Periodontal Health

Treatment Methods

Dr. Helm provides a variety of surgical and non-surgical services. We pride ourselves on the fact that we are very conservative in our treatment recommendations and limit surgery to the areas where it is absolutely necessary.

Many times, the early stages of periodontal disease are best treated with non-surgical periodontal therapy. Even in severe cases, non-surgical periodontal therapy often precedes surgical therapy. This is done to improve the overall tissue quality prior to surgery and also to help limit the areas requiring surgery.

In fact, at Bozeman Periodontics, we use technology called a perioscope that features miniature digital video technology that enables the clinician to see magnified details of tooth anatomy to diagnose and treat areas in a minimally invasive way.  Dr. Helm is the only dentist in Montana using this state of the art technology to ensure you get the best treatment possible.

 
Scaling & Root Planing

Scaling and Root Planing Overview

For a brief narrated overview of scaling and root planing, please click the image on the below. It will launch our flash educational MiniModule in a separate window that may answer some of your questions about scaling and root planing.

Scaling and Root Planing Presentation

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The initial stage of treatment is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gum line.

The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment.

The initial stage of treatment is usually a thorough deep cleaning that may include scaling to remove plaque and calculus (tartar) deposits beneath the gum line.  The tooth roots may also be planed to smooth the root surface, allowing the gum tissue to heal and re-attach to the tooth.  In some cases, the scaling of teeth is also beneficial in the mechanical disruption of plaque which is important in allowing for the improved penetration of antibiotics or chemical agents to encourage healing. 

 
Antimicrobials
 
Antibiotics or irrigation with anti-microbial agents (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis.  Plaque is present as a very organized and protective bacterial community known as a bio-film http://www.biofilm.montana.edu/.  This bio-film is organized to the degree that we have not one, but two problems:  First, it may not be accessible with traditional non-surgical therapy; second, even if it is accessible with antibiotic and chemical agents, those agents may be unable to fully penetrate the plaque itself.  In this case, surgical access may be recommended. In the event surgical therapy is not possible, compromised control of damaging inflammation can be attained with medications. 
 

Perioscopy

This is a new technology developed for the treatment of periodontal disease. The perioscope is an endoscope that has been specifically designed to explore and visualize the pocket (space) under the gum of teeth involved with periodontitis. An image on a computer monitor shows the diseased tooth's root surface. The perioscope enables the clinician to see the contents of the periodontal pocket and to analyze the root surface of the tooth for disease, causing bacterial accumulations (plaque and calculus).

The perioscope guides the clinician during the process of cleaning the root surface free of plaque and calculus – the treatment for periodontitis. It also allows the clinician to identify other problems (cracks, perforations and other disease-causing flaws of the tooth root's surface) that are located under the gum – previously requiring surgery to detect. 

Pocket Reduction Surgery

When deep pockets between teeth and gums are present, it is impossible for you and your dental professional to thoroughly remove plaque and tartar with the gum tissue in place. Consequently, surgery may be needed to improve plaque removal and facilitate future oral hygiene access.
 
Traditionally, gum disease was treated by eliminating the gum pockets trimming away the surface gum tissue of deep pockets.  This was a painful method of treatment that has been largely replaced with new and more sophisticated procedures that we routinely use today.
 
Surgical therapy today involves reflecting back the gum tissue to fully see calculus (tartar) that is present on the root but not detected otherwise.  Resulting bone defects can also be evaluated and in some cases reduced with slight bone reshaping.  This procedure has a long track record as the most effective periodontal treatment to gain access to the diseased root and bone area, remove infection, reduce pocketing and set the stage for periodontal health. 
 

During this procedure, the gum and jaw bone is reshaped so that the gum tissue can sit tighter around your teeth and both you and the hygienist can more effectively and completely remove plaque.  This procedure is often performed using intravenous conscious sedation, so that the patient is completely comfortable, without any recollection of the surgery itself.  In cases of moderate to early severe periodontal disease without the possibility of regenerative therapy, osseous surgery is frequently the best treatment option available.  Waiting with this care until bone loss is too excessive results in compromised treatment results or the inability to fully treat bone defects.

As with any periodontal treatment, a lifelong commitment to regular professional care and maintenance is essential for a durable successful outcome.

Regenerative Therapy
 
In some cases rebuilding some of the lost bone can restore support of the teeth and reduce pocket depths.  Most techniques utilize membranes that are inserted over bone graft that is used to fill the bone defects.  Some of those membranes are bio-absorbable and some require removal.  Many times, determining whether regenerative therapy is possible can only be done at the time of surgery.
 
Bite Adjustment
 

Excessive biting contact on teeth may create inflammation that can hasten bone destruction during periodontal disease.  A bite is considered to be healthy when all or most of the teeth are present and not destroyed by normal daily usage.

It is destructive when teeth show wear, looseness or when TMJ (jaw joint) damage is suspected. Bite therapy helps restore a bite that can function without damage and destruction. The therapy may include:

ü       Reshaping the bite surfaces of the teeth to eliminate improper contact

ü       Occlusal guard therapy using a custom-fitted and adjusted plastic bite guard
ü       Braces, crowns, fillings, and replacement of missing teeth may be of recommended