What is Dental Scaling and Root Replacement?
It is the most common and protective method among the treatments for gum diseases. In dental scaling, tartar and plaque, also called tartar, are removed. Plaque is a sticky substance and consists mostly of bacteria. Dental tartar forms when plaque hardens over time. Plaque and tartar adhere to the tooth surface, especially the root surface below the gum line. Root surfaces need to be smoothed as plaque tends to adhere to the rough surface. In this process, all dental stones are cleaned and irregularities on the root surface are eliminated.
When is it applied?
Scaling and root planing procedures are performed to remove plaque and tartar that cause gum disease. In the early stages of the disease, especially in gingivitis, this treatment is sufficient to control the condition. However, in advanced cases, this procedure may be the first step of treatment.
Preparation
Since this procedure may cause discomfort in some patients, local anesthesia can be applied to the area to be worked on.
What Causes Gum Disease?
The most important cause of gum disease is the sticky and colorless film layer called “bacterial dental plaque” that accumulates on the teeth. Removing dental plaque through daily brushing and flossing is a basic requirement for a healthy mouth. If plaque is not effectively removed from the teeth, it turns into an irregular and permeable structure known as calculus or tartar. Harmful products released by bacteria in plaque cause irritation in the gums. Due to these products, the fibers that firmly connect the gum to the tooth are destroyed, the gum moves away from the tooth and a periodontal pocket is formed. This makes it easier for bacteria and products to move into deeper tissues. As the disease progresses, the pocket deepens and the bacteria move deeper; It progresses to the bone and destruction begins in the alveolar bone that supports the tooth. If the disease is left untreated, the teeth will eventually become loose and may even need to be extracted.
How to Apply?
Ultrasonic tools and hand tools are used for scaling and root planing. Ultrasonic devices work with air pressure or electricity. It has two components. The first is a relatively blunt metal tip. This tip vibrates at high frequency and removes plaque and tartar from the tooth surface. The second component is the water flushing system, which helps cool the metal tip as it works and removes debris from the tooth. Hand tools have sharp edges and these edges are leaned against the teeth to remove tartar from the tooth surface. These hand tools are called scalers and curettes. They come in various shapes and sizes for different teeth and different surfaces of the same tooth, and they are not motorized tools.
First of all, large plaque and tartar are removed from the crown and root surface of the tooth with ultrasonic tools. hand tools are used to remove all remaining material and smooth the root surfaces. While the dentist is working below the gum line, he cannot see plaque or tartar. However, the roughness of the root surface guides it.
In the early stages of gum disease (gingivitis) or in cases where more advanced gum disease is localized in one part of the mouth (localized periodontitis), scaling and root planing are usually completed in a single appointment. If the patient has periodontitis, one half of the jaw is treated in a single appointment. Therefore, the treatment is completed in four sessions.
Things to Do After Treatment
There may be hot and cold sensitivity and mild pain that will disappear two or three days after the treatment. Painkillers can be used to eliminate pain. After scaling and root planing, antiseptic mouthwashes can be used, especially when there is pain that makes oral hygiene difficult. You should also continue brushing and flossing your teeth. There may be slight bleeding on the first day after scaling and root planing.
What are the risks?
After periodontitis treatment, gingivitis decreases and at the same time, gingival pockets that help hold bacterial plaque disappear. Therefore, if the treatment is successful, the gums will recede. The amount of gum recession depends on the initial depth of the gum pocket and the degree of periodontitis. After successful treatment, the greater the degree of disease, the greater the amount of gingival recession. As a result, parts of the tooth root are exposed, causing the tooth to appear longer and be more sensitive to cold and heat. To protect against root surface caries, it would be appropriate to maintain good oral hygiene and use a fluoride-containing gel recommended by your dentist.
If your doctor, who is concerned about your general health, has recommended you to use antibiotics before dental treatments, you should inform your dentist about this before scaling and root planing procedures.
What are Gingivectomy and Gingivoplasty?
Gingivectomy is the surgical removal of gum tissue. Gingivoplasty is the shaping of healthy gum tissues around the teeth. These procedures are performed by periodontists who specialize in dental tissues and gum diseases.
Where to use?
Gingivectomy is a treatment developed for the treatment of gum disease. Today, it is also used for aesthetic arrangements.
There are two reasons for removing gum tissue. The first reason is the presence of gum pockets formed between the teeth and gums. Difficulty in cleaning occurs due to the accumulation of food residues and bacterial colonies in these areas. If these pockets contain only gum tissue, they can be removed with gingivectomy.
In some cases, there may be too much gum around the tooth. This is a situation that prevents teeth and gums from being kept clean. It is also a cosmetic problem. In severe cases, it may affect chewing and speech. Some medications, such as epilepsy medications, can cause excessive gingival enlargement. Sometimes there may be no obvious reason.
Gums reshaped with the help of gingivoplasty have a more natural appearance. Disfigured or asymmetrical gums due to genetics, disease or trauma can be corrected with this procedure.
This procedure can also be performed solely for cosmetic needs. Gingivoplasty is usually performed alone. However, in some cases, it can also be applied after gingivectomy or graft application added to the gum at the gingival border.
Preparation
Your periodontist will inform you before the procedure about how to maintain oral hygiene after the procedure and other procedures that need to be applied. Scaling and root planing may be necessary to remove tartar from existing gum pockets.
How to Apply?
Gingivectomies and gingivoplasty are usually performed with hand instruments. But it can also be performed with electrosurgical instruments, laser and/or rotary instruments. Special instruments with angled edges are also used by the periodontist to reach the tooth area.
Local anesthesia is applied to numb the gums. Gingivectomy may take a few minutes or an hour. The length of time depends on the amount of tissue to be removed. Gingivoplasty takes a few minutes.
Things to Do After Treatment
After gingivectomy and gingivoplasty, a protective type of bandage is placed on the gums. This bandage should remain on the gums for 10 days after the procedure. During these 10 days when the bandage is on your gums, you should eat soft foods and avoid spicy and crunchy foods. Your dentist or periodontist will recommend pain medication and chlorhexidine mouthwash.
During the healing period, the inside of the mouth should be kept clean. Teeth within the surgical area should not be brushed while the gum is wearing a protective bandage. However, teeth in all remaining areas should be brushed and flossed. After the bandage is removed, the teeth in the surgical area must be brushed very carefully and softly. Bleeding in the healing tissues is normal during brushing and flossing after the bandage is removed.
The bandage is removed 7-10 days after the procedure. The gums regain their normal appearance within three or four weeks, but two or three months are needed for the tissue to fully heal.
What are the risks?
These transactions do not carry any major risks. Bleeding may occur, although rare. The risk of infection is also very low. Bleeding in the form of leakage may occur within the first 24-48 hours.
Soft Tissue Grafts
Gum recession may occur due to gum disease (periodontal disease), physical trauma (brushing too hard or too frequently with a hard-bristled toothbrush), position of the teeth and aging. If gum recession is severe, some of the tooth roots may be exposed. This condition can cause hot and cold sensitivity as well as root rot. It may also cause problems in terms of image.
In soft tissue grafts, more gum tissue is added to these areas to prevent future recessions. With the help of this process, the resulting root surface is covered and sensitivity is stopped. At the same time, the appearance of the tooth is also improved. People with very thin gums are likely to experience gum recession. Soft tissue graft can be applied to these people to prevent future problems.
Gum Flap Surgery
In gum flap surgery, the gums are separated from the teeth and folded temporarily. This way, the dentist can see the tooth root and bone.
In Which Situations Is It Used?
The purpose of gum flap surgery is to treat gum disease (periodontitis). This procedure is recommended for people with moderate or severe gum disease. If gingival infection cannot be eliminated by a non-surgical method, gingival flap surgery is used. Gum flap surgery can also be performed together with another procedure, bone surgery.
Preparation
First of all, all plaque and tartar around the teeth are removed and oral hygiene is improved. Your dentist or periodontist will check whether your general health or the medications you are using allow surgical procedures.
How to Apply?
The area is first numbed with local anesthesia. The gums are separated from the teeth with the help of a hand tool. Thus, the periodontist can directly access the roots and the bone tissue that supports the tooth. The infected tissues are then removed from between the teeth and from the holes (defects) in the bone. Scaling and root surface planing procedures are performed. If there are defects in the bone, they can be corrected by reshaping the bones. During this procedure, bone corners can be softened using the Er:YAG laser or rotary instruments.
After these procedures, the gums are placed back on the teeth and fixed with stitches. The surgical area is covered with a gum-protective bandage.
Things to Do After Treatment
After the procedure, it is possible to feel some discomfort. Painkillers prescribed by the periodontist can be used after the procedure. This will make you comfortable.
While the surgical area is healing, it is very important to keep the surgical area as clean as possible. You should continue to brush and floss your teeth in the remaining areas. If a periodontal bandage is used to protect the surgical field, plaque should be gently removed from the teeth. Antimicrobial mouthwashes with chlorhexidine are often prescribed after periodontal surgery. These mouthwashes do not remove plaque, but they do help kill bacteria and heal the mouth.
A small amount of swelling may occur. This can be prevented by applying ice compress to the treated area from outside the mouth (face). To prevent infection, antibiotics may be prescribed. The treated area is checked by the periodontist within 7-10 minutes.
What are the risks?
A small amount of bleeding and swelling may occur after surgery. There is also a risk of developing infection. Over time, gingival recession may occur in the surgical area. Treated teeth may become more sensitive to hot and cold. At the same time, root surface caries in the treated area may develop further.