Bone Regeneration Without Gum Surgery in Portsmouth, NH
Here’s a quiz: Take a look at the periapical images above, then guess which technique was used to regenerate an impressive amount of bone on the distal of the canine: LANAP? Bone grafting? Arestin? Emdogain? The answer is none of the above. Treatment consisted of scaling and root planing (SRP) followed by one week of systemic antibiotics. Why don’t we routinely see amazing results like this?
There are several possible answers, and they are often combined. The patient’s genetic makeup and mix of pathogenic microflora may play roles. These factors are poorly understood at present. But there are three other factors that are well-understood. First is smoking. Smokers have little or no potential to regenerate bone, and they are prone to persistence or recurrence of pockets and bony defects. They also achieve less root coverage and more relapse after gingival grafting. Our patient is not a smoker. The second factor is oral hygiene. Regeneration does not occur in the presence of plaque. Scrupulous (but not excessive) daily hygiene and close adherence to a maintenance program are essential. Our patient is spotless and never misses a hygiene appointment. The third factor is meticulous root debridement during SRP. This is challenging. SRP is one of the most difficult dental procedures to perform properly. It requires sufficient time (we allow 90 minutes for two quadrants), local anesthesia, and most importantly a highly skilled dentist or hygienist. Residual calculus and microbial biofilms on the root prevent regrowth of bone and attachment. Our hygienist is meticulous.
The result seen here can be achieved by several approaches, but each depends on the factors listed above. For example, the success of LANAP depends on effective root debridement, which is the goal of the procedure. But since LANAP, like SRP, does not allow for visualizing roots via elevation of a flap, it has the same rate of success and failure as conventional SRP. As with SRP, LANAP can yield impressive results or disappointing results. Surgical approaches allow for more predictable root debridement. And surgical approaches that eliminate deep pockets via osseous recontouring or bone grafting make post-treatment hygiene more effective, which is why these modalities have the greatest odds for success.
Most periodontal patients deserve the chance to heal themselves after meticulous SRP. When this does not occur, pocket elimination surgery has repeatedly been shown to be the most predictable next step, since it allows the surgeon to see and remove residual calculus and biofilms. This is most easily achieved with pockets 5-6 mm deep; beyond this it becomes increasingly difficult to eliminate pockets, and bacteria often recolonize residual pockets.
So the secret to successful periodontal therapy lies with both our patients and ourselves. Their responsibility is to take care of themselves. Ours is to give every pocket our best shot nonsurgically, and to move forward when we don’t achieve results like what we see here. As always, success depends on both what we do and how and when we do it.