When diagnosed and treated early, gum disease can often be reversed and the oral cavity can return to health. If it is not intercepted early, however, gum disease can progress and cause irreversible damage to the structures that support the teeth. Gum disease that has progressed is called periodontitis and manifests as infection and inflammation that has spread beyond the gums and into the bone in the jaw, the ligaments that attach the teeth to the bones, and the roots of the teeth themselves. When these supporting structures are inflamed for an extended period, the teeth gradually loosen and inevitably fall out. When there are no teeth present in the bone to stimulate its health and growth, the bone continues to degrade and be reabsorbed in the body, which can cause additional teeth to fall out and perpetuate a cycle of disease and damage.
While the effects of periodontitis cannot be reversed, they can often be repaired. Dental implants are a popular option for replacing missing teeth, but when the damage from gum disease has destroyed the bone, there may not be enough bone present to support the implants. In this case, patients will need to undergo a bone graft or other restorative procedure to replace the missing bone and create a stable structure for effective, long-lasting dental implants. Patients with active gum disease will also be treated for their periodontitis, ensuring a healthy environment in the oral cavity. Dental implants are tiny screw-like posts that are surgically placed into the jaw, where they fuse together with the jawbone as the bone heals. Once they have fully healed and fused with the bone, a dental restoration is affixed to the implant and protrudes up from the gums, creating an attractive and sturdily functioning replacement tooth. Clearly, the health and integrity of the bone are instrumental to the success of dental implant treatment.
If there is insufficient bone present in the jaw, the patient will require a bone graft surgery before dental implants can be placed. Some bone graft procedures use a piece of bone that was removed from elsewhere in the patient’s body, usually either another part of the jaw or the hip, to replace missing bone at the intended implant site. Others use externally sourced natural or artificial bone. Once this bone has been transplanted, it will gradually be replaced with new bone, repairing the damage caused by advanced gum disease and decreasing the likelihood of additional teeth falling out. Once the new bone has fully developed and healed over the course of several months, the dental implant can be placed.
To place a bone graft, a periodontist will make incisions in the gum tissue and fold them back, exposing the affected area. Once the area is exposed, the periodontist will remove any infected gum tissue and clean away dental tartar and other bacteria. They will also smooth out any rough tooth surfaces that could encourage bacterial growth or affect the healing of the gums. Once the area is clean and free of disease, the graft is placed. The graft then works with the patient’s body to generate new bone growth. You and your dentist can discuss the different types of bone graft and determine which works best for your specific needs and preferences.
Each graft type is named based on the type of material that is used. An autograft uses bone from the patient’s own body, usually the hip or an area in the rear of the jaw. An allograft uses bone that came from a human donor, and a xenograft uses a bone that was derived from an animal; most xenografts used in periodontal surgery use cow bone. An alloplast uses synthetic grafting material made of minerals that occur in human bone, including hydroxyapatite and calcium. These medical-grade materials are all highly biocompatible and conducive to healthy bone growth.
Some periodontists use additional techniques to ensure the success of bone graft procedures. These techniques include the use of mesh membranes and growth proteins to enhance the natural ability of the body to regenerate tissue, including bone tissue. One of these techniques is called guided tissue regeneration. In this procedure, the periodontist places the bone graft and then inserts a tiny mesh membrane into the area between the gums and the bone. This membrane keeps the gum tissue out of the area where the bone is supposed to grow and allows new bone to grow into place unimpeded. Innovative techniques are continuously developed by clinicians and researchers, and new materials are introduced into the medical and dental worlds regularly. These innovations continue to show promise, confirming that guided tissue regeneration enhances the repair of defects caused by periodontal disease and aids in the regeneration of new, healthy tissues.
While these advances in treatment for periodontal disease are exciting and beneficial, the ideal scenario would be to not need new bone in the first place. Preventing gum disease can prevent the woes that come with tooth loss, and this can be a simple process with effective oral hygiene. To prevent gum disease and tooth decay, brush your teeth twice a day, using a soft-bristled toothbrush and fluoride toothpaste. You might think brushing well means brushing aggressively, but this is not the case; brush gently, in a soft, circular motion, taking care to massage the gum line while brushing away bacterial plaque and food debris. Your dentist can show you the proper technique if you’re unsure. Floss between the teeth daily, gently guiding the floss around the contours of each tooth and into the crevice at the gums. Daily brushing and flossing are imperative, and regular dental checkups are the other half of the equation. In its early stages, gum disease can be asymptomatic and painless, and it’s not uncommon for people to learn that they have gum disease at their dental checkup. When it’s treated early, it can often be reversed with a thorough cleaning and maintained oral hygiene – but when it’s allowed to progress, it gets worse. In addition, dental calculus, which is calcified bacterial plaque that can hide in hard-to-clean places, can only be removed by a dental professional using clinical instruments, so regular dental checkups and cleanings are a powerful part of the prevention of periodontitis and all the challenges it causes.