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Periodontology

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Overview
Periodontology is the branch of dentistry that studies periodontal tissues and correlated pathologies. It therefore deals with all the soft tissues (periodontal ligament and gums) and hard tissues (cement and alveolar bone tissue) surrounding the tooth, ensuring its stability in the alveolar arch.

Thus, the periodontist can assess the conditions of health of these tissues and implement therapies aimed at restoring optimal conditions to the oral cavity, essential for performing other operations such as prosthetics or orthodontics.
Periodontal disease (or periodontitis) begins when one or more elements of the periodontal apparatus, after having been colonised by numerous bacterial species, stop exerting their supporting role, causing tooth instability, considered by many as the genuine periodontal disease. This is an already advanced stage of the disease which could be prevented if more attention were paid to the evident signs that appear much earlier than tooth mobility.
It is impossible to say which element of the periodontal apparatus is the most important; however, alterations in the appearance of the gums are the most evident signs of periodontal distress, although these are often unfortunately only taken into account when periodontal disease is already at an advanced stage. In fact, the gums constitute the first obstacle and the first element to succumb to the attack of the microorganisms which, after having destroyed the gum-tooth connection, move down the root of the tooth, first damaging the periodontal ligament, then the cement, and lastly, the surrounding alveolar bone. Chronic periodontitis is always preceded by gingivitis which should be recognised in time and treated.
As far as the treatment of periodontal lesions is concerned, a series of more or less complex and radical clinical procedures can restore acceptable stability to the teeth when accompanied by adequate hygiene procedures at home.

 

How it works

Laser Assisted Treatment

In-depth studies have been conducted on laser treatment of periodontal disease, especially over the last 15-20 years. The Nd:YAG (1064 nm), KTP (532 nm) and diode (810 or 980nm) laser sources have been shown to be valid for various applications and protocols in one or more phases of periodontal disease.

It is important that all protocols for laser use are accompanied by correct clinical, radiographic, and if necessary, laboratory diagnoses (tests for phagocytosis, immunoglobulin and complementary or microbiological tests), as well as exemplary aetiological treatment (initial preparation), which are crucial conditions for the success of treatment.

The lasers normally adopted offer the enormous advantage of being conveyed in a fibre, which serves as the working tip at the end of the handpiece. The use of flexible, length-adjustable optical fibre also enables efficacious irradiation of the less accessible, deeper pockets.
The most frequently used optical fibre has a diameter of 300 µm. A very important feature is the irradiation at the end of the fibre itself. By reaching deep down into the pocket it can deliver the same quantity of energy to the root (infected cement) and also to the epithelial area (granulomatous tissue) of the lesion, performing a laser-assisted curettage with extremely deep and long-lasting bacterial decontamination.

The treatment of periodontal lesions using blind techniques is recommended in:

  • cases of relapsing lesions after traditional raising of a flap;
  • cases of patients with systemic pathologies who are not able or do not wish to undergo surgery;
  • all cases in which it can reasonably be assumed that exemplary aetiology treatment has been performed with no or imperceptible root residue deposits.

All cases of medium to severe periodontitis not included in the above-mentioned groups can be treated with open surgery and can benefit from laser-assisted treatment during the aetiological therapy and intra-operational phases for the microbiological decontamination of the bottom of the lesions and root cement.
In fact, laser has a powerful antibacterial effect even in the hard component of the pocket (root cement), producing an effective and long-lasting decontamination of periodontitis pathogens.
The demonstrated in-depth decontaminating action of laser inside the tooth tubules (Schoop et al."Innovative Wavelengths in Endodontic Treatment". Laser Surg Med 2006. 38(6):624-30) illustrates how laser-assisted treatment of the root cement can play a vital role in improving all the clinical parameters of periodontitis.