Periodontitis – Teeth Supportive Bone Tissue Loss

Periodontitis – Teeth Supportive Bone Tissue Loss

Peirodontitis; is inflammation of alveolar bone that supports teeth.

When gingivitis is not treated correctly it transforms to periodontitis. We can think gingiva as a glass and alveolar bone under the gingiva as a table under the glass. If we start to fill the glass with water, the glass will contain a certain amount of water but then the water will overflow and moistens the table. In other words, when inflammation starts in gingiva, it may hold a certain amount of inflammation like the glass but afterwards if the inflammation keep continue it will proceed underlying bone tissue like overflowing glass and lead inflammation of alveolar bone. This inflammation leads bone resorption and migration of junction epithelium to more apical and transform ‘ supportive tissue loss’ in other words periodontitis.

Migration of junction epithelium to more apical related with long term alveolar bone loss due to ignoring oral hygiene in a long term period is called chronic periodontitis. In chronic periodontitis, attachment loss may be followed by;

Gingiva recession. In this case, there is supportive tissue loss. If the sulcus (gingiva pocket) is 3 mm or less, the tooth and sulcus can be cleaned by brushing but in most cases, gingiva can not follow the rate of apical migration of junction epithelium and the sulcus depth increases over 3 mm, in this case bone loss and apical migration of epithelium proceeds faster due to having areas that can not be brushed.

Some patients are more sensitive to intra oral bacteria and the destruction with bacterial plaque is more aggressive and frequent in those patients. Therefore, advanced tissue loss is observed in those patients in early age. Those type of bone loss is called aggressive periodontitis. Gingiva can not follow this fast bone loss in those individuals therefore they may not notice this problem until having advanced supportive bone loss and usually they notice this problem in their 30’s with mobility of their teeth. In those cases, the disease is progressed already and treatment is more difficult.  

Treatment of periodontitis is more difficult, complicated and expensive than gingivitis. Treatment is planned according to supportive tissue loss.

In initial period; there is attachment loss but the loss is limited with 1-3 mm. There isn’t any tooth mobility or there is 1. Degree tooth mobility. Mostly ‘Scaling’ and subsequently ‘curretage’ in other words scaling the inflammation inside gingiva under anesthesia is sufficient for treatment. However in some cases, ‘flap’ operation in other words arranging the form of gingiva and alveolar bone may be required additional to the curretage procedure. 

In moderate level attachment loss; the loss reaches 4-6 mm and mobility is 1 or 2. degree. Beside scaling and curretage procedures, regenerative treatments like grafting (bone graft) and membrane (membrane is used to cover bone graft) may be required.

In advanced level attachment loss; the loss increases over 6 mm and mobility reaches to 2 or 3. Degree and the disease is progressed to a level that may include tooth loss. In those cases, both treatment becomes more difficult and the cost is more expensive. However, success rate is decreased.