Archives for February 2018

Periodontal Disease and Dental Implants

Posted on February 28, 2018 by AllSmiles.

Periodontal Disease and Dental Implants

Hi, My periodontist recently replaced one of my missing teeth with a dental implant. It had fallen out because I have periodontal disease that went untreated for many years. I was very happy about replacing the tooth, not only because it just looks much better, but because I felt it was the answer to my periodontal disease, at least for that tooth. I must have misunderstood something because I was surprised when he told me I could still get periodontal disease around that tooth. Somehow, I thought that the titanium implant would be impervious. Can you explain?

Deb in Atlanta

Hi Deb,

While the titanium root from of a dental implant may be less susceptible to the effects of untreated periodontal disease, you still need to continue periodontal maintenance to prevent losing the implant itself. Periodontal disease doesn’t just attack the tooth root, it undermines the soft tissues and jawbone that support the root, so even if the titanium were “impervious,” as you said, there would still be a need to address the periodontal disease.

If you have lost teeth to periodontal disease, you may already know that it is a chronic condition that is never really “cured.” It may have been disappointing to learn that your new tooth will not somehow be able to withstand the effects of gum disease, but with continued periodontal maintenance, the outcome will be much better than it would have been otherwise.

Take a look at these two diagrams. The first one shows the progression of periodontal disease from completely healthy tooth, gum, and bone structure on the left of the tooth to the more advanced stage where the soft tissues and the jawbone that surround the tooth root are undermined. Then look at the second diagram, which shows a dental implant surrounded by soft tissue and bone. The comparison should make it more clear why your new dental implant will need continuing periodontal maintenance. Even if the titanium root form were left completely untouched by the surrounding disease, it would eventually not have enough bone and soft tissue to support it.

Good luck to you in maintaining your dental health.

This Blog is brought to you by David Pumphrey of Pumphrey Periodontics of Atlanta.

What is periodontal maintenance?

Posted on February 13, 2018 by AllSmiles.

What is Periodontal Maintenance?

I recently had scaling and root planing performed by my periodontist, and now she wants me to come back four times a year for periodontal maintenance. I am a little concerned because I have always heard that you should go to the dentist for cleaning and maintenance twice a year. Why the extra maintenance?

Michael in Florida

Hi Michael,

It’s great that you got your periodontal disease treated with scaling and root planing, but it sounds like maybe your periodontist just didn’t provide enough information about the follow-up treatment. Periodontal maintenance is needed to keep your periodontal disease from returning. So let’s see if we can’t give you the reassurance you need to continue keeping your teeth healthy.

Periodontal disease is a chronic condition. There is no “cure” for it, but with proper treatment and continued maintenance, you can keep it from loosening your teeth and causing other health problems.

Scaling and root planing is usually performed to eradicate the current causes of the disease: these are pockets of bacteria that form under the gums that undermine the underlying structures that support the teeth. That is why this disease is so damaging. It breaks down the tooth itself as well as the soft tissues and bone that hold it in place.

Once scaling and root planing have removed the current sources of disease, it is imperative to maintain the new state of health. You can see in this illustration how plaque builds up and eventually begins to undermine the soft and bone tissues under the gums, where we can’t see what is going on. The left part of the tooth in this diagram shows healthy tooth, bone, and gum, and the right part shows what happens in periodontal disease.

Periodontal maintenance is a two-fold process with both at-home and in-office steps. The at-home steps involve effective hygiene. This means that you will need to be very careful about brushing and flossing every time you eat. Once you have periodontal disease, you can no longer afford to skip this step.

The corresponding in-office step is the maintenance cleanings your periodontist recommended. They need to be more frequent to prevent the disease from returning. In addition, these maintenance cleanings require that the hygienist have more training and skill, and you can expect that they will take longer as well.

Think of it this way: if you do all you can to keep up with your at-home hygiene and return regularly for your maintenance cleanings, you may never have to experience another scaling and root planing procedure or the more severe aspects of untreated periodontal disease.

Good luck to you in maintaining your dental and overall health with regular cleanings.

This Blog is brought to you by David Pumphrey of Pumphrey Periodontics in Atlanta.

Bone grafts for dental implants

Posted on February 2, 2018 by AllSmiles.

Bone Grafts for Dental Implants

I am in my early 40s, and I recently looked into getting a couple dental implants to replace two front teeth I lost when I was just 18. I have always had two removable false teeth that clipped in behind the two adjacent teeth, and it has always bothered me. So I talked to my dentist about getting a more permanent (and hopefully more aesthetic) solution. He told me I would need a bone graft for the dental implants, so now I’m wondering if it is too much trouble. I really want my front teeth to look more natural, but I feel like a bone graft will be too much pain to go through.

Arabella in Atlanta

Hello Arabella,

Many people who explore the possibility of a dental implant or implants end up needing bone grafting, and while it is one more procedure to go through and heal from, it should not deter you from obtaining the smile you want.

Let’s first talk about the reason you probably need bone grafting at this point, then we’ll talk through the procedure, so you understand what it entails and can calm your fears.

Reason for Bone Grafts

If you’ve had false teeth for 22 years or more, it is likely that your jawbone has atrophied and lost density in the area below those teeth. This is because false teeth, dentures, and bridges only replace the crown or visible part of the tooth without addressing the loss of the tooth root.

The body interprets the loss of a tooth with its root to mean that the supporting bone structure is no longer needed. It begins to absorb the bone-building minerals that once supported the tooth for use elsewhere in the body. This leads to situations like yours in which there is not enough bone structure left to support a dental implant. And in the case of the loss of all of the teeth, it can lead to facial collapse.

That’s why dental implants are a very good choice: they replace both the tooth root and the crown. In fact, a dental implant is a replacement root that is implanted directly into your jawbone, and it is strong enough to support a crown. As you can see from the diagram here, the tooth root form needs enough bone material to be stable. Only then can it support the crown.

Bone Grafting Procedure

So now that you know why, let’s talk about how. It’s easy to fear what we don’t really understand, so hopefully, a little more information will go a long way here. To begin with, the tissue used for the bone graft can be found in your own jawbone, and when this is not possible, it can be obtained from a tissue bank.

Because there have been many recent advances in techniques and technology, bone grafting is now a minimally invasive and safe procedure. Your periodontist will place the new tissue after making an incision, and because your body will recognize the graft material as its own bone, and will gradually replace the graft with more bone-building minerals. This way, through guided tissue regeneration, you end up with more of your own natural bone than you had before the graft.

And modern sedation and pain-relief methods will keep the procedure and healing period for both the bone grafting and the implantation of the tooth root form relatively pain-free.

It is a really good idea to explore all these topics with your periodontist or oral surgeon who will perform the procedures. This will help you build more trust and lessen your fear as well. You can look forward to a permanent and beautiful smile.

Good luck in finding the right solution for a healthy and happy dental future.

This Blog is brought to you by Dr. David Pumphrey of Pumphrey Periodontics in Atlanta.