Dental prosthetics

Periodontology deals with the prevention, diagnosis and treatment of pathologies affecting the periodontium, i.e. the set of tissues supporting the teeth (gingiva, periodontal ligament and bone).The most serious of these pathologies is periodontitis, which, if not adequately treated, leads to the loss of teeth, even if they are in perfect condition, due to the progressive reabsorption of the bone and gum tissue by which they are supported.

Bacterial plaque and tartar
Our oral cavity is colonised by more than 500 different types of bacteria that our body, by means of the immune system, manages to keep at bay until they become too numerous. If oral hygiene is neglected, plaque, a substance formed by saliva, food and fluids that is deposited on tooth surfaces, is rapidly colonised by bacteria that use sugars for energy and adhere more tenaciously to tooth surfaces.Plaque takes root mainly in interdental spaces, occlusal surfaces, enamel irregularities or near the gum and tooth (collar). When plaque accumulates and is not removed, it can crystallise and become tartar, which adheres firmly to the enamel and can only be removed by the dentist.Plaque and tartar bacteria produce acids and toxins that attack tooth enamel, damage the gums and cause periodontal diseases that destroy the periodontium.

What is periodontium
The periodontium is the set of structures that support the tooth and is formed by the gums, periodontal ligament, root cementum and alveolar bone. The gums are the set of soft tissues that surround the teeth and cover the alveolar bone; near the collar, the gum forms a small basin called the gingival sulcus.
The periodontal ligament surrounds the roots of the teeth, anchoring them with its fibres to the surrounding bone (the alveolar bone). Root cementum is a very strong calcified tissue that forms the outer covering of the tooth root; the fibres of the periodontal ligament are attached to it. The alveolar bone is the bone tissue around the teeth.The main function of the periodontium is to keep the teeth attached to the jaw bone tissue and to cushion mechanical stresses on the dental elements (e.g. during chewing).

Gingivitis
It is an inflammatory type of disease, quite common even in children, which can be cured easily if diagnosed in time. It is caused by particular types of bacteria, partly anaerobic (living in the absence of oxygen), and usually starts asymptomatically. Gingivitis manifests as reddened, soft gums that bleed when brushing the teeth.It is easily treated through dental hygiene sessions to remove bacterial plaque. Untreated gingivitis can become pyorrhoea and periodontitis, extending to the entire tooth support (periodontium) causing destruction and subsequent tooth loss.

Periodontitis
Periodontitis is a degenerative inflammatory disease that leads to the formation of gingival pockets and the destruction of the tooth's supporting tissues, i.e. bone, gingiva, cementum and periodontal ligament. Pockets are gaps between the tooth and gum that increase in depth when the gingival grooves, located on the sides of the teeth, attacked by significant inflammatory pathologies, react by forming gingival, or more correctly, periodontal pockets.Bacteria multiply in periodontal pockets producing toxins that destroy the cells responsible for bone reproduction, leading to bone resorption and consequently, instability and tooth loss. Cleaning the teeth is an important factor in preventing periodontitis, but there are many elements that predispose to the disease: smoking, stress, hereditary and hormonal factors, diseases such as diabetes or aids, drugs that induce salivation, dietary problems, poorly executed fillings and restorations, and dental malpositions.

Diagnosis of Periodontitis
Inflammation of periodontal pockets often has no obvious symptoms, so periodontitis can progress silently. However, there are certain symptoms that allow the disease to be detected. First of all, bleeding gums, chronic halitosis and tooth sensitivity to heat or cold. If the process is very advanced, diastemas, i.e. excessive spaces between teeth, recession of the gums and, finally, mobility of even apparently healthy teeth, appear. Obviously, it will be up to the periodontal specialist to determine the condition of the patient's periodontal pockets, because bleeding and swelling of the gums are not always caused by plaque and tartar, but may also depend on other conditions (pregnancy and breast-feeding, hormonal changes, blood circulation problems or taking anticoagulants). A vitamin C or K deficiency can also lead to gum bleeding.In addition, it should be remembered that there are certain conditions that can fuel gum disease, such as diabetic diseases, contraceptive therapies, taking cortisone and antidepressant drugs. Gingival pockets also form more easily in smokers, in stressed individuals and during adolescence, when fluctuating hormones favour the onset of gingival inflammation.Through specific radiographic examinations and periodontal probing, which consists of inserting a millimetric probe between the tooth and the end of the gum, so as to establish, in a totally painless manner, the depth of the pockets, the periodontist will be able to assess the stage of the pathology and the best method to treat it.

The treatment of periodontitis
Initial therapy includes professional oral hygiene sessions with plaque and tartar removal, elimination of caries and non-functional fillings, lifestyle control, reduction or elimination of smoking, and control of any metabolic diseases. Non-surgical mechanical therapy involves the removal of tartar and bacterial plaque from supra- and subgingival tooth surfaces (scaling) and the polishing of tooth and root surfaces.
It can be done at:
1. 'closed sky' (without dislodging the gingiva):
2. 'open sky' (by lifting the gingival flaps). In addition, all determinants of supra- and subgingival plaque (fillings, overflowing prosthetic margins, caries, tartar, contaminated root cement) are eliminated.
Treatment can be supported by local subgingival antimicrobial therapy with specific drugs.

Surgical treatment of periodontitis
Performed under local anaesthesia or under sedation, it is used to correct deep bone defects, periodontal pockets and to heal and remodel diseased areas.These operations serve to create a more accessible environment for home oral hygiene techniques as well as guaranteeing greater stability of the dental elements over time.The choice of the appropriate surgical technique depends on several factors including the severity of the disease, the type of bone resorption, the site where the disease occurs, and the patient's ability to cooperate. Surgical treatment must be considered as an additional means to non-surgical mechanical therapy. After surgical therapy, one can move on to possible prosthetic rehabilitation for full aesthetic and functional recovery. It is essential, however, that the tooth is absolutely healthy before this stage, otherwise both the teeth and the restoration will be lost over time.

Peri-implantitis
Peri-implantitis is a disease similar to periodontitis that attacks dental implants with the same microflora present in the periodontal pockets and developing the same loss of supporting bone tissue.For this reason, it is of paramount importance to place implants in a mouth that is not affected by periodontitis because the same bacteria can easily migrate from a tooth to an implant. This is not to say that implants cannot be placed in a patient with periodontitis, but simply that natural teeth must be cared for before implant screws are placed, decontaminating the tissues of bacteria that will be removed through oral hygiene and laser sessions.


Consequences of periodontal disease
A strong link between the effects of chronic inflammation of the oral pathway and overall health has been demonstrated.Patients suffering from periodontal disease develop alterations in inflammatory parameters of the entire body, which can also be detected at the blood level, so much so that it is suggested that inflammation localized at the level of the gingiva may extend to the entire body.In fact, these patients present with higher values of white blood cells, protein and other inflammatory parameters. Because of these inflammatory mechanisms, periodontal disease is considered a risk factor for the development of systemic diseases, and conversely, certain systemic diseases can have a major impact on oral health.There are more than 100 systemic diseases that have oral manifestations such as, for example, cardiovascular disease, stroke, respiratory infections, pancreatic cancer, diabetes, and nutritional problems. Having consistently high inflammation should be considered a favorable element for the development of atherosclerotic disease and myocardial infarction.


Periodontology and prevention
Preventing periodontitis and tooth loss is possible.The actions and behaviors to be put into practice, from an early age, are simple and can prevent and recognize at the first symptoms of diseases of the teeth and mouth.Prevention begins at school age, when the first molars emerge at age 6 and the permutation of the incisors takes place. It is essential to teach children basic oral hygiene techniques and effective plaque control.An orthodontic evaluation, prevention of malocclusions and bone defects, should also be performed.After the eruption of permanent teeth, it is important to always check the condition of the gums. If they are red and bleeding, it is best to have a specialist visit to a periodontist. Bleeding gums is a very strong indication of active periodontitis.Do not underestimate the importance of professional hygiene, which should be performed at least every 4/6 months. Reduce cigarettes to no more than 3 or 4 per day and abolish cigars and pipes.Smoking increases the risk of losing teeth to periodontitis 7 to 10 times, and treatments are less effective with smoking. Perform specific medical checkups in case of diabetes, atherosclerosis, and osteoporosis.Do not underestimate the role that toxins and the bacteria themselves, which constantly enter the bloodstream, can play in these diseases.In fact, many systemic diseases are related to periodontitis.It should always be remembered that to resolve periodontal infection, it is not enough to remove teeth and replace them with titanium implants.The same bacteria that cause periodontitis also affect implants, causing peri-implantitis, and the loss of implants.