Periodontitis Treatment

The treatment of periodontal diseases (periodontal diagnostics, non-surgical and surgical periodontitis therapy and recall/prophylaxis) are a focus of our practice.

 

Periodontitis is a chronic inflammatory disease of the periodontal apparatus.

t is an infectious disease caused by certain bacteria. These paropathogenic bacteria are responsible for the destructive inflammatory process of the tissues of the tooth supporting structures / periodontium (the gum, the root cementum, the periodontal ligament with collagen fibers and the dental tooth socket in the jaw bone).

f this inflammatory disease remains unrecognized / untreated, it leads to irreversible bone loss and ultimately to tooth loss.

Periodontits is now a real national disease - approximately 50% of adults (35-44 years) suffer from moderate periodontal disease and 20% of adults suffer from severe periodontal disease.Periodontitis can occur at any age, localized or generalized (a few or more teeth are affected) and with different rapidity and in varying degrees of severity.

Apart from the fact that periodontal disease is the main cause of tooth loss in the adult age, it has also a negative impact on, for example, heart / circulatory diseases.

Signs of possible periodontitis:
Gum bleeding
Gum is delicate or swollen / looks reddened
Gum recession (visible gaps between the teeth)
Gum recession (teeth look as if they were longer)
Loosening and shifting of the teeth / changed tooth position / changed bite
Altered taste / pus between teeth and gums
Mouth odor / bad breath

 

The Pretreatment of Periodontitis includes all the accompanying measures which are necessary to achieve success at the actual periodontal therapy.

The professional cleaning of the teeth by our prophylaxis assistants with targeted cleaning instructions to optimize your daily oral hygiene is often sufficient in the initial stage of periodontitis, ie gingivitis (gum disease).

Furthermore, the consistent implementation of general dentistry treatment (therapy of caries, root inflammation/apical periodontitis, removal of hopeless teeth, elimination of disturbances of the tooth holding apparatus,...) and your own awareness and the modulation of risk factors such as smoking and stress are a decisive success factor in the actual periodontal therapy.

 

The Periodontal Diagnosis is used for evaluation of your actual situation. Itis used specifically during the course of the therapy and follow-up: imaging procedures (such as right angle

x-rays, panoramic x-ray and digital volume tomography), periodontal anamnesis, periodontal status (pocket depth measurement, ...), microbiological germination test, hygiene and inflammation indices, .

 

Periodontitis therapy

Periodontitis therapy includes all measures to combat bacterial infection and can be started at any time and at any stage.

Ultimately, the main goal is to achieve stable, inflammation-free periodontal conditions that can be cleaned (no elevated, inflamed gingival pockets)!

The non-surgical (conventional) periodontal therapy
- Scaling and root planing (SRP)
serves the debridement/cleaning and smoothing of the root surfaces without opening/flapping the gums (closed therapy).

Depending on the severity of the periodontal disease, medication is applied to furher combat the infection and promote tissue healing: anti-infective drugs (are preferred - avoidance of resistances) applied to the gingival pockets, and, where appropriate, locally applied antibiotics. Also specific systemically administered (in capsule form) antibiotic combinations can be given.

For example:

Ligosan made by Kulzer: Local antibiotic slow releasing therapy

Periochip
Periochip is a cellulose chip that releases the disinfecting agent CHLORHEXIDIN over a period of 7 to 14 days. When it's placed in the defect it prevents a secondary infection and therefore aids in the healing of the wound.

 

Surgical periodontal therapy
is used for the optimization of highly destructive periodontitis defects and is specifically used to maintain one or more teeth. Surgical intervention usually results in the desired treatment result in most cases where the previous non-surgical therapy cannot lead to our main goal.

Ultimately, the main goal is to achieve stable, inflammation-free periodontal conditions that can be cleaned (no elevated, inflamed gingival pockets)!

All flap surgery procedures for healing and regeneration of the infectiously destroyed and reduced tooth supporting structures (= FLAP SURGERY) are practiced.

Open Flap Debridement is the most common procedure:


Scaling and root planing (SRP) are used here for cleaning and smoothing of the root surfaces under direct view, ie opening/flapping the gums (open therapy).

An optimization of the defective bone anatomy can beapplied here, if necessary - the bone defect remodeling helps to reach our main treatment goal - in particular the creation of cleanable periodontal conditions.

Whenever possible, we try to recreate lost bone at suitable bone defect sites with regenerative methods.

(see also tissue engineering)

 

Recall / Maintenance phase / re-evaluation / supervised recall programme

After successful periodontal therapy - the reaching of our main goal, ie stable, inflammation-free periodontal conditions that can be cleaned (no elevated, inflamed gingival pockets) - accompanying symptoms of periodontitis such as bad breath, gum bleeding and loosening of the teeth should be cured.

Supportive periodontal therapy (SPT) at intervals of 3-6 months (depending on the initial extent and severity) includes all measures at our supervised recall programme for the long-term maintenance of inflammatory-free and stable periodontal conditions.

Regular periodontal re-evaluation as part of our professional tooth cleaning and the targeted treatment of recurrences (new inflammatory sites) are essential for the long-term maintenance after the active treatment phase.

The recall / prophylaxis times vary according to the severity & extent of the disease pattern, oral hygiene, smoking habits, stress, and genetic predisposition of the patient.

A consistent and professional recall / follow-up ensures the long-term treatment success.

 

Implantology in the periodontally compromised patient

Even in periodontally highly compromised conditions, we can successfulllyplace implants.In these particularly difficult cases due to the often already strong bone loss in severe cases of periodontitis, special techniques for bone augmentation (to create new bone volume in defecient bone sites) and augmentation-free techniques for total reconstructions with implants are practiced.

 

However, a stringent, consistent follow-up therapy is a prerequisite for maintaining your own teeth and especially for implants placed in periodontally compromised situations.

Skipping of paropathogenic bacteria, eg neglecting your own oral hygiene, from tooth to tooth can also occur from tooth to implant.

Perimucositis (gingivitis near implants – analogous to gingivitis / gum inflammation in natural teeth) and periimplantitis (inflammation involving gums, connective tissue and bone around implants – similar to periodontitis in teeth), can or certainly will if untreated, lead to implant loss (analogous to a tooth loss in untreated periodontitis).

 

Implant prophylaxis / professional implant cleaning (basically the same as professional tooth cleaning) serves the long-term maintenance of the inserted implants and the targeted prevention of occurring bacterial inflammation in implants triggered by biofilm/plaque.

Simple cases (no need for bone grafting) can be done in as few as four appointments

1. First visit involves a comprehensive consultation including medical history, clinical inspection, x rays, DVD scans and implant simulation. A detailed treatment plan including a breakdown of costs and schedule will be made.

2. At your 2nd visit implant placement and temporary restoration will be done.You will never leave our practice without temporary teeth whilst the implant osseointegrates (fuses to your bone). In a conventional implant procedure a healing abutment (unsubmerged healing) or cover screw (submerged healing, below the gums) is put on the implant. In immediate loaded implants a temporary crown is loaded onto the implant right after the implant placement (see immediate implantation).

3.The osseointegration phase (the healing in phase of your implants) takes around 3 months (complex cases involving bone or soft tissue replacement take longer).
At your 3rd visit we will take impressions which allow our technician to make your final implant supported tooth.

4. At your final visit your implant supported tooth (fixed implant crown) will be integrated (fine tuned) to your bite and mastication.

Replacing a single tooth

If you are missing a single tooth, one implant and a crown can replace it. A dental implant replaces both the lost natural tooth and its root.


Replacing a single tooth with a single implant and a crown

Main benefits

  • A fixed, stable & secure solution
  • A long-lasting solution, often for life
  • Healthy, neighbouring teeth are not part of the reconstruction like in a bridge

Installing a single tooth implant most times falls in the category of simple implant cases.

Replacing multiple teeth

If you are missing several teeth, implant-supported bridges can replace them. Dental implants will replace both your lost natural teeth and some of the roots.

Main benefits of implant bridges

  • A fixed, stable & secure solution
  • A long-lasting solution, often for life
  • Healthy, neighbouring teeth are not part of the reconstruction like in a bridge
  • Dental implant bridges are the only fixed alternative in situations where no teeth are present in the molar region (free end gap) or where no natural neighbouring teeth are suitable as abutments (anchoring teeth) for a fixed bridge


First visit
involves a comprehensive consultation including medical history, clinical inspection, x-rays, DVD scans and implant simulation. A detailed treatment plan including a breakdown of costs and schedule will be made.


Typical free end gap situation


At your 2nd visit implant placement and temporary restoration will be done.You will never leave our practice without temporary teeth whilst the implant osseointegrates (fuses to your bone). Implant bridges are normally done in a conventional implant procedure where a healing abutment (unsubmerged healing) or cover screw (submerged healing, below the gums) is put on the implant. Immediate loaded implant bridges, where a temporary bridge is loaded onto the implant right after the implant placement, can only be done if multiple implants have been placed.


The osseointegration phase (the healing in phase of your implants) takes around 3 months (complex cases involving bone or soft tissue replacement take longer).
At your 3rd visit we will take impressions which allow our technician to make your final implant supported teeth.

At your final visit your implant supported teeth (fixed implant bridge) will be integrated (fine tuned) to your bite and mastication.


Screw retained implant bridge


Cemented implant bridge

Replacing all your teeth

If you are missing all of your teeth, an implant-supported full arch bridge or implant retained full denture can replace them. Dental implants will replace both your lost natural teeth and some of the roots.

Before the availability of dental implants - replacing all your teeth - meant removable full dentures. Dental implants are the solution that your next set of teeth are permanently fixed and look and feel like natural teeth. The placement of multiple strategical positioned implants around the jaw form the foundations for a full set of beautiful fixed teeth.

Each case must be carefully planned and considered on an individual basis. The amount and quality of bone must be measured with the help of DVD scans. In case of atrophied jaws (bone loss), the direction of any bone and soft tissue loss must be carefully evaluated. Availability of bone will finally decide the number of implants and implantation techniques, as well as the material and reconstructive kind of your new teeth.

Main types of full arch implant supported teeth replacement:

A) Full arch fixed implant supported bridge
B) Implant retained overdentures
C) All on 4 concept

 

 

full arch fixed implant supported bridge

For dental implants with dental bridges - the dental implants act as new tooth roots with a fixed dental bridge over these dental implants. With this dental implant teeth option - it is similar for the patient to having a new set of teeth, only this time on implant posts.

Main benefits of full arch implant bridges

  • A fixed, stable & secure solution
  • A long lasting solution, often for life
  • no more loose dentures, especially in the mandible (lower jaw) – improved quality of life
  • Full arch dental implant bridges are the only fixed alternative in situations where no teeth are present for anchoring.

A full arch fixed implant bridge is the closest to natural teeth and over time will just feel like natural teeth. They will provide you the comfort and natural look like a full set of natural teeth.

 

 

Implant retained overdentures

An implant-supported overdenture is a full denture that is supported by a variable number of dental implants.
Especially in lower jaws or highly bone atrophied upper jaws full dentures that only rest on the gums, where no supporting teeth are left, tend to fit less firmly and come loose easily.
Implant supported overdentures are provided with special attachments that retain them on implants providing more stability and therefore a more carefree life with dentures.

Benefits of Implant retained Dentures

  • Implant retained overdentures provide you with more stability in comparison to conventional dentures
  • allows you to eat nearly all kind of food and avoids uncomfortable situations while speaking
  • upper jaw overdentures no longer have to cover the palate of your mouth
  • dental implant overdentures are the financially economic alternative in comparison to full fixed bridges


Types of Implant Supported Overdentures

Basically there are two types of implant retained overdentures - dental implants with a bar or ball overdenture. The overdenture is removable and can be cleaned.

Bar-retained: The normally placed implants are connected by a thin metal bar that follows the curve of your jaw. A minimum of two (up to five implants) have to be inserted in your jawbone – the more implants the better the resulting stability of your denture. Various other attachments can be fitted into the bar to heighten denture stability.


Ball-retained:
The inserted implants are fitted with ball shaped or similar attachments that fit into the counterpart in the overdenture.

 

 

all on 4 concept

The All on 4 dental implant treatment is a revolutionary cost-effective technique that enables us to replace all your teeth with just 4 implants.
It has been developed for patients who lack sufficient bone volume and are not willing to undergo a cost and time consuming bone grafting procedure prior to implant placement.
The All on 4 makes maximum use of your bone in the anterior jaw and by tilting the two posterior implants at a 45° angle an immediate function prosthesis can be provided on the same day – also known as 'teeth in one day'.

Who benefits most from All on 4

  • Patients who have loose fitting full or partial dentures, due to severe lack of bone, will get back a quality of life like with a full set of natural teeth - for most patients an overwhelming, positive experience.
  • Patients with severe periodontitis affected teeth
  • Patients with only a few badly infected/decayed teeth left

What means 'Teeth in a day':


The All on 4 immediate function technique can be done in one day:

  • remaining teeth can be extracted before implant placement (all in one surgery)
  • fixed (non removable) acrylic provisional denture is provided on the day of the surgery

The all on 4 bridge/denture replaces not only your teeth (like in a fixed implant bridge in patients with an abundant bone situation) but also your missing jaw bone and gums (the pink part of the bridge).

If indicated a guided surgery can be done

The provisonal acrylic bridge of the surgery day should be replaced after a healing in time (osseointegration of your implants) of about 3 - 6 months by a definitve long term all-on-4 bridge solution. The better the material of the reconstructive solution - the better can be created a look and feel like sensation like with natural teeth – starting from a metal reinforced high impact acrylic bridge, to solutions involving titanium and zirconium hybrid bridges.

All on 6 dental implants: the same as all on 4 but with one additonal implant in the pterygoid region of the upper jaw.

Immediate replacement

After the loss of a tooth or multiple teeth the supporting tissues like bone and gums begin to diminish rapidly. In the first 3 months the biggest soft and hard tissue reorganization takes place – therefore the longer implant placement is postponed the more tissue gets lost. That's why it is normally best to replace teeth that need to be extracted immediately or after 4 to 6 weeks with dental implants when no socket preservation (see bone grafting) is done.
Since the first introduction of implants into dentistry, technology (implant thread design and surface texture) and our understanding behind implant osseointegration has changed dramatically. Given good bone conditions - modern implants, in many cases, can be loaded immediately (to place a crown on the implant) following implant placement.

This means teeth straight away after implant placement or also known as teeth in a day.

In most immediate dental implant cases an immediate tooth replacement by a temporary crown can be achieved.

Of course, careful evaluation of bone quality and quantity must be done in every single case, but immediate placement and restoration with a crown is done nowadays much more often than in the past.

Advantages of immediate replacement:

  • realisation of your desire to fill gaps as soon as possible
  • usually better gum management around dental implants
  • only one surgical appointment
  • often a less invasive surgery, which allows for quicker healing

Dental implant bone grafting & Dental implant soft tissue grafting

When teeth are lost, the bone and gums around them begin to diminish rapidly. Successful and long lasting implants require sufficient bone and healthy soft tissues/gums at the dental implant placement site. Bone volume can be affected by various factors but especially periodontitis, acute infections and the length of time after the loss of teeth are most critical.

The longer you wait before implant placement the more bone volume shrinks – especially in the aesthetic anterior region the inherent loss of gums can be irreversible.

As the needs of each person are different so each dental case/situation can be different. A critical and careful evaluation of the hard and soft tissues at missing teeth sites is essential for successful implant prosthetics.
Bone and soft tissue grafting techniques basically encourage the growth of bone and soft tissue where they have been lost. Bone grafting provides an optimum foundation for your dental implants and is essential in cases where aesthetics are most important.

REGENERATE WHAT HAS BEEN LOST

There are many grafting methods and materials to achieve a natural and long lasting result.
The idea behind any bone graft or transferred soft tissue graft is that it is eventually replaced by your own tissue to help support the foundations for your new teeth.

Soft tissue grafting is basically practised to optimize your gums around dental implant crowns. We want to see gum tissue (keratinized soft tissue that is naturally found on your palate and around your natural teeth) around your implants. Soft tissue grafts, either free gingival grafts or connective tissue grafts, are harvested from your tuberosity or palate. There are also various materials available that help to regenerate stable perimplant soft tissues.

Dental implant bone grafting is mainly used:

  • to create new bone volume in defecient bone sites before or simultaneous with implant placement
  • as a socket preservation immediately after extraction in order to prevent further bone loss
  • to graft around implants in order to fill gaps or smaller defeciencies

There exist various types of bone grafting materials:

  • Autogenous bone: bone harvested from other intraoral areas like the tuberosity, minimally invasive near the implantation site, the chin or in severe cases out of practice from the hip bone
  • Xenografts: bone substitute processed from other species (bovine, …) most evidence based and most often used in our practice. For further information see also the most popular brand Bio Oss http://www.geistlich-na.com/en-us/
  • Barrier membranes (often xenografts) are used to guide the generation of new bone and allow maturation of new bone by blocking out other faster growing cells from the regeneration site (epithelial and connective tissue cells)
  • Alloplastic or synthetic bone graft materials: various materials with different resorbing times are successfully used here – normally some type of calcium phosphate
  • Autotooth bone: grafting material processed out of your extracted teeth– very promising but we wait for more long term evidence – soon to come in our practice
  • Allografts: bone substitute material processed out of the human species – various types eg demineralized freeze dried bone

Most often used types of bone grafting techniques in our practice:

  • GBR (Guided Bone Regeneration) / Barrier Membrane Technique
  • (see above: xenograft barrier membranes ), various kinds of membranes exist – most are resorbable like for example collagen membranes like BioOss or have to be removed at a later date
  • Block bone grafts: (see also above: autogenous bone) are only done in cases of severe atrophy of the jaw bone – not only bone blocks are transferred here, various mixed techniques exist
  • Sinus lift: The most often done bone augmentation in our practice for patients who wish for fixed teeth solutions and have not sufficient natural bone left in the posterior region of the upper jaw. The maxillary sinus (a paranasal sinus) is situated right above your upper molar teeth and if there is not sufficient bone left below the sinus an implantation is not possible without sinus augmentation. There are basically two different approaches (depending on the height of your natural bone left subantral (below) the sinus): the lateral (from the side of the sinus) and the percrestal or internal sinus lift where access is done over the implant site.


For full arch missing teeth, graftless dental implant solutions are available:

  • Allon 4 dental implants (see all on 4)
  • All on 6 dental implants: the same as all on 4 but with one additonal implant in the pterygoid region of the upper jaw

Full arch fixed implant supported bridge

For dental implants with dental bridges - the dental implants act as new tooth roots with a fixed dental bridge over these dental implants. With this dental implant teeth option - it is similar for the patient to having a new set of teeth, only this time on implant posts.

Main benefits of full arch implant bridges

  • A fixed, stable & secure solution
  • A long lasting solution, often for life
  • no more loose dentures, especially in the mandible (lower jaw) – improved quality of life
  • Full arch dental implant bridges are the only fixed alternative in situations where no teeth are present for anchoring.

A full arch fixed implant bridge is the closest to natural teeth and over time will just feel like natural teeth. They will provide you the comfort and natural look like a full set of natural teeth.

Implant retained overdentures

An implant-supported overdenture is a full denture that is supported by a variable number of dental implants.
Especially in lower jaws or highly bone atrophied upper jaws full dentures that only rest on the gums, where no supporting teeth are left, tend to fit less firmly and come loose easily.
Implant supported overdentures are provided with special attachments that retain them on implants providing more stability and therefore a more carefree life with dentures.

Benefits of Implant retained Dentures

  • Implant retained overdentures provide you with more stability in comparison to conventional dentures
  • allows you to eat nearly all kind of food and avoids uncomfortable situations while speaking
  • upper jaw overdentures no longer have to cover the palate of your mouth
  • dental implant overdentures are the financially economic alternative in comparison to full fixed bridges


Types of Implant Supported Overdentures

Basically there are two types of implant retained overdentures - dental implants with a bar or ball overdenture. The overdenture is removable and can be cleaned.

Bar-retained: The normally placed implants are connected by a thin metal bar that follows the curve of your jaw. A minimum of two (up to five implants) have to be inserted in your jawbone – the more implants the better the resulting stability of your denture. Various other attachments can be fitted into the bar to heighten denture stability.


Ball-retained:
The inserted implants are fitted with ball shaped or similar attachments that fit into the counterpart in the overdenture.

All on 4 Implants Concept

The All on 4 dental implant treatment is a revolutionary cost-effective technique that enables us to replace all your teeth with just 4 implants.
It has been developed for patients who lack sufficient bone volume and are not willing to undergo a cost and time consuming bone grafting procedure prior to implant placement.
The All on 4 makes maximum use of your bone in the anterior jaw and by tilting the two posterior implants at a 45° angle an immediate function prosthesis can be provided on the same day – also known as 'teeth in one day'.

Who benefits most from All on 4

  • Patients who have loose fitting full or partial dentures, due to severe lack of bone, will get back a quality of life like with a full set of natural teeth - for most patients an overwhelming, positive experience.
  • Patients with severe periodontitis affected teeth
  • Patients with only a few badly infected/decayed teeth left

What means 'Teeth in a day':


The All on 4 immediate function technique can be done in one day:

  • remaining teeth can be extracted before implant placement (all in one surgery)
  • fixed (non removable) acrylic provisional denture is provided on the day of the surgery

The all on 4 bridge/denture replaces not only your teeth (like in a fixed implant bridge in patients with an abundant bone situation) but also your missing jaw bone and gums (the pink part of the bridge).

If indicated a guided surgery can be done

The provisonal acrylic bridge of the surgery day should be replaced after a healing in time (osseointegration of your implants) of about 3 - 6 months by a definitve long term all-on-4 bridge solution. The better the material of the reconstructive solution - the better can be created a look and feel like sensation like with natural teeth – starting from a metal reinforced high impact acrylic bridge, to solutions involving titanium and zirconium hybrid bridges.

All on 6 dental implants: the same as all on 4 but with one additonal implant in the pterygoid region of the upper jaw.

Dental Implants

Today missing teeth in the anterior or posterior region of the jaw can be replaced safely and long lasting with implants.


Without dental implants, missing teeth have to be replaced with removable dentures and bridges on neighbouring teeth. But with dental implants healthy neighbouring teeth remain intact.

Do you want only fixed teeth?

Implants are the solution that allow me to provide you with a reliable long-term fixed solution for missing teeth.
With state of the art dental implant procedures it is now often possible to remove a hopeless tooth and insert an implant in just one surgical procedure (see immediate implantation) and replace the missing crown immediately (immediate loading).

Advantages of Dental Implants

  • Your healthy, neighbouring teeth do not have to be treated
  • Implants or implant crowns and bridges are fixed and do not need to be removed
  • Removable dentures are often the cause of embarrassement – not implant retained dentures
  • Feel save while speaking and eating – sometimes a real challenge with removable dentures
  • The cost of a single implant restoration is comparative to having a 3 unit bridge
  • Dental implants are a long term solution – most often a life long solution with the right after care (see implant prophylaxis / professional implant cleaning)
  • A predictable restoration technique

our SERVICES

Loupes / Microscope

Oral hygiene and prophylaxis

DIAGNOSTICS

Dental implamants and bone augmentation

Oral surgery and tissue regeneration

Plastic - Aesthetic gum surgery

Ceramic crown - bridge technique

Filling and tooth reconstruction techniques

Prosthodontics

Focal therapy

Root canal treatment

Aesthetic dentistry

your REQUEST

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CONTACT

Altgasse 25a, 1130 Vienna
+43 (0) 1 8775542

Office hours:
Mo - Tue + Thur - Fr from 9am to 6pm

Make an appointment:
Mo - Tue + Thur - Fr from 9am to 1pm
and from 2pm to 5pm
Public Transport

Tram Line 58/60: Station Dommayergasse, 1 minute walk
Subway Line U4: Station Hietzing, 6 minutes walk

Parking:

Garage: Auhofstraße 8, or Zufahrt Hietzinger Kai 11-13, 1 minute walk