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.
Scaling & Root Planing
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.
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 chemical agents to encourage healing.
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. 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.
“Current controlled studies have shown that similar results have been found with the laser compared to specific other treatment options, including scaling and root planing alone. Scaling and root planing is a traditional non-surgical therapy used to treat periodontal diseases.” American Academy of Periodontology Statement
American Academy of Periodontology best evidence consensus statement on the efficacy of laser therapy used alone or as an adjunct to non‐surgical and surgical treatment of periodontitis and peri‐implant diseases (25 April 2018) (Mills_et_al-2018-Journal_of_Periodontology). This is an exhaustive review of all quality studies available and looks at lasers of all wave lengths. Conclusions:
“Current evidence fails to demonstrate a beneficial long‐term (> 48 months) effect of laser treatment used as an adjunctive therapy to non‐surgical treatment in providing a more maintainable environment.”
“There is little convincing clinical evidence that adjunctive laser curettage produces a result superior to adjunctive
mechanical or chemical curettage, or even scaling and root planing alone. Current evidence suggests that therapies
intended to arrest and control periodontitis depend primarily on effective root debridement.”
FDA approval/clearance through 510(k) requires only data showing safety of use; it does not require published clinical trials and/or related studies showing efficacy of treatment.
Dr. Helm currently feels studies do not substantiate the added treatment cost and discomfort of lasers to patients. At this time he does not use a laser to treat periodontal disease. He reviews specialty journals for the latest studies to be sure his care is well founded, safe, and as predictable as possible.
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.
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.
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:
- Reshaping the bite surfaces of the teeth to eliminate improper contact
- Occlusal guard therapy using a custom-fitted and adjusted plastic bite guard
- Braces, crowns, fillings, and replacement of missing teeth may be of recommended