Healthy gums do not bleed! Bleeding is the manifestation of an inflammatory state that can involve tissue to a greater or lesser degree. The main causes of inflammation are related to the presence of bacterial plaque, but this is not the only factor that causes inflammation. Certain systemic diseases and other individual factors may predispose some patients to periodontal disease. Healthy gums have a pink color, when you see bleeding gums it is very important to brush more carefully involving the gum margins, use interproximal cleaning devices (wire and brush), and visit a periodontist to receive a thorough examination and make early diagnosis. If left untreated, gum disease can spread to the supporting tissues, evolving into periodontitis. More advanced stages of the disease can lead to progressive tooth loss.

Periodontitis is an inflammatory disease involving the deep tissues surrounding the tooth: bone, gingiva, and periodontal ligament. Its generally slow and gradual progression leads to the loss of the bone surrounding the root of your teeth, the gingiva recedes, and your teeth appear longer.

Periodontitis is a very common disease in the adult population and if left untreated can lead to alveolar bone resorption and tooth loss. The goal of periodontal therapy is to maintain the patient’s teeth by controlling infection and correcting areas of bone resorption caused by the disease.

Surgical periodontal therapies allow regeneration of periodontal tissues (bone, periodontal ligament, and gingiva) that have been lost. The biological potential for periodontal regeneration is very high and can be further exploited through the use of various biomaterials to optimize the results of corrective therapy.

Bone grafting refers to the placement of a regenerative material within a defect (area of bone resorption in the upper or lower jaw) performed to increase volume or to regenerate the amount of bone that has been lost. Graft material can be taken from the patient (autologous), can be of animal origin (xenograft), or synthetic. The use of these materials has been studied for decades, and numerous studies have shown that it is a safe and predictable way to reconstruct lost bone.

Typically, a person may need a bone graft following:

• Dental extraction
• Trauma
• Bone resorption caused by periodontitis
• Replacement of a missing tooth with a dental implant

Bone regeneration procedures are performed every day in our dental clinic. After thorough local anesthesia (the same as when a filling is performed), a small incision is made at the gum level, and after cleaning and disinfecting the area with the bone deficit, graft material is inserted to fill the defect. In many cases, the graft is covered with a membrane (resorbable collagen or nonresorbable, to be removed at a second stage) to provide more protection and prevent the proliferation of gingival tissue in the area where bone tissue is to be regenerated instead. To provide stability and protection to the bone graft, custom titanium meshes can be used. These are meshes that are custom-made for each individual defect following the anatomy analyzed after a 3D radiographic examination (CBCT). Unlike nonabsorbable membranes, these types of devices by adapting with great precision to the anatomy of the defect reduce operative time and promote healing.

There are also molecules that are used to promote graft regeneration. These are gels containing proteins derived from the dental enamel matrix or more recently polynucleotides and hyaluronic acid, which can stimulate and promote cell viability potentially speeding graft maturation.

Finally, the flaps are repositioned and the small incision is closed with resorbable stitches.

Most of these surgeries have a fairly simple postoperative course although minimal swelling and pain controllable with common analgesics can be expected. These side effects generally last a few days.

Usually after bone regeneration surgery, the patient is able to resume normal work and social life activities after a few days. However, the bone healing process takes several months. If bone regeneration was done for the purpose of subsequent placement of a dental implant, the implant may be placed after a healing period of four up to even twelve months. The required time depends on several factors such as the type of bone graft, the area in which the graft was placed, the size of the defect, and the individual healing ability.

The development of surgical techniques in periodontics has now led to a minimally invasive approach where incisions can be only a few millimeters in size. In some cases it is possible to regenerate periodontal defects and reconstruct lost bone tissue without the insertion of grafting materials as long as the stability of the clot, which will then be transformed into new bone, is ensured.

On the other hand, when the graft is placed to regenerate bone volume in preparation for the placement of a dental implant, (after tooth loss), the clot alone will not be sufficient, so it will be necessary to use graft biomaterials that will act as a scaffold and maintain the space so that the body can regenerate the lost tissue.

The potential for oral tissue regeneration is very big, and there are many techniques and materials available.

Periodontitis is a disease that affects about one in two adults over the age of 35. In the over-65 age group, more than 70% of the population suffers from it. Of these about 15% are affected by a severe form that can lead more or less rapidly to the loss of their teeth. This disease in its early stages is essentially painless, and the first signs may be bleeding gums or bad breath. In the past, for some people uninitiated, a diagnosis of periodontitis (commonly called gum disease) might have sounded like a death sentence, resigning us to having to wear dentures sooner or later.

Thanks to the advancement of research, this has not been the case for decades now. Periodontitis, especially when diagnosed at a stage that is not yet severe, can be treated with predictable therapies that allow one to maintain one’s teeth for a lifetime.

Periodontal therapy generally consists of two active phases: a first, the quality of the patient’s daily oral hygiene is improved and plaque and tartar are removed by the dentist or dental hygienist bringing infection and inflammation under control. In more advanced stages of disease, a second, so-called surgical, phase may be necessary, where through surgeries the damage caused by the disease to the deep tissues that support the tooth is corrected. The bone is reshaped or regenerated.

The word surgery can instill a certain fear in the collective imagination, this is because perhaps there is a lack of knowledge of modalities, healing time and postoperative course. In reality, the advancement of research in the field of periodontal surgery, the development of new techniques and new instruments make it possible to intervene in an increasingly targeted and less invasive manner.

Periodontal surgery is performed under local anesthesia, that is, with the same anesthesia that is also used for other dental care such as fillings or root canal treatments.

In most cases today when people talk about periodontal surgery, they are talking about minimally invasive procedures that require incisions of only a few millimeters on one side of the tooth thanks to which it is often possible to regenerate the bone and gum tissues that support the teeth in a virtually painless manner. Even when the clinical situation requires working in larger areas of the mouth because of the involvement of multiple teeth, new techniques such as fiber preservation have been shown to give less discomfort to patients in the weeks following surgery than more traditional approaches. In fact, recent studies on the subject conducted by research groups at the University of Turin and the University of Florence have verified that modern approaches to periodontal surgery result in a significant reduction in sensitivity, pain, and pain medication use after surgery.

Although periodontal surgery is becoming less invasive and painful, it should be emphasized that prevention and early diagnosis remain the best weapons. It is important not to underestimate early signs of gingival inflammation such as bleeding and not to wait for pain as a symptom of periodontitis. In fact, nonsurgical therapies of the less severe stages of the disease are much less painful and less expensive than more invasive, corrective ones.