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Periodontology in Kensington

Maintain a fresh smile
Prevent loosening and losing your teeth
Correct your receding gums

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What is periodontitis

Gum disease (periodontitis) refers to an infection-induced inflammatory process involving tooth-supporting structures.

This most common human oral disease is caused by certain bacteria which start to increase in number and virulence when the related risk factors such as multiplying bacterial deposit can grow undisturbed under the unreachable gum pockets while producing by-products which may stimulate the body's defensive inflammatory response in the around the teeth. This inflammatory chronic disease may progress and cause gradual bone destruction over the years when untreated efficiently.

How the progression of periodontitis can be recognised

The inflamed gum called gingivitis may be recognized as red, swollen and bleeding gums during brushing due to remained discoloured layer of bacterial plaque on the teeth.

In some individual gingivitis may progress to gum disease (periodontitis) when untreated. Consequently, you might experience some changes over time such as Increased gum-bleeding during brushing or eating, bad breath, drifting teeth, gum recession, and tenderness in the gum.

Controversially, bleeding from the gums may be less noticeable in smokers, as nicotine has an adverse effect on blood vessels by reducing the local blood circulation and as a result reduced bleeding in diseased gum.

The presence of periodontitis can be left unrecognized until its very late destructive stages. Therefore, it is paramount that a dentist or a more specialised clinician such as a gum specialist (periodontist) will detect the specific signs and symptoms of the gum disease at an early stage of its progression in order to be able to treat and monitor the health status of periodontal tissues.

Causes of Periodontitis

Inadequate teeth cleaning leads to accumulation of bacterial deposits (dental plaque) adjacent to the gums, which gradually may enhance the number and virulence of the bacterial colonies while reducing the natural local tissue defences.

The growing soft bacterial plaque can be combined with minerals over the time building up a harder deposit called tartar (dental calculus) which further encourages the growth of the bacterial plaque along the tooth roots surfaces causing an inflammatory process and destruction of the peripheral healthy tissue and a periodontal pocket around the gum as a result. The bacterial infection-induced inflammatory process which causes progressive destruction of the tooth-supporting/periodontal tissues is called periodontitis.

The pathologic pocket around the root surface favour the colonization, growth and multiplication of the virulent bacteria which are capable to destruct the tissues both directly by releasing enzymes, toxins and other bi-products the body's defence mechanisms, and indirectly by inflammatory stimulation of the local immune system.

Among the factors involved in the progression of the periodontitis, the number and type of virulent bacteria, the ability of the individual's local and systematic defence mechanisms coupled with the tissue healing capacity, the presence of the other risk factors such as smoking, stress, systematic disease e.g. diabetes, and certain drugs regulating the tissue response has been recognised.

Prevention of the Periodontal Disease

Factors prevailing the chronic gingivitis should be recognised and addressed during professional dental and periodontal examinations and treatment sessions.

The risk factors for periodontitis

Recognised factors involved in the development and progression of periodontitis may be disease compromised the local and systemic health status such as diabetes, as well as stress, and smoking.

It is scientifically well-proved that smoking adversely affects the status of the local health, healing, and immune response of periodontal tissues and successful treatment of gum disease as a result.

Before
After

Treated Advanced Generalised Periodontitis followed by the Restorative correction of the advanced Gum recession

Based on the case studies, clinical research, and epidemiological studies there are strong evidenced-based associations between periodontal disease and cardiovascular disease (CVD).

https://www.efp.org/fileadmin/uploads/efp/Documents/Campaigns/Perio_and_Cardio/Recommendations/Perio_cardio-Recomm-01-OralHcTeam.pdf

The rationales behind these reports are mainly association studies which support:

  • The higher incidence of pathogenic periodontal bacterial release to the bloodstream called bacteraemia with deleterious biological impact on the systemic and general health status
  • Some spices of the site-specific periodontitis pathogens (e.g. Porphyromonas gingivalis) are associated with the formation of Atheroma and development of Atherosclerosis
  • The cross-reaction of some cardiovascular-specific antibodies (e.g. anticardiolipin) with cardiovascular system leading to CVD

https://www.efp.org/gum-disease-general-health/perio-cardio/animations/

The association studies suggest a higher level of:

  • Periodontitis-released cytokines and inflammatory mediators in patients with CVD
  • Thrombotic factors e.g. fibrinogen
  • Increased CVD. Risk factors e.g. Cholesterol, LDL, Triglycerides, VLDL, Oxidised LDL, etc.
  • Both Periodontitis and cardiovascular disease have co-genetic risk factors or genetic predisposition.

The epidemiological evidence, and the consensus report from by the perio-cardio Workshop & and the World Heart Federation (WHF) Global Heart held by EFP (The European Federation of Periodontology) in Feb. 2019, predict an increased future risk for atherosclerotic cardiovascular disease and make the basis for the Perio-Cardio Campaign.

https://www.efp.org/fileadmin/uploads/efp/Documents/Campaigns/Perio_and_Cardio/Recommendations/Perio_cardio-Recomm-01-OralHcTeam.pdf

Multiple gene-expression on chromosome 9 has been demonstrated to be linked to Type-2 diabetes and Alzheimer's Disease.

Gum infection linked to Alzheimer's disease, a new study suggests

Ashley May USA TODAYPublished 12:41 PM EST Jan 27, 2019

https://eu.usatoday.com/story/news/health/2019/01/25/gum-disease-could-cause-alzheimers-disease-new-study-claims/2675823002/

Chronic periodontitis is associated with erectile dysfunction: a case-control study in a European population

Amada Martín, Manuel Bravo, Miguel Arrabal, Antonio Magán-Fernández, Francisco Mesa J Clin Periodontol. 2018; 45: 791-798.

https://www.efp.org/publications/jcp-digest/jcpdigest-2018-7-45-7-791-798.pdf?ga=bmo022019

1) How old are you?
2) Are you male or female?
3) Are you a smoker?
4) Do your gums often bleed when you brush your teeth?
5) Have you noticed that your teeth are becoming loose?
6) Have you noticed the presence of receding gums or do your teeth seem to be "longer"?
7) Do you have regular checkups (at least once a year) at your dentist’s for normal professional cleaning of your teeth?
8) Do you use dental floss and/or interdental brushes on a regular basis?
9) Do you suffer from heart disease, osteoporosis, or diabetes?
10) Has your dentist ever told you that you suffer from gingival problems, gum infections, or inflammation?
11) Have any of your teeth ever been extracted for periodontal reasons or because they were too loose?
12) Does anyone in your family have, or have they had, problems with their gums (pyorrhoea)?
13) Do you think you have, or have you been told that your breath is not pleasant?

With careful assessment and treatment, it is usually possible to completely halt the progress of periodontitis. The key to success is to eliminate the bacterial plaque which is triggering the periodontal disease process and to establish excellent oral hygiene practices.

Please refer your question regarding Periodontal Disease & Treatment to the following European Federation of Periodontology & implantology website: https://www.efp.org/gum-diseases/video-resources/

We provide the following periodontal specialist services:
  • Clinical assessment, diagnostic, treatment of the patient with aggressive and chronic periodontitis
  • Diagnosis and treatment planning for patients with the oral manifestation of systemic disease
  • Clinical assessment, diagnostic, treatment of young patients who require pre-orthodontic surgical tooth exposure, and patients who require post-orthodontic surgical soft tissue and hard tissue regenerative procedures.
  • Clinical assessment, diagnostic, treatment of patients who require post/endodontic and/or pre-prosthodontic root amputation and crown lengthening.
  • Clinical assessment, diagnostic, treatment of patients with clinical periodontal disease symptoms in need of occlusal re-organization by means of fixed and removable prosthodontics
  • Clinical assessment, diagnostic, treatment of patients presenting with peri-implantitis

At London Specialist Dentist, we implement Triple-Wavelength-Technology using the latest generation of LASER in dentistry.

SiroLaser Blue is equipped with a high-tech laser versatility module in Laser Dentistry by providing three different forms of laser in one single device.

SiroLaser Blue wavelength of 445 nm provides the best surgical cutting efficiency of all dental diode lasers.

SiroLaser Infrared wavelength of 970 nm is effectively used in the decontamination of infected periodontal, peri-implant pockets, and infected root canals, as an adjunct to the mechanical and chemical debridement within the periodontal, peri-implant, and Endodontic treatment protocols.

This means the indication for adjunct use of antibiotics and their consequent side effects is drastically reduced.

The laser-assisted periodontal therapy (LAPT) results in improved periodontal health with minimal discomfort following both non-surgical or surgical periodontal treatment intervention.

During endodontic treatment, LASER is utilised after preparing and rinsing the root canal in addition to the conventional treatment.

The red wavelength of 660 nm is perfect for Photo-biomodulation (PBM) or Low-Level-Laser-Therapy (LLLT)

Photo-bio-modulation works through the application of photon energy of light to the tissue.

It passes through the skin barrier and is absorbed by the cells where it initiates physiological reactions within the mitochondria.

Photo-bio-modulation is associated with Improved wound healing & surgical tissue regeneration as well as reduction of acute and chronic pain in Temporomandibular joint dysfunction (TMJD)

For further information about the diagnosis, and treatment of periodontal disease, please see the following links:

https://www.bsperio.org.uk/patients
https://www.efp.org/for-patients/

Periodontal Treatment

Epidemiology of periodontal diseases

Approximately 5% to 20% of any population suffers from severe generalized periodontitis even though moderate periodontal disease affects a majority of adults.

Treatment with Straumann® Emdogain
Treatment with Straumann
Treatment with Straumann
Treatment with Straumann
Treatment with Straumann
Treatment with Straumann
Treatment with Straumann
Treatment with Straumann
Treatment with Straumann
Treatment with Straumann
  • Conditioning of root surface with Straumann® PrefGel.Application of Straumann® Emdogain (timescale: seconds).
  • Amelogenins precipitate out and a matrix layer on the root surface is formed (timescale: seconds).
  • Formation of blood coagulum of fibrin and erythrocytes. Replaced by granulation tissue. Serves as the skeletal structure for wound healing and regeneration (timescale: hours).
  • Adduction and proliferation by mesenchymal cells (timescale: days).
  • Cells secrete natural and specific cytokines and autocrine substances which promote the required proliferation (timescale: weeks).
  • Attraction and differentiation to cementoblasts. Begin of formation of cement matrix in which desmodontal fibres will be fixed (timescale: weeks, months).
  • Anchorage of desmodontal fibres in the root surface (timescale: months).
  • Filling of defect with newly formed desmodontal tissue (timescale: months).
  • In connection with the processes, new alveolar bone grows on the root surface and into a defect gap (timescale: months).
  • Regeneration of the desmodontium, building of new functional attachment.
Clincal Indications
1. Treatment of periodontal Intrabony defects
Single-wall defect Treatment of periodontal
Two-wall defect Treatment of periodontal
Three-wall defect Treatment of periodontal
Treatment of periodontal
Treatment of periodontal
Treatment of periodontal
Treatment of periodontal
Treatment of periodontalFirst visit
Treatment of periodontal8 years after treatment
Courtesy G. Heden, Karlstad (Straumann Education)
2. Treatment of periodontal Furcation defects
Degree I. Treatment of periodontal
Degree II. Treatment of periodontal
Degree III. Treatment of periodontal
 Treatment of periodontal
Treatment of periodontal

Characteristic of Severe furcation involvement:

  • horizontal bone loss
  • highly avascular target area
  • mesenchymal cell source far away
  • proper debridement difficult / impossible
Class II mandibular furcation defect

with minimal interproximal bone loss

Treatment of periodontalBaseline
Treatment of periodontal12-month follow up
Treatment with Straumann® Emdogain
3. Treatment of periodontal Recession defects
Treatment of periodontalStraumann® Emdogain in conjunction & Coronally Advanced Flap (CAF)
Treatment of periodontalSubepithelial connective tissue graft with CAF
Surgical Procedure
Surgical Procedure
Surgical Procedure
Surgical Procedure
Surgical Procedure
Treatment of wider intrabony periodontal defects: Scaling, root planning, and conditioning
Surgical Procedure
Surgical Procedure
Surgical Procedure
50% of 0,7 ml Syringe on root surface; 50% mixed with Straumann® Bone Ceramic Suturing; Straumann® EMD Plus application
Pre-surgical procedure
  • Careful patient selection:
  • Oral hygiene, smoking etc.
  • Cleaning, scaling, reducing degree of inflammation
  • Follow up after 2-3 months, measurement of PD, tooth stability
  • Periodontal disease has to be eliminated
Pre-surgical procedure
  • Remove any remaining plaque and/or calculus as well as blood from root surfaces exposed during
  • periodontal surgery
  • Apply Straumann® PrefGel onto exposed root surfaces for 2 minutes
  • Rinse thoroughly with sterile saline solution
  • Avoid recontamination of the conditioned root surfaces after the final rinse and prior to treatment with Straumann® Emdogain
Postsurgical follow-up & maintenance

Day of operation:

  • Start rinsing with chlorhexidine solution (0,2 - 0,12%)
  • Refrain from/minimize smoking
  • Do not brush the area of the operation
  • Avoid hard and crispy food
  • (Antibiotics, if deemed appropriate based on the clinician’s judgement)
  • Wound stability & infection control

Week 1 postoperative:

  • Removal of sutures which no longer add to the stability of the healing wound
  • “Professional tooth cleaning” as needed
  • Continue to rinse with chlorhexidine solution (or apply chlorhexidine gel locally in the operated area).

2 - 6 weeks postoperative:

  • Removal of any remaining sutures
  • “Professional tooth cleaning” as needed
  • Continue to rinse with chlorhexidine solution (or apply chlorhexidine gel locally in the operated area)
  • Week 4 start careful tooth-brushing in the operated area on buccal/lingual surfaces, but not interproximally

6 weeks postoperative:

  • Stop rinsing with chlorhexidine
  • “Professional tooth cleaning” as needed
  • Start interproximal tooth cleaning in the operated area
  • Fluoride application as needed
  • Decide on subsequent (individual) recall schedule

6 - 12 weeks postoperative:

  • Adequate tooth cleaning in the operated area
  • Decide on subsequent (individual) recall schedule
  • X-rays at 12 months
  • No probing before 6 months!
  • Follow-up radiographs at 12 and 24 months
  • Individual recall program
Dental Hygienist

Millions of people end up at their dentist, requiring treatment for tooth decay and gum disease every year. With good dental education and a regular oral hygiene routine, many of these conditions and the suffering they cause can be prevented.

Preventative Care
Preventative Care

Dental hygiene clinic is the area of dentistry that focuses primarily on preventing oral disease and the maintenance of sound oral health of the teeth and gums.

Good oral care habits need to be established from childhood and are the foundation of lifelong healthy teeth and gums. Our Dental Hygienist is highly trained in this area to provide you with the following services:

  • Adult Oral Health Education
  • Treatment of Gum Disease
  • Prevention of Tooth Decay
  • Bad Breath Treatments.
  • Individual Oral Hygiene Care
  • Scale and Polish
Preventative Care
Preventative Care
Fresh Smile Clinic

It is estimated that millions of people suffer from Chronic Bad Breath (Halitosis). Halitosis is an embarrassing problem that can affect you both personally and socially.

An underlying medical condition could cause bad breath. Dental disease ranged from leaking fillings, caries, root infection, and gum disorders are the reason for most bad breath disorders. Bad breath can also be caused by poor dental hygiene resulting in the accumulation of bacteria, which release gases with an unpleasant odour.

Treatment is based on an integrated approach involving a detailed examination and correction of any underlying dental disease. An individually tailored self-performed plaque control and prophylactic care is planned for each patient following the completion of the hygienist work.

We recognize the concern the bad breath can bring to someone life and we will help our patients alleviate this common problem using modern techniques.

Preventative Care
Preventative Care
Frequently asked questions
What is bad breath?

Bad breath, otherwise known as oral malodour or halitosis, is a build-up of several excess bacteria gases. These gases have an unpleasant odour, which is noticeable when one speaks or breathes out. This can often be worse after a night’s sleep and is called “Morning Breath”. This is also treatable.

Where does the problem come from?

Bad breath is a common condition, which usually originates in the mouth. Research shows 55% to 65% of people have halitosis chronically and 95% at some time or other. Even when the sufferer is diligent with good oral hygiene, bad breath usually comes from the “oral cavity”. Bad breath seldom comes from the gastrointestinal tract (stomach).

What causes bad breath?

Oral malodour mainly occurs from an accumulation of oral bacteria if the whole mouth is not thoroughly cleaned daily. Other conditions that can cause bad breath are illness, low fluid intake, stress, lack of salivary flow and exercise.

How can I tell if I Have a Bad Breath?

It is notoriously difficult for anyone to detect whether they have halitosis. The best way to check if you have bad breath is to ask a family member, partner or a close friend for their opinion. Another simple way to check if you have bad breath is to lick your wrist, starting at the back of the tongue and wiping the inner wrist to the tip. Leave the saliva to dry for 10 seconds and smell the area for any unpleasant odours. Many people think they have a problem with halitosis when they do not. LSD can examine and test you to find out if there is a problem.

Even though I brush my teeth daily, I still have bad breath. Why?

Oral bacteria cause the odour of the bad breath. People who have gum disease have more oral malodour than people without gum disease. If your gums have any redness, swelling or bleeding at all on brushing, flossing or interdental cleaning, then you may well have some gum disease. However, gums may not be the only area where bad breath originates due to bacterial build-up within the mouth.

Can mouthwash or tablets cure my bad breath?

An average of £258 million per year spent in the U.K. on mouth fresheners that do not work or are not used correctly. They disguise one odour with another that lasts no more than 15 minutes. Mouth rinses alone will not solve the problem. The treatment of halitosis is more complex and combines several approaches.

Is oral malodour (bad breath) treatment successful?

Yes! The modern techniques used at our clinic have successfully conquered the problems caused by oral malodour. The vast majority of patients have experienced a total cure or at least a very substantial reduction in bad breath. The treatment is both painless and not at all invasive.

Do foods cause temporary bad breath?

Yes. This is known as “Food Breath”. It is a well-known fact that certain foods such as onions, pizza, garlic, alcohol, and spicy foods can cause bad breath. However, not eating these foods solves this problem. Likewise, many kinds of medication can have a similar effect.

Gum Recession

Gum recession or receding gum could be defined as the clinical loss of gum margin toward and along the root surface. Gingival or gum recession could be caused by the damage to the tooth-supporting periodontal tissues, i.e. fibres, cementum, and alveolar bone, such as iatrogenic factors, orthodontic movement, infectious oral disease, chemical trauma, e.g. chewing betel nuts.

Periodontal disease, aggressive oral hygiene activities, frenal pull, bone dehiscence, a defective restoration, tooth misalignment, viral & bacterial infections have all individually or in combination been associated with the gum recession. The clinical signs & symptoms attributed to gum recession are tooth hypersensitivity, root caries, and disturbing aesthetic.

The most efficient clinical approach to the restoration of the gum recession defects both in the short- & long-term is the application of periodontal plastic /gingival transplant surgery to augment and replace the function and architecture of the lost tooth-supporting/periodontal tissues.

The periodontist in London Specialist Dentist with more than 2 decades of experience in periodontal specialism offers the most well-documented treatment strategies, i.e. free gingival, connective tissue transplant, and tunnel techniques combined with guided-tissue-regeneration (GTR) strategies to restore both the soft and hard tooth-supporting tissues to enhance the long-term prognosis of your tooth.

Before
After

Photo 1: Gum recession on the tooth 31 (LL1) cervical margin

Photo 2: Root coverage following the surgical gum transplant

Mucogingival deformities

Gingival recession is a part of mucogingival deformities with a prevalence of ca. 50% in people aged between 18 to 64 years and ca.88% in people aged > 65 years.

The adverse impacts of gingival recession for the patient are as follows:

  • Aesthetically compromise
  • Dentin Hypersensitivity
  • Root surface alterations: Denuded root may be associated with cervical carious lesions (CCL) or non-carious cervical lesions (NCCL), e.g. abrasion and erosions, with increased age-related prevalence.

Cairo et al. described gingival recessions based on interdental Clinical Attachment Levels (CAL) and treatment-oriented classification:

  1. Recession Type 1 (RT1): Gingival recession with no loss of interproximal attachment. Mainly associated with traumatic tooth-brushing.
  2. Recession Type 2 (RT2): Gingival recession associated with interproximal CAL loss. Mainly associated with horizontal interdental bone loss.
  3. Recession Type 3 (RT3): Gingival recession associated with interproximal CAL loss. It could be associated with infrabony defects (IBD).

A thin gingival biotype is more prone to develop increasing gingival recession lesions. There is evidence reporting a correlation between the gingival and buccal bone plate thickness (bone morphotype).

The severity of the gingival recession has also been correlated with 1) the interdental clinical attachment level, 2) the gingival phenotype, 3) root surface condition, 5) tooth position, 6) aberrant frenulum, and 7) the severity of adjacent recessions.

The presence of marginal tissue recession is associated with:
  1. Traumatic tooth-brushing (Khocht et al. 1993)
  2. Alveolar bone dehiscences (Bernimoulin & Curilivic 1977; Løst 1984),
  3. High muscle attachment and frenal pull (Trott & Love 1966),
  4. Plaque and calculus (van Palenstein, Helderman et al. 1998; Susin et al. 2004), and
  5. Iatrogenic factors related to restorative and periodontal treatment procedures (Lindhe & Nyman, 1980; Valderhaug, 1980).
  6. Periodontal CAL loss may cause compensatory remodelling and MBL, hence apical migration of gingival margin (Serino et al. 1994).
Other contributing factors:
  1. Para-functional activities
  2. Localised tooth-related factor: proclined tooth position
  3. Excessive buccal alveolar bone resorption/dehiscence caused by:
    • Aggressive non-regenerative surgical periodontal treatment
    • Uncontrolled aggressive orthodontic teeth movement beyond the buccal bone plate/alveolar bony housing surpasses natural bone turnover.
    • Inter-dental attachment/bone loss
    • Localised dental prosthesis-related factors
    • Necrotizing Ulcerative Periodontitis
    • Localised prosthesis-related factors
Confounding factors:
  • High aberrant muscle & frenal attachment
  • Reduced vestibular depth
  • Inadequate attached gingival
Aetiology of progressing gingival recession

Based on the clinical observation that recession may occur during orthodontic therapy involving sites that have an “insufficient” zone of the gingiva, it was suggested that a grafting procedure to increase the gingival dimensions should precede the initiation of orthodontic therapy in such areas (Boyd 1978; Hall 1981; Maynard 1987).

As discussed previously, concerning orthodontic therapy, this would imply that as long as a tooth is moved exclusively within the alveolar bone, soft tissue recession will not develop (Wennstrom et al. 1987).

Predisposing alveolar bone dehiscences may be induced by uncontrolled facial expansion of a tooth through the cortical plate; thin gingival biotype without a gingival recession is at a greater risk for the future development of gingival recessions. The attention of the clinicians to prevention and careful monitoring should be enhanced.

Management of the mucogingival deformities

1. Cause-related therapeutic schedule, treatment:

Traumatising tooth brushing technique & para-functional activities

  • Information about the aetiology and treatment strategies of gum recession
  • Oral hygiene instruction
  • Modification of brushing technique with a soft brush

2. Corrective/ rehabilitation phase of therapy (Muco-gingival/ periodontal plastic surgery):

Conventional Gingival Transplant
https://www.youtube.com/watch?v=QtWYxIT9ZGA

Gum Recession After Wearing Braces Can Now Be Treated Without Gum Grafting Surgery
https://www.youtube.com/watch?v=Cod9fYjctSA

Gum Transplant

Most periodontal plastic surgical protocols involve the correction of gum/mucogingival deficiencies and root coverage. Albeit, there is a need to optimize the currently advocated conventional treatment strategies and diminish the untoward postoperative surgical morbidity and optimise the clinical outcome.

The currently advocated minimally invasive surgical protocols have addressed some of the surgical trauma concerns when rectifying the soft-tissue deficiencies and root exposure.

The modified‐Vestibular Incision Supra‐periosteal Tunnel Access (M‐VISTA) has been claimed to implement the principles of minimally invasive mucogingival surgery to optimise the treatment outcome and patient-reported outcome measurements (proms).

The recently well-published minimally invasive (M-VISTA) consider supra-periosteal tunnel-access with graft stabilisation (Zadeh, 2011).

This M-VISTA technique is claimed to reduce surgical time and increase patient comfort by preventing excessive facial bone loss by traumatising the periosteum and reducing the grafted connective tissue vascularity.

Besides, studies have implied that the lamina propria consists of genetic information that dictates the overlying surface's keratinisation.

A tension-free coronally-advanced supra-periosteal mucosal flap will preserve the structural and vascular integration of the papilla. Compared to a non-autogenous graft, the connective tissue may enhance the zone of keratinization (Karring et al. 1975). In all procedures, graft stabilization is crucial for increased plasmatic perfusion and vascular circulation.

Regenerative Tunnelling TechniqueMiller Class II / Cairo RT1
Regenerative Tunnelling TechniqueMiller Class II / Cairo RT1
Regenerative Tunnelling TechniqueIncision & release of the mucoperiosteal flap
Regenerative Tunnelling TechniqueTunnelling & release of the mucosal flap
Regenerative Tunnelling TechniqueFlap elevation and CTG in-Situ
Regenerative Tunnelling TechniqueTunnelling & coronal advanced flap
Regenerative Tunnelling TechniqueExternal suturing of advanced flap & CTG
Regenerative Tunnelling TechniqueInternal stabilisation of advanced flap & CTG

Zadeh HH. Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet‐derived growth factor-BB. Int J Periodontics Restorative Dent.2011;31:65

Karring T, Lang NP, Loe H. The role of gingival connective tissue in determining epithelial differentiation. J Periodont Res.1975; 10:1‐11.

Gummy smile / Excessive gingival display

Excessive gingival display (EGD) or gummy smile is defined as a lack of balance between the anatomic variations within the static landmark of the gingival margins and the dynamic positioning variations of the upper lip in relation to the smile line.

While the patients subjective complains express mostly their increasing concerns about their gummy smile affecting their social and professional roles, the clinicians may analyse the clinical features of the excessive gingival display (EGD) in order to make a correct clinical diagnosis on the basis of which an appropriate surgical procedure can at best be planned.

Causes of Gummy smile

Identifying the source of this oro-facial aesthetic concern whether of a dento-alveolar or neuro-muscular origin leads to a correct therapy plan.

Dento-alveolar aetiologies could be due to the gingival overgrowth, and/or dento-alveolar extrusion, which results in short clinical crowns and/or altered passive eruption (APE).

In periodontal practice, altered passive eruption (APE) and mild vertical maxillary excess (VME) are frequently identified in gummy smile cases (GS) cases.

In cases where the clinical features of GS or EGD are caused by combined aetiologies, cause-related interdisciplinary approaches are frequently indicated in the form of periodontal surgical approaches, orthodontics, and/or surgically facilitated orthodontic treatments.

Non-dento-alveolar aetiologies include skeletal and/or facial soft tissue anomalies, including a short upper lip, and/or vertical maxillary excess (VME) which is unfortunately recognizable more readily after the orthodontic treatment.

These cases may only be treated by orthognathic or facial plastic surgical approaches (e.g. myotomy or resection of the smile muscles through a nasal columellar incision).

Although Botulinum toxin A (BTX-A) could effectively rectify GS caused by hypermobile upper lip, in mild VME cases however, this approach requires repeated treatments.

To mask mild to moderate cases of VME due to hypermobile upper lip, lip-repositioning or reverse vestibuloplasty procedure has been popularized recently to correct such GS cases almost permanently.

Before
After

Photo I. depicts existing hypermobility of the upper lip with a normal width and volume of the upper lip.

Photo II. Lip-repositioning or reverse vestibuloplasty procedure has been performed to rectify the gummy smile in this young gentleman.

We live in a fast-paced world where we demand faster and more predictable treatment outcome.

Accelerated Orthodontics provides you with the beautiful and harmonic smile within half of the treatment time required for traditional braces. With Accelerated Orthodontics, aesthetically pleasing ceramic braces and clear aligners, e.g. Invisalign®, can be worn in patients who prefer efficient results with non-metal braces.

What is Accelerated Orthodontics?

The slow and continual application of mild orthodontic forces initiates and maintain biological processes resulting in a very slow type of tooth movement. Traditional orthodontics applied for the past 100 years requires longer treatment time due to the limitations of the bone remodelling activity.

Accelerated Orthodontics is a well-proven revolutionary adjunctive treatment approach culminated by clinical research over the last two decades to s prevail the clinical safety and predict faster orthodontic tooth movement by approximately two times.

What are the benefits of accelerated orthodontics?

The benefits are that if the orthodontic treatment is shorter, the problems that arise with long term braces such as tooth decay or gum problems are reduced.

With accelerated orthodontics, the patient sees the change quickly. This allows the patient to see the benefits of the treatment more quickly. It also helps the dental team and the patient decide on the ideal mouth disciplinary treatment plan.

Additional benefits of Accelerated Orthodontics due to the activated and augmented bone can be:

  • an increased bone volume which can improve facial aesthetics in some cases
  • increased tooth and post-orthodontic stability
  • fewer extractions required for orthodontics
  • repair of the existing tooth-supporting bony and/or soft tissue defects
How long is the treatment going to take?

Accelerated Orthodontics facilitates tooth-movement into the desired position in just 4 to 10 months versus the 1 to 3 years of treatment time required conventional orthodontic. This offers the patients a clear advantage in reducing their normally-accepted orthodontic treatment period, and the orthodontists increased patient compliance and case completion.

The fast track patients undergoing accelerated orthodontics would complete their treatment less than patients having conventional orthodontics.

Treatment procedure with Piezocision

The older technique was an extensive surgery requiring direct exposure of the alveolar bone. The new method was developed by Professor Dibart and his team from Boston, USA. Therefore, the accelerated orthodontic by Piezocision involves only minimally invasive selective vertical fine incisions with a Piezo device using micro-vibrations in the bone surrounding the teeth. The stimulated bone accelerates the activity in bone remodelling (demineralisation and remineralisation) adjacent to the site of the activation.

Both upper and lower jaws can undergo the procedures at the same in-office appointment and a single tooth or groups of teeth.

Is accelerated orthodontic a suitable treatment for all patient categories?

This technique is ideal for most adolescents, young adults, adults, and adults wearing fixed braces and removable clear aligners, e.g. Invisalign®, provided there is no contra-indication to surgery, e.g. bone disease, ankylosed teeth, patient non-compliance, and heavy smoking.

There is a good body of evidence-based research to support that accelerated orthodontics cause no adverse biological effects on the periodontium. It is a predictable surgical procedure as long as all the postoperative instructions and care are followed correctly.

After consultation with DR Sidi, or Dr Kamosi, you will be provided with adequate information on different accelerated orthodontic treatments.

How long the procedure would take, and what would be the postoperative pain or discomfort?

The procedure is painless and takes between 45min -1 hours, depending on how many teeth need to be treated. There might be mild soreness for one or two days after the surgery, while the recovery is generally very rapid.

What is the other method of accelerated orthodontics?

During the recent decade, a few different methods of accelerated orthodontics have been developed. Similar techniques are described as:

Propelling technique

Accelerated orthodontics utilising propelling technique involves making small perforations in the alveolar bone to initiate micro-trauma followed by healing of the bone. These perforations can be performed at sequential stages during orthodontic treatment. This technique is also minimally invasive; however, it is not always safe and viable when there is no space for bone perforation between the crooked teeth' roots.

What are the stages in the treatment?
  • Assessment by the Orthodontist and preparation of an Orthodontic Treatment Plan.
  • Assessment by periodontist in preparation for the surgical phase including any Radiographs and CBCT Scans.
  • Placement of Braces or Aligners
  • 2 weeks later Piezocision carried out by Periodontist
  • 2 weeks later further review and possible adjustment of Orthodontic appliance by the Orthodontist.
  • 2 weeks later healing review by Periodontist

If you have always been concerned about crooked teeth causing aesthetic disturbances or biting and chewing discomfort.

If you didn’t like the idea of wearing braces for many years, accelerated orthodontics could be a promising treatment option for you.

If you are interested in having an accelerated orthodontic treatment, make an appointment with a specialist.

Accelerated ortho