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Periodontitis or pyorrhea is a set of inflammatory diseases that affect the periodontal tissue, ie.tissue that surrounds and strengthens teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to loosening and loss of teeth. Periodontitis is caused by microorganisms that adhere to and proliferate on the surface of the tooth, along with too aggressive immune response to these microorganisms. Periodontitis is diagnosed by examining the soft tissue (gums) around the teeth with a probe (clinical testing) and evaluating the patient's x-ray (radiographic testing), which determines the amount of bone loss.

Periodontics (from Greek peri - around, odous - tooth) is the branch of dentistry that studies supporting structures of teeth, diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes gengiva (gums), alveolar bone, cementum and periodontal ligament.

Periodontal diseases

Periodontal diseases occur in a variety of forms, but are usually the result of merging of accumulated bacterial plaque biofilm and calculus and complex bacteria (eg. includes P. gingivalis, T. Forsitus and T. denticola) gingiva and teeth, combined with local immuno mechanisms and other risk factors that lead to the disintegration of the supporting bone structure around natural teeth. If left untreated, the disease leads to the loss of alveolar bone and teeth, and is still one of the most common causes of tooth loss in adults.

Initial therapy

Removal of microbiological plaque and tartar is necessary to ensure periodontal health. The first step in the treatment of periodontitis involves non-surgical procedure of cleaning below the gum which is called curettage of the hard and soft tissue (scaling and debridment). In the past, it was used to remove the modified cementum from the tooth root.

This procedure involves the use of specialized curettes so plaque and tartar below the gum can be removed mechanically. It is likely that in this case it may take several visits and local anesthesia. In addition to curettage, it is possible that the adjustment of the occlusion (bite) will be necessary to prevent excessive force on teeth that have a reduced bone support.

It may also be necessary to perform other dental procedures, such as replacing of inadequate dentures that detain plaque, closure of interdental spaces and any other requirements diagnosed during the first examination.

Flap surgery

Should non-surgical treatement fail to eliminate the symptoms of the disease, it may be necessary to perform periodontal surgery in order to prevent progressive bone loss and regenerate lost bone wherever possible. In the treatment of progressive periodontitis many surgical approaches are used, including the raising and processing of bone flap pockets, as well as guided tissue regeneration and bone adding. The goal of periodontal surgery is to allow access to the complete removal of tartar and surgical correction of bone irregularities due to the development of the disease, and to decrease pockets to maximal extent.

Long-term studies have shown that, in moderate to advanced cases of periodontitis that are surgically treated, patients have had fewer problems over time, and with a regular regime of postoperative therapy it can be successfull in preventing dangling teeth, in nearly 85% of patients.