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4 Phases of Periodontal Therapy

4 Phases of Periodontal Therapy

According to a 2012 report from the Center for Disease Control, one out of every two Americans over 30 has some form of periodontal disease. As we age, the prevalence rate increases to 70 percent. If periodontal disease affects half of the country, it’s time we do something about it. Our office offers an array of services aimed at mitigating this progressive condition. Here are the four phases of periodontal therapy.

It is important to note that we aim to solve the problem with the least of amount of invasive procedures. Which means that after each phase of therapy we will allow time for healing and then will assess the success of the treatment.

1. Prevention

While technically this is not periodontal therapy per se, we have to mention that periodontal disease prevention is always the best option. Daily brushing, and especially daily flossing, are key. So are regular dental appointments.

2. Non-Surgical Treatment: Scaling and Planing

If you have been diagnosed with periodontal disease, one of the first steps is to do a non-surgical periodontal cleaning treatment. This involves removing tartar and plaque buildup that has accumulated. We will remove the calculus (calcified plaque) that you are unable to remove at home with a toothbrush.

The best way to remove these hardened debris is with scaling and planing done by a dental hygienist.. A scaler is a hand-held instrument with one end that is shaped like a hook or curved blade. The hygienist will scrape off plaque with this edge. Ultrasonic scalers are also used and they are especially effective because they create tiny air bubbles and bacteria can’t survive in the presence of oxygen.

Root planing is the process of removing plaque that has accumulated below the gumline. Any time you are addressing an issue below the gumline is it considered subgingival treatment. Conversely, cleaning above the gumline is referred to as supragingival cleaning.

After this removal process, we will apply an antimicrobial solution to sanitize the area.

For many people, non-surgical procedures are successful and they can maintain gum health on their own with consistent hygiene habits.

3. Surgical Treatment 1: Pocket Reduction Procedures

If your periodontal disease has progressed to the formation of pockets of gum that are not snugly attached to the tooth, pocket reduction surgery can be done. These pockets need to be eliminated because they are breeding grounds for bacteria to accumulate and can eventually lead to bone deterioration.

Measuring the size of your pocket will help us know whether or not a pocket reduction surgery is needed. Pocket depth of 5 or more millimeters is typically cause for concern.

The procedure involves folding back your gum tissue, removing the offending bacteria and then securing the gum tissue back into place. This procedure is important not only because the bacteria needs to be removed, but also because when a pocket becomes very deep it is difficult for you to clean at home and reducing the size will make it more manageable for home care and prevention.

We also may smooth the bone tissue during this procedure to allow your gums to adhere more securely to your tooth.

We can also apply a special protein, enamel matrix derivative (EMD), to the area to biomimetically stimulate tissue regrowth.

4. Surgical Treatment 2: Gum & Bone Grafting


If pocket reduction techniques cannot successfully repair the damage done by periodontal disease, gum and bone graft procedures can be done. When it comes to gum grafting, we can use connective tissue taken from underneath a flap on the roof of your mouth and place it on the area that is receded.

We can also harvest gum tissue directly from the roof of your mouth, this is called a free gingival graft.

Yet another option is the pedicle graft method where we collect graft material from the gums adjacent to the tooth in need of repair. In a pedicle procedure and we cut away a flap, pull it over the receded area and then sew it back into place. This method is only feasible if you have plenty of gum tissue near the tooth.


Bone grafting is definitely the last resort option for attempting to repair the damage done by advanced periodontal disease. It is an intense procedure that should only be done if all other avenues have not yielded results. It is often done in conjunction or in preparation for a dental implant.

In a bone graft, we fold back the gums, clean out the bacteria and then bone tissue is inserted. The bone graft tissue is commonly harvested from your own chin or jaw. If more tissue is needed, it may be collected from the hip or shin bone. Synthetic material is also available or we can also use bone tissue from a cadaver or cow.

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