When the diagnosis is made with the anamnesis and the complete periodontal study (radiographic series, probing, gingival retractions, mobilities...) conclusions about the prognosis and treatment are drawn.
- Hygienic phase: where the thick plaque is removed and the patient is instructed in the correct techniques of brushing and auxiliary methods (interproximal brushes, dental floss, irrigator, etc.).
- Inflammatory phase: which consists in making some scaling and straightening of the roots with some instruments called curettes, in order to eliminate tartar and subgingival plaque. This phase is usually performed with anesthesia and quadrants (the mouth is divided into four parts). If the disease is moderate, this phase and periodic maintenance (regular professional cleanings) may suffice.
- Surgical phase: Once the gum has been de-inflamed, it is necessary to eliminate those bag bottoms (periodontal pockets) where the germs are quartered. The goal of the surgery is to eliminate the periodontal pockets, which are no more than spaces that form between the surface of the gum and the bone that surrounds the teeth and correctly smoothen the bone that surrounds the roots. At the bottom of these pockets there is a microbial metabolism that makes the process perpetuate because it is impossible to reach the bottom of the bag (when it is deep) with conventional means of oral hygiene. Then the gum is sutured on a healthy bone base with no space left or very little between it and the bone. In this way the patient can access the spaces in a visible way to be able to sanitize it.
- It is evident that when this treatment is carried out, the gum recedes and the roots become sensitive in the first days. This has as a counterpart, which is when changing the position of the gingiva (when eliminating the pocket) teeth remain "longer" and the more the greater the loss of bone. This is a handicap in the anterior sector, especially if the patient has a gummy smile. In these cases to avoid this phenomenon, a more conservative technique is followed in these sectors, and if this is not possible due to the severity of the disease, an aesthetic treatment of the anterior area will have to be performed once the underlying disease has healed.
- With gum surgery we do not generally look for (except in specific cases where it can be regenerated by placing a graft) recover the lost bone, but stabilize the disease, that is, keeping the teeth the longer we can.
It is evident that if the disease is very advanced with great loss of maxillary bone around the tooth and important mobility, little can be done to maintain those teeth. On the other hand, if the bone loss is incipient or moderate, the treatment usually obtains exceptional results for the maintenance of those teeth in long-term health, as long as the patient understands the problem and carries out at home a strict plaque control.
Each mouth is a world, but basically the complete treatment consists of three phases: