Following cause-related therapy, a formal review of healing is completed to determine the effectiveness of treatment and the possible requirement for additional care.
In some situations, it is not possible to adequately clean the root surfaces via scaling and root planing alone. In these cases, there may be a requirement to “lift” the gum back to get better access to the root surface. If this occurs, it allows the Periodontist to do a number of things. It may be possible to reshape the gums and bone so that when closed up and healed, the gum no longer has a deep pocket. This is known as pocket reduction/elimination surgery. It facilitates easier home care and more comfortable (and potentially less frequent) professional maintenance.
Another approach involved is the use of regenerative materials. Emdogain is a protein gel, which when applied to the tooth root at the time of surgery, can stimulate the ligament cells to migrate up over the previously diseased root surface and create new periodontal ligament and bone.
This may be used in combination with mineral bone substitutes, which act as a scaffold for the regrowth of damaged bone.
Surgical procedures may be completed using the laser used for root surface decontamination and possibly tissue and bone re-contouring. This results in less discomfort, faster healing and a cleaner surgical field.
Following control of active disease, its long-term success is achieved with regular professional support care, in combination with excellent home plaque control. Maintenance therapy requirements vary from patient to patient, and may be anywhere between 3 and 12 monthly, although the vast majority of patients are 4-6 monthly.
Disease recurrence can and does occur in the absence of maintenance.
Prolonged periods without maintenance may make a second course of initial cause related therapy necessary, which everyone wants to avoid. Maintaining your gums is like maintaining your car: doing a little maintenance regularly is simpler and less expensive than waiting for a problem to occur.