We have more options. Less invasive procedures result in less pain and shorter recovery. Better methods of gingival reshaping, orthodontic movement, tooth bleaching and laminate veneers can sometimes replace larger procedures. Still, a recent study conducted by the Centers for Disease Control and Prevention CDC shows one out of every two adult Americans suffers from moderate to severe periodontal disease. The public must be motivated to seek care and be informed that periodontists are the group that specializes in treatment of moderate to advanced forms of these diseases.
Yes. Periodontitis is now considered a risk factor for atherosclerotic vascular disease, much like smoking or high cholesterol. Experts also see links between periodontal disease and diabetes, some forms of arthritis, Alzheimer’s disease and, during pregnancy, preeclampsia, preterm birth and low birth weight babies. Preventing and treating periodontitis is clearly important, and we have made great strides in identifying patients at risk.
Periodontists now use connective tissue grafts or biologics to cover unsightly root exposure and establish healthy gums. It is less invasive, encouraging more patients to seek care. Five years ago you observed that general practitioners were becoming more involved in periodontology.
Many general practitioners are treating more cases of gingivitis/periodontitis than in the past. Periodontistsare still recognized as the specialists in treating advanced and complex cases with gingival recession, bone defects or furcations, etc. Happily, periodontists and restorative dentists collaborate more and more on diagnosis, risk factors, sequence of therapy, maintenance schedules and esthetics. Satisfied patients refer their friends and family, usually to the general practitioners first, so both patients and dentists win in this collaboration. More dentists also place implants. This results in more complications being seen. I feel it is essential that dentists placing or restoring implants be trained to recognize these complications early and either treat or refer these patients to specialists.
While prevalence of peri-implantitis is estimated at between 10-50%, methods to predictably treat this disease are only just being documented. Much research is in progress. I have strong hopes that regenerative techniques used to treat natural teeth affected with periodontitis could also rebuild soft tissue and bone around implants, promote re-osseointegration, and avoid implant removal and replacement.
The new technologies make our work more predictable and less risky for the clinician and the patient. Digital 3D X-rays can more accurately diagnose problems. Simulated implant and abutment placements allow more accurate surgical planning. CAT scans and 3D radiographs show tissue structures which previously could not be precisely located, improving planning and identifying sinus and bone problems that need attention before surgery.