Surgery: restoring health to the gums and the bone
Periodontal surgery deals with restoring health to the gums and bone. It is used to intervene when conservative methods (such as polishing, scaling, root planing and curettage) are not sufficient to eradicate periodontal diseases (periodontitis or pyorrhea) or because the problems afflicting the patient are too severe. In these cases, the dentist practices minor surgery, called flap surgery, that corrects the contacts between the bone and gums. In certain cases, this type of intervention can be carried out, with excellent results, by using a laser alone. In the most serious cases, the intervention requires reshaping gums against a tooth's hard tissues: bone support. This remodelling involves reconstructive bone surgery or restorative techniques. The latter approach entails the insertion of synthetic bone in order to recreate lost supporting tissue. The dental surgery also undertakes the extraction of teeth, particularly the germectomy of wisdom teeth. Germectomy is the removal of the tooth when it is in the process of formation into bone and it is performed mainly in boys and girls who are undergoing orthodontic treatment in order to avoid the recurrence of tooth misalignment (malocclusion) that can occur even after several years. A laser is very useful if it is necessary to perform a frenectomy (removal of a small flap of tissue between a lip and the gum) on a child. A laser gives the doctor the chance to use very little anaesthesia and avoids intra-operative bleeding and post-operative pain so that paediatric patients are not traumatized by the intervention and they are unlikely to fear the dentist on subsequent visits. Additionally, a laser is very useful in the surgery on the soft tissues of the mouth such as for the removal of small polyps formed inside of the cheeks or gums or growths (epulis) that are formed as a result of trauma to the gums. Both, Dr. Riccardo Mannoni and Dr. Anna Mazzaglia are able to perform all types of surgery, having acquired over time the dexterity and expertise to cope with even the most complex cases that arise in daily dental routine.
Gingivitis affects the gum line and is characterized by a reddening of the gum line, swollen gums, bleeding on probing, and sometimes by increases in gingival volume. It is a bacterial inflammation that affects the periodontium surface, localized or generalized, usually involving the taste buds, the gingiva and the free gingival margin. If left untreated, it can develop to more serious forms and can evolve into periodontitis, leading to the loss of the deep tissue that supports the tooth. As it is often painless, gingivitis can progress without you realizing until the gums and bone are seriously damaged. It is, in fact, one of the most common causes of tooth loss in adults. Gingivitis is completely reversible, but may precede a periodontitis.
Gum receding on upper incisor.
During the same sitting, the frenulum is disengaged so that it is no longer traumatic for the attached gingiva, and the defect is resolved with a free gingival graft taken from the palate.
Healing after 15 days: you can see a small remnant of the frenulum that is removed by laser.
With the removal of the apex of the tooth, the infected part is removed and there are no more recurrent infections.
You can be healed of pyorrhea or periodontitis after a series of small interventions.
Periodontics: preventing and curing all gum diseases
Periodontics is responsible for preventing and curing all gum diseases. In mild cases of periodontitis can be dealt with by applying conservative methods of cleaning that remove the sub gingival calculus, a procedure that only a well-trained operator can carry out. This first phase is called "curettage" and is accompanied by scaling and root planing (the removal of tartar from the sick gum and root polishing). This is a particularly delicate phase and must be performed under anaesthesia by the dentist, who uses both manual tools and a laser together with antibiotics (tetracycline) that will disinfect the pockets. The dentist takes care to follow the patient during the healing phase and makes a re-evaluation after 20-30 days to determine whether this type of therapy alone has been effective enough to cure the gingival inflammation.
Periodontics also takes care of gingival recessions, that is, those parts of the root where the gum has withdrawn, exposing a part of the tooth whose collar has become sensitive. Recessions can be cured with gum grafts taken from the palate and/or by the covering of the roots via connective tissue grafts. Dr. Anna Mazzaglia has passionately followed the developments in this aspect of dentistry for years and keeps up to date through internships in Italy and abroad.
An abscess is an infection with the production of pus, accompanied by more or less intense inflammation of the periodontium and alveolar bone. The presence of an abscess requires the dentist to determine the cause, which could be a granuloma or an endodontic-periodontal pocket.
A granuloma is the result of an infection at the apex of a tooth. It can be cured by treating the infected canal with washes and endodontic instruments. If untreated, a granuloma can develop into a cyst in apex and this can lead to the loss of the affected element. It is a region of local infection that must be removed for the health of the patient.
Deep gum receding on upper right incisor, which can be improved with a gum graft.
Healing after 15 days. The mucus of the graft has become equivalent to that of the receiving site.
Periodontal disease starts out as a simple gingivitis that, if left untreated, can escalate over time, ranging from a few months to a few years, in a full-blown periodontal disease, with bone loss. It is a chronic disease and its performance proceeds to an "advanced" phase with peaks of activity and rest. Unlike tooth decay, which can be treated in one session, periodontal disease requires careful monitoring over time because it is a disease subject to relapses and, if not detected and treated, it leads to tooth loss.
Upper incisors severely compromised by a "periodontal disease": The teeth are moving.
The incisors and canines were stuck with one splinting: the wire is immersed in the composite to make it invisible while simultaneously uniting and strengthening your teeth.
Thanks to the material, nothing can be noticed from the outside. The gap between the central and lateral incisors was also closed, and the beauty of the smile is recovered.
Endodontics: Care of root canals
Endodontics deals with the treatment of root canals, for example in a situation , where a cavity has reached the pulp of the tooth and infected it, leading to a related toothache., The dentist has the task of devitalizing the tooth, that is, to replace the infected pulp with root canal filling material. To do this, the dentist needs to shape the inside of the tooth. This can be done by hand or preferably with Ni-Ti instruments (titanium nickel) whose flexibility provides access to more difficult areas. A laser is useful for the disinfection of infected canals, particularly of those teeth that have recurrent abscesses or that are resistant to traditional therapies. Both Dr. Riccardo Mannoni and Dr Anna Mazzaglia have drills suitable for operating Ni-Ti instruments, which because they are very sophisticated, cannot be used with standard drills.
Reprocessing of a lower molar where there is a granuloma and a post-implant.
Devitalization of the two central incisors before proceeding to building of a ceramic veneer.
Pulpitis is the inflammation of dental pulp tissue. Usually it is associated with toothache.
For this patient, a pulpitis was found after root canal treatment of a molar. As you can see, the infected tissue is rather large and it perfectly fits the shape of the pulp chamber.
X-ray of a root
Pediatric Dentistry: Care of milk teeth
Paediatric dentistry deals with the treatment of deciduous teeth (baby teeth) in young patients and with the prevention of caries during the transition from child to adult dentition. It requires infinite patience from the dentist because children are often intimidated by surgery and the stories they hear in the family. The primary task of the dentist is to reassure the young patients and then provide them with the care they need. The cures range from fillings to root canals of deciduous teeth to the sealing or extractions of deciduous molars that sometimes prevent the proper eruption of permanent teeth. Dr. Anna Mazzaglia uses various aids to put young patients at ease. There is a booster pillow that makes the chair suitable for children. A monitor mounted on the dental chair screens cartoons. Drills offer a particular angle that allows operating in the mouths of patients as young as two or three years old. The instrumentation is also of sufficiently small to be suitable for the size of milk teeth. At the end of therapy, the child receives a certificate of bravery to show to parents and a small toy, so that the child will have a positive memory of the clinic.
Fillings can be carried out even if a child is wearing braces.
Deciduous teeth or milk teeth are an individual's first set. Milk teeth are essential for proper development of the jaws and are pushed out by the eruption of permanent teeth. The first milk teeth are the lower incisors, which appear at around 6/8 months; the last deciduous teeth, which are replaced at around the age of 12, are the canines.
It is important to pay attention to the eruption of 1st permanent molars at around 6 years of age. These teeth erupt behind the milk molars and it is often only the dentist, during follow-up visits, who becomes aware of their presence.
It should be advisable that children have a first check-up at around 3-4 years of age and, from then on once a year until the age of 6. After that, it is essential to visit every 6 months.
A dentist can seal the grooves of the permanent molars or can locally apply high concentrations of fluoride so as to prevent the occurrence of caries.
It is important to prevent your children from consuming too much sugary food or drink as these lower the pH of the saliva, causing decalcification of the enamel, which can result in the onset of caries.
Avoid the use of a pacifier sweetened with sugar or honey.
With the laser, the children do not feel any pain and do not see any blood.
After the frenulectomy, you can see that there is no bleeding and no stitches. Five days after treatment, the wound is already practically healed.
Caries of a milk molar tooth filled with composite material.
Complex composite fillings performed on a deciduous molar.
Number of molar fillings carried out using Ketac.
Removing the plaque and tartar
Hygiene, scaling or deep teeth cleaning are the cornerstone of the prevention of dental disease. Thanks to these treatments, tartar above the gum can be removed. The build-up of tartar is the primary cause of gum diseases and a source of bad breath. It is also the main cause of all teeth decay or cavities. Our hygienist is Mrs Giovanna Aganetto who, after substantial training, performs all scaling and plaque removal plague for our patients. Her role is to advise and instruct on a specific home care routine, suited to your individual needs.
Patients with periodontal problems or fixed denture wearers should use small cylindrical brushes that go well into the wide interdental spaces. Also a spongy thread that can go under the elements of the intermediate bridges can remove coarse food residues. Use of an oral shower (water jet) complements good hygiene at home. Fluorine, administered both in pregnancy and in children under 12 years of age, makes teeth more resistant to decay.
There are various types of substances that can augment the treatment of oral diseases. Chlorhexidine and hexetidine mouthwashes are useful for lowering the bacterial load, Mouthwashes based on fluorides serve to limit the sensitivity of teeth, and those based on essential oils improve halitosis.
For teeth, toothpaste has a detergent power comparable to that of the soap. surfactant elements entrap particles of dirt.
A toothpaste must have a low abrasive, especially in the presence of gingival recession.
This power is expressed by a code and a number: RDA 50 indicates a high abrasiveness, 25 indicates a low level.
Toothpastes are of various types for specific oral problems. Those based on fluorine are especially useful for combatting caries as fluoride has the ability to bind to the enamel of the teeth, making it harder.
Toothpastes for sensitive teeth, however, contain stannous fluoride, which closes the dentinal tubules, helping to counteract the sensitivities.
Whitening toothpastes have a high abrasive power and should be used sparingly. Used occasionally, they can be used to remove stains from tea, coffee and smoke. There is no point in using them routinely in the hope of changing the natural colour of the teeth. The increased shine they give is only due to the abrasion of the surface layers of the tooth, and, in the long run, this results in a greater sensitivity to hot and cold.
It is the basis of oral health. It is practiced at home with a toothbrush, toothpaste and dental floss, and in the clinic with scaling. It is advisable to schedule a check-up at the practice for every 6 months, or even more frequently depending on the advice of the dentist.
A toothbrush properly used three times a day (after meals) and for three minutes per session ensures the well-being of your teeth and our gums. The toothbrush should preferably have medium hard synthetic bristles, or soft in the presence of periodontal problems.
Your toothbrush should not be very large but of a size that lets you easily reach all the surfaces of the teeth. Worn-out toothbrushes not only provide poor oral hygiene but can also damage the gums. Normally you should change your toothbrush every 2 to 3 months or when the bristles are bent or worn. It is very important to brush your teeth gently. Very energetic movements or the use of toothbrushes with bristles that are too hard or worn out can cause gum irritation or tooth abrasion. The toothbrush must be recommended by your dentist in addition to proper brushing techniques.
Tartar can be defined as a set of solid deposits and calcification that are located both above and below the gum. The deposits above gum can be removed with a simple scaling; those below gum are removed by the dentist with the use of curettes. Because of their porosity and roughness, deposits of tartar favour encourage the settlement of the plaque and the subsequent occurrence of periodontal disease.
Laser: treatment of soft and hard tissues without pain
The ND: YAG laser is a latest-generation device that assists the clinician in the treatment of soft and hard tissues. It is very useful in the treatment of periodontal pockets, for the disinfection of s particularly infected canal, and for perform surgery in situations where it can replace the scalpel. As an example of this last use, it is very helpful in frenulectomy because it allows the removal of the frenulum without bleeding or the use of stitches. These benefits are extremely advantageous for children who need this type of intervention without any type of negative consequence (burning, pain, and swelling).
A laser is also very useful for the excision of polyps, due to trauma inside the cheeks, or growths. It eliminates the bacteria in root canal treatments, reducing the risk of granulomas, reduces the need to use anaesthesia in surgery, and eliminates the drawbacks of post-operative problems (pain and swelling). Lasers are also useful in the treatment of canker sores and oral herpes.
A small operation performed with the laser on a lower molar. The gum does not bleed.
The wisdom tooth is not completely extruded. Since the gum becomes inflamed frequently, it was decided to remove the tooth by laser.
It can be noted that the surgery performed with a laser gives little bleeding and sharp cut. Also the wound-healing time is significantly reduced.
Photography of the polyp.
Test lead of the laser. You can see the red laser light guide.
Mucosal appearance after excision: you can see the complete absence of bleeding and the sharpness of the cut.
Report after excision.
Check after 7 days: notice the perfect re-epithelialisation of the mucosa.
Removal of the upper labial frenulum with the laser.
You may notice the precision of the cut and the complete absence of bleeding, which avoids the use of sutures.
Healing after 5 days