OUR SERVICES

at Sydney Periodontics

Periodontal disease is an inflammatory disease of the supporting tissues of the teeth (gums and bone). Periodontal disease covers a broad spectrum of conditions ranging from a mild gingivitis to an advanced periodontitis.

Periodontal disease is caused by an accumulation of plaque on the tooth surface, around and below the gum margin. Plaque consists mainly of bacteria which produce toxins. These toxins stimulate the body’s immune system to produce inflammation in the gum tissues. In its mildest form of disease, gingivitis, the gums are red, swollen and bleed easily. There is usually little or no discomfort at this stage.

If left untreated, gingivitis can progress to a periodontitis. The inflammation becomes chronic and the bone that supports the teeth is gradually destroyed. As bone is lost, spaces or pockets develop between the gum and the tooth. More plaque accumulates in these pockets and so the inflammation and bone destruction continues. Eventually the teeth will become loose and subsequently will be lost.

Although plaque is the main cause of periodontal disease, other factors such as age, smoking and some medications can increase the risk of developing periodontitis. Some people are genetically predisposed to periodontal disease.

When you are referred to a specialist for a periodontal assessment, the periodontist will usually begin with a full review of a patient’s medical and dental histories. This will include any current medications and those taken in the past two years. This history will assist in identifying risk factors and any medical conditions which must be considered before treatment is commenced.

This will be followed by a clinical examination where the oral tissues are examined and the bite (occlusion) is assessed. The periodontist will measure and record pocket depths, levels of recession and mobility for each tooth. X-rays may also be taken to assess the health of the bone which is supporting the teeth.

Following a thorough examination, the periodontist is able to formulate a course of treatment which is suitable for each individual. Treatment options will be discussed at this stage.

Treatment of periodontal disease

Gingivitis

This is a reversible condition and can be treated simply by providing patients with a good oral hygiene routine. If plaque has been present for some time, it may have transformed into hard, rough deposits (calculus) and these will need to be removed with scaling by a clinician. Gingivitis is usually treated by your general dentist or hygienist.

Periodontal disease

Periondontitis

More extensive treatment is required when bone loss has occurred and the pockets around the teeth become too deep to clean with daily oral hygiene methods. The aim of periodontal treatment is to reduce the pocket depths to stop the progression of disease and eliminate inflammation. It will then be possible to maintain a healthy periodontium with good daily oral hygiene practices.

Initially, periodontitis is treated conservatively with scaling and root planing to remove infected tissue and deposits. Deep pockets are carefully cleaned to remove all plaque and calculus and the root surfaces are smoothed. This is usually carried out with local anaesthesia and will require 2-4 appointments. Some tenderness may be experienced following the procedure but this will subside as the gum tissue heals.

A re-evaluation of initial treatment is carried out 2-3months after the initial scaling and root planing. Oral hygiene is assessed and pocket depths are re-measured. Pockets which remain greater than 5-6mm and bleed upon probing will require further treatment.

Periodontal surgery is needed in areas where conservative scaling and root planing has been unsuccessful in stopping the progression of periodontitis. The gum is folded back to give direct access to the root surfaces. This is especially useful where bone loss extends to the areas between the roots of molars. Infected tissue and deposits can be removed more successfully. Sometimes irregular bone surfaces are smoothed before replacing the gum.

More Services

Supportive periodontal therapy

This is also known as periodontal maintenance. Effective daily oral hygiene is critical following successful periodontal treatment. It is also important to have regular periodontal reviews and cleaning to prevent a buildup of deposits which harbor the bacteria responsible for periodontal disease. Problem teeth can be closely monitored and treated if disease should recur.
Implant placement

A dental implant may be used to replace a lost tooth or teeth to restore function and aesthetics. It is basically an artificial root made from titanium which is placed into the jaw bone. The implant integrates with the bone tissue and acts as an anchor for an artificial tooth or bridge. If all the teeth are missing, it may be possible to construct an implant supported full bridge or denture.
Sinus lifts

Adequate bone height and width is required to successfully place a dental implant. In the back of the upper jaw there is often insufficient bone and this is further complicated by the close proximity of the maxillary sinus. A sinus lift can help correct this problem by raising the sinus floor and developing new bone for placement of a dental implant.
Management of peri-implant disease

The soft gum and bone tissue around dental implants can be affected by inflammatory peri-implant disease. This is similar to periodontal disease around a natural tooth. Bacteria colonise the base of the implant producing inflammation of the soft tissue around the implant (peri-implant mucositis). If left untreated, the inflammation will lead to loss of bone which supports the implant (peri-implantitis). Implants require good oral hygiene and regular reviews. Risk factors for developing peri-implant disease include smoking, diabetes and previous periodontal disease.
Soft tissue grafting

Gingival recession is a common problem which results in exposure of the root surface. According to the National Survey of Oral Health, 88% of seniors aged 65 years or more and 50% of adults aged 18 to 64 years have lost gingival form and function and have one or more sites with recession. If recession is minor, no treatment is required. However, if the recession results in tooth sensitivity or creates an aesthetic concern, a gingival graft (gum graft) is a treatment option. A thin piece of tissue (graft) is taken from the palate or gum tissue is gently moved across from adjacent areas to cover the exposed root surface. This procedure accomplishes a number of objectives: the prevention of further recession, a reduction or elimination of sensitivity, decreased susceptibility to root decay and a cosmetic improvement.
Crown lengthening

This procedure is necessary when there is insufficient tooth structure above the gum to adequately restore a tooth. There may be decay or a fracture below the gum. Crown lengthening will adjust the gum and bone level to expose more of the tooth and give your dentist better access to place a filling or crown. Crown lengthening can also be a cosmetic periodontal procedure. In some cases, there is excess gum tissue around the upper teeth, producing what we call a “gummy smile”. The excess gum may be removed to expose more of the natural tooth. This can also be carried out on individual teeth to correct an uneven gum line.
Cosmetic periodontal surgery

Gingival grafting and crown lengthening are cosmetic periodontal surgery procedures used to cover root surfaces and sculpt the gum line to produce a more aesthetic smile. When a tooth is lost, the bone which once supported the tooth will slowly recede. This can produce indentations in the gum and jawbone. Even when the lost tooth is replaced, the surrounding gum may appear unnatural. There may be an unsightly gap between the false tooth in a bridge and the gum below. A more natural contour of the gums and jaw can be achieved by using soft tissue and/or bone to fill in the defect. This is known as ridge augmentation. Obviously, preventing bone loss in the first place is easier than creating new bone later on. Another procedure, socket/ridge preservation, may be used at the time of extraction to minimise bone loss which would normally occur following tooth loss. Usually, the tooth socket is filled with a bone substitute material and covered by gum or an artificial membrane. New bone forms in the socket, maintaining the ridge contour and providing a good foundation for future implant placement and other restorative options such as bridges and dentures.
Bone grafts

Bone grafting is possible because bone tissue, unlike most other tissues, has the ability to regenerate completely if provided the space into which to grow. As native bone grows, it will generally replace the graft material completely, resulting in a fully integrated region of new bone. The biologic mechanisms that provide a rationale for bone grafting are osteoconduction, osteoinduction and osteogenesis.
Regenerative procedures

Patients are more conscious of dental esthetics and are requesting more root coverage proce- dures. This generates a need for clinicians todevelop materials and techniques that will pre- dictably satisfy these patient-centered esthetic demands.According to the National Survey of Oral Health, 88% of seniors aged 65 years and more and 50% of adults aged 18-64 years have lost gingival form and function and have one or more sites with recession.
Surgical procedures in orthodontic treatment

Orthodontists may refer patients for surgical procedures to assist with their orthodontic treatment plan. These procedures include: 1. Pericision. A procedure designed to sever the gingival fibres around a tooth. It usually reduces the tendency to relapse when teeth are orthodontically rotated. 2. Exposure of an unerupted tooth which lie in an abnormal position. The crown is exposed so that a bracket can be attached and the tooth moved orthodontically into its correct position. 3. Frenectomy. A frenum is a band of tissue containing muscle fibres connecting the inner aspect of the lip to the gum. If a frenum is too large it may prevent the teeth from coming together. This is commonly seen between the upper central incisors. A frenectomy is the surgical removal of a frenum. 4. Placement of temporary anchorage devices (TADs). These are small titanium screws which are placed into the jawbone in certain orthodontic cases. They are temporary devices which help achieve tooth movement with more efficiency.

Services

Our Services

Treatment of periodontal disease
Supportive periodontal therapy
Implant placement
Sinus lifts
Management of peri-implant disease

Soft tissue grafting
Cosmetic periodontal surgery
Bone grafts
Regenerative procedures
Surgical procedures in orthodontic treatment