Periodontitis is an inflammation of the parotid tissues, leading to atrophy and degeneration of the structures that hold the root of the tooth. It is manifested by bleeding gums, bad breath and shaky teeth. Periodontitis is the 2nd most common cause of tooth loss in patients after 35 years. If pathology is detected in the early stages, conservative treatment is possible. The maximum preservation of their own teeth is, in fact, a manifesto for all periodontists, and a goal that all dentists have been following for many years. Technological improvements have made this goal more achievable than before, but even despite the possibilities of periodontal regeneration and reconstruction of the periodontal ligament, cement, gums and alveolar bone, it has not been possible to completely solve the problem of periodontal lesions.
Indications
The patient needs surgical intervention in the presence of such indications:
- Deep dental pockets (0.5 cm or more);
- Ineffectiveness of conservative treatment;
- Foci of purulent infection;
- Massive granulations in the gingival margin;
- Hyperplasia of the interdental papillae;
Contraindications
Acute viral and bacterial infections (flu, sore throat, etc.);
Bite pathology;
Neglect of oral hygiene;
Destruction of bone tissue;
1.Periodontitis of mild severity –
With a mild form of periodontitis, firstly, all the symptoms of catarrhal gingivitis will persist, i.e. the patient will continue to complain of periodic soreness and bleeding when brushing his teeth. In addition, there will still be swelling, cyanosis or redness of the gingival margin, as well as accumulation of microbial plaque or tartar in the area of the necks of the teeth.
The main diagnostic criterion distinguishing the symptoms of the initial stage of periodontitis from the symptoms of catarrhal gingivitis is the formation of periodontal pockets (dental pockets) – up to 3.5 mm deep. Such pockets are formed due to the destruction of the attachment of the soft tissues of the gum to the necks of the teeth, which leads to the penetration of pathogenic bacteria below the gum level. As soon as this happens, inflammation and pathogenic bacteria lead to the destruction of the periodontal and bone tissue near the root of the tooth.
On the surface of the root of the tooth (in the depth of the periodontal pocket) – there are hard dental deposits, and the lumen of the pocket is filled with serous-purulent discharge. During the period of decreased immunity, the patient may notice that purulent discharge may be released from the periodontal pockets – this becomes especially noticeable when pressing on the gum in the projection of the periodontal pocket. In patients with this stage of periodontitis, a panoramic radiograph can show a decrease in the level of bone tissue (interdental septa) – up to 1/3 of the length of the roots of the teeth, and there may be 2 types of inflammatory bone resorption:
Horizontal bone resorption is characteristic of elderly and relatively elderly people, usually there is a slow progression of the disease (with a uniform decrease in the height of bone tissue in the area of all teeth). Thus, in this group of patients, it is sometimes possible not to see periodontal pockets with a depth of 3.0-3.5 mm, but there is a uniform decrease in the level of bone in the area of all teeth.
Vertical bone resorption it is typical for young and relatively young people. The nature of the course of inflammation is usually aggressive (with rapid progression). Bone destruction takes place only in the area of periodontal pockets formed along the surfaces of the roots of the teeth. At the same time, as such, there is no decrease in the height of the interdental bone septa. This form is the most difficult to treat.
Important: with periodontitis of mild severity, there is still no mobility of the teeth, as well as their displacement under the action of chewing pressure (all this is characteristic of periodontitis of moderate and especially severe degree).
2. Periodontitis of moderate severity –
This stage of the inflammatory process is distinguished by the fact that the number of periodontal pockets increases significantly, and their depth can already reach 5.0 mm. An increase in the depth of the pockets creates excellent conditions for the reproduction of pathogenic pyogenic bacteria, and therefore the release of serous-purulent exudate from the pockets becomes rather the norm (which is especially evident when pressing on the gum in the projection of the periodontal pocket). In addition to pathogenic bacteria, periodontal pockets at this stage may also contain fungal flora, which is important in choosing drugs for the treatment of periodontitis.
An increase in the depth of periodontal pockets to 5.0 mm means a decrease in the bone level by about 1/3-1/2 the length of the roots. Visually, this can be expressed in a decrease in the gingival margin relative to the necks of the teeth, i.e., the roots may already be exposed. In addition, with such a degree of bone destruction, there is – 1) mobility of teeth of 1-2 degrees, 2) the inclination of some teeth may appear, 3) a fan-shaped divergence of the front teeth may begin to appear. The latter is especially characteristic for patients with the absence of a large number of lateral chewing teeth.
Periodontitis of moderate severity –
At this stage of inflammation, patients often complain of deterioration of the general condition – there is increased fatigue, weakness, there is also a decrease in immunity + frequent colds. This is due to the fact that serous-purulent discharge is always present in periodontal pockets, from which toxins and pathogens are absorbed into the blood and spread throughout the body, affecting primarily the immune system.
Very important: once again, we draw your attention to the fact that at this stage of periodontitis, “secondary deformities of the dentition” already occur, i.e. the teeth begin to “move apart” (changing their position depending on the direction of the usual chewing pressure). Therefore, the treatment of periodontitis of moderate severity is already much more complicated – in comparison with periodontitis of a mild degree, and will require you to have very significant financial costs for splinting and prosthetics of teeth. Therefore, it is important not to bring it to such a state, and not to self-medicate.
3. Severe periodontitis –
A severe form of periodontitis is characterized by a further deterioration of all symptoms. The depth of periodontal pockets can already reach 6.0 or more. Accordingly, a decrease in the level of bone tissue in the area of the interdental septa – already reaches 2/3 or more of the root length. Mobility is observed in most teeth, and in some teeth it already reaches 3-4 degrees. With this severity of periodontitis, exacerbations of the inflammatory process often occur, which are accompanied by the formation of abscesses, sharp swelling of the gums, pain in them, and a sharp increase in tooth mobility.
It should be noted that in severe cases, patients begin to suffer not only from local symptoms in the oral cavity, but also complain of weakness, malaise, poor sleep, appetite (24stoma.ru ). Severe chronic inflammation of the gums can also affect the frequency of exacerbations of chronic diseases of internal organs. The condition of patients with diabetes mellitus, cardiovascular, hormonal, rheumatoid diseases is particularly deteriorating.
Exacerbations of periodontitis –
there is also such a thing as “the course of the disease”. As a rule, periodontitis is characterized by a sluggish chronic course, i.e. when the symptoms are smoothed out (there are no acute inflammatory phenomena), but exacerbations of the inflammatory process may occur periodically. During exacerbations, symptoms become much more pronounced – tooth mobility and bleeding gums increase, gum swelling and the formation of purulent abscesses may occur, and purulent discharge from periodontal pockets may also appear. The development of exacerbation may be associated with both the depletion of local protective mechanisms of the oral cavity and a decrease in the body’s immunity. Next, we will talk about how to treat periodontitis.
How to treat periodontitis correctly:
Treatment of periodontitis will depend primarily on the severity of the inflammatory process in a particular patient. The greater the level of bone loss and the degree of tooth mobility, the more missing teeth you have, the more difficult, longer and more expensive the treatment will be. It all starts with a consultation, and you should not go to an ordinary dentist-therapist, but only to a periodontist (this is a doctor specializing in the treatment of gum inflammation).
These surgical interventions are based on the Cieszynski-Widman-Neiman operation, which is carried out with a pocket depth of more than 6 mm. The essence is to cut out and fold back the muco-periosteal flap, followed by careful treatment of the roots of the teeth, bone pockets, and the inside of the flap.
Treatment begins with a thorough examination of the patient, including general and local status. An important point is the assessment of the quality of oral hygiene at the preoperative stage of treatment, which is also a decisive factor in deciding on the possibility of surgery.
At the initial stage, the removal of unpromising teeth is carried out in the oral cavity sanitation scheme. When determining the indications for tooth extraction, not only the degree of destruction of the marginal periodontal and pathological mobility are taken into account, but also the condition of the periapical tissues, the possibility of using the tooth to fix the prosthesis, the position in the dental arch, the continuity of the dentition, the form of destruction of the alveolar process, as well as the general health of the patient.
All periodontal interventions can be divided into two groups. The first group includes interventions aimed at eliminating the periodontal pocket:
1) Curettage of the periodontal pocket is closed.
2) Curettage of the periodontal pocket is open.
3) Gingivectomy.
4) Patchwork operations.
5) Apically displaced flap.
6) Directed regeneration of periodontal tissues.
The second group includes interventions aimed at eliminating violations of the structure of the soft tissues of the vestibule of the oral cavity, which not only aggravate the course of the inflammatory process in the periodontal, but in some cases themselves are the causes of its specific lesions. This:
1. Plastic surgery of bridles and cords (frenulotomy and frenulectomy).
2. Vestibuloplasty.
3. Operations to eliminate recessions.
Why you can’t self-medicate periodontitis
To understand how “effective” the treatment of periodontitis with “grandmother’s” remedies at home is, it is enough to refer to the personal experience of patients. Patients have been trying to treat bleeding and gum inflammation at home for years – with various rinses, gels, toothpastes. But at the same time, they do not fight the original cause of gum inflammation (dental deposits), and as a result, mild gum inflammation slowly turns into severe chronic periodontitis, occurring with the mobility of teeth and the need to remove them.
While working as a periodontist, I have consulted thousands of patients who come to me with periodontitis. They asked me about how to cure periodontitis, but at the same time, most of them demanded from me a quick and simple treatment – no more complicated than what they were used to at home (they thought it was enough to prescribe the RIGHT gel or the RIGHT rinse, well, or a miracle gum paste). Hardly agreeing to the removal of dental deposits (the main cause of periodontitis) – they did not believe that the cause of gum inflammation is dental deposits and poor oral hygiene.
Description of the operation
Anesthesia is performed by injection anesthesia indicated for a specific area of surgical intervention.
Using an eye scalpel, incisions are made along the marginal gum from the vestibular and oral surfaces in such a way that subsequently one flap exceeds the other in height. Their location depends on the localization of bone pockets and the level of resorption of the alveolar bone. From the side of the bone pockets, the incision passes below the marginal part of the gum by 1-2 mm; from the side of the preserved alveolar bone, the incision is performed as close as possible to the edge of the gum. As a result, the last flap will be larger in height. Along the length of the incision has the shape of a straight line with the ends bent towards the crowns of the teeth that are not subject to removal (subsequently closing the defect of the dentition). The arc at the end of the linear incision is formed in order to prevent gum recession in preserved teeth.
Conclusions:
1. According to the generalized data of independent WHO experts, inflammatory periodontal diseases are detected in 90-95% of the adult population and lead to pathological changes in the dental system associated with tooth loss, 5 times more often than with complications of caries.
2. The main etiological factor is the presence of periodontopathogenic microflora and poor oral hygiene.
3. Methods of surgical treatment aimed at restoring bone defects in periodontal diseases: curettage (open and closed) flap operations, targeted tissue regeneration.
4. The main indications for them: the presence of a periodontal pocket, exposure of necks and roots of teeth, incomplete destruction of the alveolar process.
5. To date, the drug “Bio-Oss” of the Swiss company “Geistlich Pharma AG” has received the greatest demand and popularity, which meets all the requirements set for osteoplastic drugs.