makes it easier for food particles to get into the gap between it and the teeth, which are a favorable environment for the development of bacteria. Gradually, this leads to a deepening of the gum pockets, which even more "accommodate" food particles and microbes, and this in turn contributes to the progression of the disease.

Usually, during resection of the gingival pocket, the gingival margin is excised to a depth of up to 3 mm. The rest of the gum pocket is treated with curettage or ultrasound.

The operation of resection of the gum pockets is performed under local anesthesia. After excision of the "excess" of the gums, a gingival bandage is applied to it. When bleeding, swabs moistened with a 2% hydrogen peroxide solution are applied.

This operation leads to lengthening of the crown of the tooth - the tooth becomes visually longer, although, in fact, the zuyu does not increase.

What is the resection of gum pockets?

Resection of gum pockets is crucial moment in the treatment of periodontal diseases. Deep gum pockets are a reservoir for food particles and bacteria, which create a favorable environment for development there. The simple application of antibiotics without removing the gum pockets will not lead to success, as these pockets will again and again accumulate food particles, and therefore bacteria. Moreover, deep gum pockets make it difficult for both the patient and the dentist to clean the teeth from dental deposits.

It is worth noting that when gum pockets are removed, the exposed part of the teeth becomes more sensitive to hot or cold food.

Bone regeneration

The bone regeneration procedure is another surgical method for the treatment of periodontal tissue disease, in cases where bone resorption is noted. The essence of the bone tissue regeneration procedure is that a special protein is installed in the place where this bone tissue is damaged by a pathological process, which stimulates bone tissue regeneration.

The very procedure of bone tissue regeneration is carried out as follows. Under local anesthesia, the doctor makes an incision in the gum area. Then the resulting gum flap is “folded back”, after which the doctor cleans the bone from pathological tissues. For this, both curettage and ultrasonic cleaning can be used.

In addition to therapeutic purposes, bone tissue regeneration can also be performed for cosmetic reasons.

Currently, periodontists have several options in their arsenal for the regeneration of jaw bone tissue in periodontal disease: this is the use of special materials and proteins that stimulate the process of bone tissue synthesis. In the first case, after the extraction of the gum flap, a special material is installed around the tooth, which prevents the gum tissues from growing into this area, where the bone should be, as a result of which it is the bone tissue that is restored in this area. In another case, a special protein-based gel is used that stimulates bone growth.

Tooth crown lengthening

The procedure for lengthening the crown of the tooth does not consist in lengthening the tooth itself, but in lengthening the so-called clinical crown of the tooth - that part of it that is visible above the gum. This procedure is the opposite of soft tissue grafts. If during periodontal disease the teeth may look too long, due to the fact that the gum tissue, as it were, resolves, then with hypertrophic gingivitis, some teeth may look short, as gum tissue grows on them. To treat such a pathology, a small section of the gum is removed, due to which an elongation of the tooth crown appears.

The use of soft tissue grafts

As we have already said, with periodontitis and periodontal disease, resorption of periodontal tissues, including gums, can be noted. This leads to the exposure of the tooth tissue, up to its root, which is manifested by increased sensitivity of the tooth to cold and hot. The treatment for this problem is the use of soft tissue grafts. To do this, a piece of tissue is taken from the palate area, which is sutured to the affected area. This procedure helps to prevent further formation of a gum pocket, as well as to cover the tooth, which protects it from the development of caries. Such a procedure, in addition, can be carried out for cosmetic reasons.

People do not often think about caring for their gums, although the state of the whole organism depends on their health. Gum disease is accompanied by symptoms such as bleeding, bad breath, hypersensitivity, for example, painful reactions to cold or hot, tooth mobility and their loss. microbes, causing inflammation in the oral cavity, can also provoke diseases of many internal organs.

Periodontal Science

Healthy gums

Periodontology is an independent branch of the science of dentistry that studies diseases of the periodontium - tissues support apparatus tooth. Various changes periodontal disease is present in 70% of the world's population, but not everyone is aware of the presence of special doctors, naively believing that the dentist is the only doctor who treats teeth. And therein lies the rub - most of takes care of people's teeth, but does not even worry about the periodontium, and in fact it is the "home" for these same teeth.

Periodontology today is rapidly developing, studying the ways and methods of treatment and prevention of diseases. Unfortunately, as in any branch of medicine, there is no panacea to be found here, and many periodontal scientists are still struggling with the problem of bone pocket formation, bone tissue atrophy, and many other diseases.

The most common periodontal diseases

– inflammatory disease, leading to a change in the structure of tissues, for example, loosening of the gums, disruption of the connection with the tooth, exposure of the root, loss of teeth. Caused by pathogenic microflora that inhabits plaque. The defeat of periodontitis does not allow prosthetics for lost teeth.

- an inflammatory disease of the gums, formed against the background of adverse effects of both general and local factors. Does not cause damage to the integrity of the dentogingival connection.

- systemic non-inflammatory change in the periodontium.

What causes periodontal disease?

The main ones are:

• improper oral care, poor hygiene;
• non-compliance with the usefulness of the diet, and as a result, the lack of vitamins and minerals;
• protracted inflammatory processes and their long-term treatment;
• smoking and alcohol abuse;
• chronic diseases of internal organs;
• changes in bone structure;
• incorrect position of the teeth;
• injury.

Prevention of periodontal disease is very important, because it is always easier to prevent than to treat. It is necessary to carefully monitor oral hygiene, eat right, saturate the diet with vitamins and microelements and limit the consumption of sweets, since such an environment is the best for the reproduction of pathogenic bacteria.

Important: be sure to visit the dentist 2 times a year, this is the only way to identify diseases at an early stage.

Despite the fact that most people are well aware of the obligation to care for the oral cavity, only a small part does it scrupulously.

Working methods

Scientists traditionally divide methods of work into 2 categories: therapeutic and surgical periodontology.

Therapeutic periodontology

Therapeutic (conservative) periodontology includes drug treatment and physiotherapy activities. This can be symptomatic, preventive or supportive treatment that improves the health of the periodontal tissues.

What is the point of this treatment? The fact is that oral cavity bacteria are constantly inhabited, most of them cannot cause harm - we coexist peacefully with them, however, an excessive increase in the number of microorganisms can lead to diseases. In keeping normal microflora concluded the meaning of preventive therapy.

Symptomatic and supportive treatment, respectively, is prescribed for inflammatory processes that have already begun and diseases in remission. For example, with normal inflammation of the gums, ointments are used that alleviate the symptoms of the disease and destroy pathogenic microbes.

If every person has encountered conservative treatment in his life, then surgical periodontology for the majority is a mystery shrouded in darkness.

Surgical intervention in periodontics involves changing the structure and shape of the gums, the level of its attachment. In the event that there is exposure of the tooth or gum recession, such treatment is simply necessary.

Sometimes the gum area is not attached enough, then when the lips or cheeks move, the mucosa lags behind the tooth. In this case, under local anesthesia, a resection of the gingival pocket is performed - removal of the exfoliated gums.

Also to surgical interventions include crown lengthening and bone tissue regeneration. In the first case, there is a need to build up a crown. This happens when (due to injury, carious lesions) gum leans on upper edge tooth. Tissue regeneration involves the installation of a special material that stimulates the restoration of bone tissue at the site of injury.

Surgical periodontics involves the struggle to save each patient's tooth. It should be remembered that and conservative treatment, and surgery can be successful only if further prevention oral diseases.

New technologies

Modern medicine has learned to use in medicinal purposes laser as an alternative to scalpel. Laser vision correction has been around for many years, and there is no person who has not seen advertisements for such a treatment method.

In dentistry, lasers are also used during interventions. The use of such a tool allows for painless and bloodless operations with high precision.

For example, when conducting, the beam penetrates to the required depth and evaporates the granulations, while it sterilizes the periodontal pockets. For comparison: when using surgical instruments granulations are scraped off, and this is not such an accurate effect.

Also used in diagnostics laser technology- this is how the study of blood microcirculation in the periodontal tissues is performed. This method allows obtaining high-precision information, makes it possible to objectively assess the state of periodontal blood supply.

Periodontology involves the use of materials that improve the regeneration of bone tissue (this is necessary in case of its destruction). Currently, it is possible to use cell cultures that selectively improve the quality of recovery. These cultures include stem cells, fibroblasts, etc. Inplant materials and membranes, artificially created tissues, also improve regeneration.

In periodontics, as in any medical science prevention is at the core. Studying the nature and causes of the disease makes it possible to find new ways of treatment, at the same time improving the material and technical base.

Periodontology is studying ways to save the patient's own teeth, because even with the current development of prosthetics, no, even the most good prosthesis it will not be better and more convenient than your own, even aching teeth.

Periodontal disease is the most common cause of tooth loss in people over 35 years of age. Most often (in 90-95% of cases) diseases are to blame for this inflammatory nature such as periodontitis and gingivitis. Conservative and surgical periodontology deals with the treatment of these and other diseases.

Treatment of periodontal disease, gingivitis

Periodontal disease is a disease in which periodontal tissues (bone, gums, ligaments, soft tissues mucosa). For the treatment of this pathology, methods such as closed and open curettage can be used.

The first is carried out at mild degree periodontal disease (there is no tooth mobility, and the depth of periodontal pockets does not exceed 5 cm), and the second - with severe and moderate diseases. If the patient has a bare tooth root, soft tissue grafts are transplanted.

Other treatments are considered radical. The indication for gingivectomy is the possibility of spreading pathological processes, and indications for removal are severe periodontal disease, bleeding gums and high tooth mobility. Removal is performed if other methods have failed.

As for gingivitis, it is an inflammation of the gums (the marginal part adjacent to the tooth). It can be catarrhal, atrophic, hypertrophic and ulcerative necrotic. The method of treatment depends on the condition of the gums. AT advanced cases practiced surgical removal overgrown or dead tissue.

How is it different from "adult"? His narrow profile of duties includes work with the alveolus, periodontium and root cementum. These tissues in a child are constantly exposed to growth and deformation.

See the procedure for periodontal teeth cleaning.

O specialized centers periodontics you will learn.

Vector therapy

Most patients suffering medium degree periodontitis, do not perceive this pathology seriously and refuse complex surgical treatment.

An alternative to surgery can be vector therapy, which is not as painful as classical methods of treatment. The appearance of the Vector system was a huge achievement modern dentistry, because it allows you to work with tissues at the micro level.

The principle of operation of the device is as follows: "Vector" creates ultrasonic waves that cause the death of microorganisms, particles of the cleanser smooth the surface of the tooth, and the liquid intensively rinses the pockets. This allows you to get rid of harmful microorganisms, their waste products and unpleasant odors. There is no soft tissue injury.

The basis for conducting vector therapy can be:

• the initial stages of periodontal disease;
• recent periodontal treatment;
• the presence of tartar;
• an impressive amount of prosthetics (the use of locking clasp prostheses, metal ceramics);
• prevention of implant rejection.

The duration of the session is determined by the complexity of the work and the number of teeth. Typically, vector therapy is carried out in 40-120 minutes. This treatment does not require anesthesia, because it does not cause any pain or discomfort.

After vector therapy, the following happens:

• periodontal tissues affected by local infection are restored;
• tooth mobility decreases or stops (the achievement of such a result is possible in the case of complex therapy);
• gums become stronger, stop bleeding;
• the progression of the bony paradental pockets stops.

As a rule, one session of vector therapy is enough, but in some cases (with a hereditary predisposition to periodontal pathologies and complicated clinical situations) it is possible re-holding procedures.

Splinting of teeth

This method is referred to as a dental treatment of the dentition.

Usage this method possible in case:

• mobility, pathological unsteadiness of single teeth or the entire dentition;
• exposure of the roots of the teeth;
• bleeding gums;
• rapid formation of plaque and stone;
• the appearance of deep pockets between the teeth and gums.

Splinting is carried out using fiberglass, armid thread, crowns, clasp prostheses.

To date, splinting can be:

1. Temporary. It implies the installation of tires for a short period of time - from one to five months. Held on initial stages diseases, as well as in the treatment of pathologies with a mild course. Distinctive features of this procedure - the possibility of rapid modification and the absence negative impact on soft tissues.
2. Long-term. In this case, tires are installed for up to three years (this is determined clinical picture diseases). Applies to early stages loosening of teeth in the absence of indications for their removal.
3. Permanent. Represents the installation of tires for a long time. Supports teeth after the progressive influence of periodontal diseases, eliminates the consequences various injuries. Tires used for permanent splinting should be as reliable and aesthetic as possible. Such tires allow you to achieve a more stable and pronounced effect, do not have a negative effect on the gums.

Today, there are many splinting structures. In particular, they may be removable or non-removable. The first set in case of lack of teeth, and the second - to prevent overload of periodontal tissues.

When choosing a splinting structure, several factors are taken into account, namely:

• the number of missing teeth;
• the severity of inflammatory processes in the gum area;
• type of tooth deformity.

Most often, splinting is prescribed for people with severe forms of periodontitis - this helps to avoid tooth loss.

Surgical periodontology

The most common methods in this area are:

1. Resection of gum pockets (including with the use of a laser). In such pockets, bacteria multiply over time, contributing to the development of inflammatory processes. The use of antibiotics will kill the bacteria, but over time, new microorganisms will appear there. Eventually the only way is the surgical removal of gum pockets.
2. Bone regeneration. The essence of this procedure is as follows: a special protein is installed in place of the damaged bone tissue, which stimulates the regeneration of the damaged area.
3. The use of soft tissue grafts. With periodontitis and periodontitis, periodontal tissues, including gums, can be resorbed. Because of this, the root is exposed, the tooth reacts to the use of hot and cold food. To solve this problem, soft tissue grafts are used. The essence of the method is reduced to the following set of actions: a periodontist surgeon removes tissue from the palate and sews it to the affected area of ​​the gums. This protects the surface of the tooth from external influences, prevents the development carious processes and the formation of gum pockets, makes the smile beautiful and aesthetic.
4. Crown lengthening or gingivectomy. It is characterized by elongation not of the teeth themselves, but of the so-called clinical crowns protruding above the gums. In patients with hypertrophic gingivitis, the gum tissue increases in size, making the teeth look short. Removing a small area of ​​the gum allows you to solve this problem and restore the smile to its former beauty.

Under surgical periodontology refers to a branch of periodontology that specializes in the treatment of periodontal pathologies.

Ozone therapy

If you believe medical literature, ozone has a spectrum useful action: antibacterial, fungicidal, antiviral, anti-inflammatory, analgesic, cytostatic (antitumor) and immunomodulatory.

Ozone therapy is prescribed for patients with periodontal diseases, including all its forms (it does not matter if they are in the stage of exacerbation or in remission). Some doctors use ozone to treat inflammation around implants. The gas promotes regeneration, improves blood circulation and heals wounds after surgery. There are cases when ozone has become a full-fledged replacement for drugs.

Surgical treatment of periodontal disease has become widespread in dental practice. Modern methods allow you to perform operations painlessly.

Therefore, if a surgeon offers you a surgical treatment of a particular pathology, you should not refuse - such treatment can be very, very effective.

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