Introduction
In periodontal treatment, the first step is to free the gums and periodontal apparatus from inflammatory processes. The course and intensity of periodontal therapy, as with most dental treatments, depends to a large extent on the initial condition. Therefore, the dentist must first get an idea of the severity and extent of the disease when treating periodontosis.
He can do this with quite simple means. First, he will examine the condition of the gums (gingiva) with the naked eye, because inflammation of the gums quickly causes visible discoloration. Once rosy, light-colored gums with normal blood supply become increasingly darker and appear to be affected even with the naked eye.
It is also useful to assess the depth of the gum pockets. For this purpose, he inserts a narrow probe along the tooth into the pockets. The so-called PSI (Periodontal Screening Index) forms the average value of the pocket depths of each section of the dentition.
A much more accurate method is the complete detection of all gingival pockets, the dentist collects three values per tooth for this purpose. Afterwards, an X-ray overview image (OPG) is usually taken, which allows the precise assessment of the bone condition and thus the evaluation of the further course of treatment. In addition, a microbial test should be carried out during the diagnosis to determine the exact germ count.
In the course of this test, absorbent paper pens are inserted into the gum pockets between the gum and tooth substance and then examined for germs in the laboratory. Periodontal treatment is divided into three phases. The diagnostic, the hygiene and the treatment phase.
The diagnostic phase described above is followed by both the hygiene phase and the actual periodontal treatment. During the hygiene phase, the entire dentition is professionally cleaned with the help of so-called curettes (professional tooth cleaning, PCR). These curettes are sterilizable hand instruments, which are ground at a specific angle at the ends, so they can be guided closely along the tooth and enable the removal of hard and soft plaque.
During the hygiene phase, all plaque above the gum line (supragingival) is removed. In addition, fixed tartar is also removed. In order to effectively remove plaque below the gum line, a so-called closed curettage can be performed under local anesthesia.
In this treatment measure the anaesthetic is introduced into the gums in the area of the pockets to be treated. Afterwards, professional tooth cleaning can be performed in depth. In addition, the periodontal treatment includes training in oral hygiene, during which the patient learns an effective, gum-sparing tooth brushing technique and the handling of dental floss and/or interdental space brushes.
Only the complete cleaning of the interdental spaces (lat. interdental spaces) can ensure the long-term results of periodontal treatment. This fact can be explained by the fact that the bristles of an ordinary toothbrush are not able to penetrate into the deepest furrows of the interdental spaces.
This problem is intensified in cases of severe tooth misalignment. Even in patients undergoing orthodontic treatment and wearing fixed braces, interdental brushes are indispensable for daily oral hygiene. The use of small sandblasters is possible, but is now rather controversial, because the sand particles seem to attack the tooth substance and thus create new dirt pockets.
Just during this hygiene phase alone, the condition of the gums and the periodontium can be improved enormously. However, their success depends not only on a capable dental team, but above all on the cooperation of the patient. If the periodontal disease is already more advanced, your periodontal treatment is followed by the closed treatment phase.
During this phase, the plaque under the gum line (subgingivally) is removed. In addition to the curettes used in the hygiene phase, sound- and ultrasound-operated hand instruments are now also used to loosen stuck concrements. The gums and periodontium are then allowed a healing period of one to two weeks, during which the pocket depth can be reduced.In a control appointment after the periodontosis, the dentist in charge of the treatment will again survey and compare the pocket depths.
In this way it is possible to evaluate the effectiveness of the therapy measures carried out so far. In case of an imperceptible improvement or very deep initial pockets (usually starting from a depth of 7mm), it is often necessary to choose an open treatment strategy for periodontal treatment. In this open procedure, the gum pockets are surgically opened with a scalpel and the dentist can then remove the subgingivally located plaque under visual control.
Bone defects that have already occurred can be filled with bone replacement material during this procedure. However, the disadvantage of open periodontal treatment is the prolonged healing time, because the surgical incisions always mean trauma for the penetrated tissue. In the meantime, periodontal treatment with laser is a useful addition to the old, proven forms of therapy.
With the help of this new method, the diseased areas of the periodontal apparatus can be treated particularly gently and gently. The unique advantage of periodontal treatment with laser is the fact that the special laser light is suitable for effective killing of bacteria. The majority of patients also report that the application of the laser is absolutely painless.
However, before the laser can be used, the affected areas still have to be cleaned by curettes to remove food residues and plaque. Only then is a thin laser probe inserted between the gums and tooth substance and guided to the bottom of the gum pocket populated by germs. By emitting the laser light, the periodontosis-triggering bacteria within the gum pocket can be eliminated.
As a rule, periodontal treatment with laser must therefore be regarded as a complementary therapy to normal curettage. However, there are cases where the use of laser seems absolutely necessary for tooth preservation. The reason for this is that different anatomical conditions or the course of a disease make it almost impossible to carry out professional tooth cleaning in an optimal way.
The periodontal treatment with laser should therefore be carried out by Teeth that have multiple or curved roots (especially in the posterior region) Poorly visible and/or very deep gum pockets Patients suffering from regularly recurring periodontosis Massive inflammatory processes Evidence of particularly aggressive bacterial strains Periodontal treatment with laser can ensure the success of treatment in these special cases and reduce the risk of reoccurrence enormously. In addition, everyday clinical practice clearly shows that the rate of teeth that can be preserved is much higher with laser periodontal treatment. The cost of periodontal treatment with laser depends mainly on the time required, the number of teeth affected and the depth of the gum pockets. Since it is still a purely private service, the patient can expect to pay about 10 to 25 euros per tooth to be treated.
- Teeth that have multiple or curved roots (especially in the posterior region)
- Poorly visible and/or very deep gum pockets
- Patients suffering from periodontal disease that recurs regularly
- Massive inflammatory processes
- Detection of particularly aggressive strains of bacteria
