Periodontal Disease - Treatment

Postsurgery Pain and Discomfort. Post-surgery discomfort is usually managed easily with over-the-counter medications such as ibuprofen. If discomfort is severe, stronger analgesics may be prescribed. Some patients experience sensitivity to hot or cold temperatures from exposed roots; these problems can be managed with topical fluoride treatments or, in severe cases, with dental restoration.

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Techniques and Materials for Restoring Gum Tissue and Bone

Guided Tissue Regeneration. A more advanced technique is called guided tissue regeneration, which is being used to stimulate bone and gum tissue growth:

First the root surfaces and diseased bone are meticulously cleaned out. Preventing bacterial contamination is very important; the more residual bacteria, the greater the chance that the treatment will fail.
A specialized piece of fabric is sewn around the tooth to cover the crater in the bone left after the cleaning. It is either absorbable or nonabsorbable. (Studies are reporting highly beneficial results with new absorbable materials, including one that is coated with the antibiotic doxycycline.)
The gum is then sewn over the fabric. The fabric prevents the gum tissue from growing down into the bone defect and allows the bone and the attachment to the root to regenerate.
After4 to6 weeks the nonabsorbable fabric must be removed using a minor surgical procedure. The absorbable membrane may be left in. In general, there is little difference in outcome between absorbable and nonabsorbable procedures. The absorbable fabric may not be as effective as standard grafts if gum tissue is thin, although newer materials may prove to produce better results.

One 1999 study found that guided tissue regeneration techniques surpassed open flap curettage alone in improving pocket depth and attachment gain. In one study of patients who were followed for4 to7 years after guided tissue regeneration, the general failure rate was 41%. In smokers, however, the failure rate was 80%.

Bone Grafting. In some cases of severe bone loss, the surgeon may attempt to encourage regrowth and restoration of bone tissue that has been lost through the disease process. This involves bone grafting:

The surgeon places bone graft material into the defect.
The material may be either bone from the same patient or a substance called decalcified freeze-dried bone allografts (DFDBA) which is obtained from a donor. In one study, bone gain from freeze-dried bone was still maintained after3 years, although another study indicated that commercial batches of DFDBA varied in their ability to induce new bone growth. Bone from older donors appears to be less effective for restoring new bone.
This material then stimulates new bone growth in the area.