Strategic Approaches to Periodontal Disease Treatment

By Rebecca Stone January 14, 2019

When pathogenic bacteria are allowed to run rampant in the oral cavity, they can infect the gingiva. This type of infection can lead to gingivitis, periodontitis, bone and periodontal ligament damage, and, ultimately, tooth loss. The key to periodontal health, of course, lies in prevention. But when this fails and periodontal disease takes hold, therapeutic intervention, typically starting with scaling and root planing, is warranted.

Scaling and Root Planing

Used to remove plaque and calculus buildup on teeth and root surfaces, deep scaling, and root planing give gingival tissues a chance to heal. Such processes also aid in the tightening up of periodontal pockets.

If periodontal pockets are excessively deep and there is evidence of bone loss, or if tissues are not healing, a trip to the periodontist may be the next stop for the patient, as surgical intervention may be indicated. If this is the case, additional excision of inflamed tissue via flap surgery may stave off further damage. Such procedures reduce pocket sizes, shrinking the reservoirs in which bacteria thrive.1Treating Periodontal Diseases. Available at: Accessed November 26, 2018.

Tissue Regeneration

Depending on the extent of the damage done to bone and soft tissues, techniques such as guided tissue regeneration may be used to stimulate regrowth. For instance, bone or soft-tissue grafts, barrier membranes, or proteins designed to stimulate growth can be used to rebuild native structure.2Treating Periodontal Diseases. Available at: Accessed November 26, 2018.3American Academy of Periodontology. Periodontal Pocket Reduction Procedures. Available at: Accessed November 26, 2018.4Garaicoa-Pazmino C. Graft craft. Mentor. 2017;8(3):33-36.5Stone R. Skin in the game. Mentor. 2017;8(11): 20-24.

Tissues used for grafting include autografts, in which patients supply their own tissue; allografts, which involve transplanting tissue from one person to another such as a cadaver; xenografts, which involve tissue taken from another species; and alloplasts, or synthetic materials available for tissue grafts.6Garaicoa-Pazmino C. Graft craft. Mentor. 2017;8(3):33-36.7Stone R. Skin in the game. Mentor. 2017;8(11): 20-24.

Grafts are often accomplished with the help of growth factors such as autologous platelet-rich plasma and platelet-rich fibrin. These kinds of proteins can stimulate cell growth and proliferation, and direct stem cells to differentiate as bone or soft tissue. They offer normal healing, but at an accelerated rate. They may be used in gingival grafting, implants, sinus bone augmentation and alveolar ridge augmentation.8Garaicoa-Pazmino C. Graft craft. Mentor. 2017;8(3):33-36.9Preeja C, Sivadas A. Platelet-rich fibrin: its role in periodontal regeneration. Saudi J Dent Res. 2014;5:117–122.

Keeping it Clean

In any type of surgery, including oral surgery, isolation of the surgical field is critical. Not only does it provide a dry field in which visualization is enhanced, but it lessens the chance of bacterial contamination. It also shields the throat, preventing ingestion or inhalation of foreign objects.

Nonsurgical scaling and root planing, often performed by dental hygienists without the aid of assistants, can also benefit from good isolation systems. From single-handed retraction of soft tissues while placing medication to keeping fluids and debris under control while using ultrasonic instrumentation to maintaining a clear, illuminated field of view, clinicians have their hands full.

In such challenging scenarios, systems such as the Isolite 3 are valuable aids. While its flexible mouthpiece shields the patient’s throat, the Isolite also keeps soft tissues retracted and safely out of the way. Integrated illumination helps maintain a highly visible field of view while hands-free evacuation continually controls liquids and debris resulting from scaling and lavage, and keeps mirrors fog-free. As an added bonus, the system serves as a bite block, sure to be a patient pleaser during lengthy procedures.

But perhaps the greatest patient pleaser of all is that, thanks to innovative, cutting-edge procedures, they get to keep their teeth.