Aesthetic and prosthetic treatment of periodontal patients

Periodontitis is one of the most serious dental diseases.

It is the progression of gingivitis, an inflammatory disease of the gums, which, if not treated promptly, develops into periodontitis. The inflammation spreads from the gums to the bone that supports the teeth, which slowly subsides.

If periodontitis is left untreated, more bone is lost, so teeth gradually start to move and eventually need to be extracted.

Patients who have not received timely dental treatment experience severe symptoms such as mobility, migration and loss of teeth. They often complain that the teeth they lost were as good as new. The teeth may have been decay-free, but since they had suffered significant bone loss, it was inevitable that they would be lost.

It is quite common for the disease to cause posterior teeth, which are used for chewing, to become loose. When this happens, patients start chewing with their front teeth, which are not designed to withstand chewing forces, and weakened by the bone loss that has occurred, they start to migrate labially.

Periodontitis is successfully treated by dentists and specialists called periodontists. With ongoing monitoring and care, periodontal patients can keep their teeth for many years.

However, it is not uncommon for periodontal patients to lose teeth before or during treatment. In some cases, teeth may migrate to a new position due to reduced bone support. In other cases, the dentition develops gaps between the teeth, causing aesthetic problems.

The need for prosthetic restoration of lost teeth and aesthetic improvement of the smile in patients with periodontitis is a common problem we face as prosthodontists.

A prerequisite for prosthetic restoration is the successful treatment of periodontitis. Only after the inflammation has been treated and the patient has agreed to continuous monitoring, can we start the prosthetic treatment of periodontal patients.

We often work with orthodontists who help us move the teeth into the correct position to start a predictable prosthetic treatment.

Below is a series of prosthetic cases of periodontal patients treated in our clinic, sorted according to the patient’s main concern.

1. Migration of teeth

We start with a young patient who had been treated by a periodontist and was looking for an aesthetic solution to the lateral insicor that had moved out of the dental arch and was affecting the aesthetics of the smile.

The images above show the original smile and the corresponding intraoral image.

If we had only worked on the lateral insisor, we would have had to grind the tooth down to the point where we would have lost most of it.

By combining the aesthetic improvement of the lateral area with a procedure on the adjacent canine, we were able to reduce the amount of tooth substance that had to be removed in order to get the tooth into the correct position in the dental arch.

We replaced the posterior cantilever bridge with a new one supported by the canine.

This provided better support for an existing bridge and improved the appearance of the natural canine.

At the same time, we worked on the lateral incisor and made a new crown for the tooth, which restored the lost harmony in the patient’s smile.

In the next case, the aesthetics of the smile were severely compromised by the migration of the central incisor due to periodontal disease.

There was so much bone loss around the tooth that it had to be extracted.

In place of the missing tooth, we fabricated an all-ceramic zirconium bridge that solved the problem both functionally and aesthetically.

2. Black triangles between teeth

After periodontal treatment, large spaces are sometimes left between the teeth. These black triangles can be treated with porcelain veneers, as in the following case.

3. Loss of multiple teeth :

Loosing posterior teeth can be of great importance  because it creates not only esthetic but mostly functional problems.

In this case, we placed 6 dental implants in the upper jaw to replace all of the patient’s missing posterior teeth. The missing teeth were replaced with a screw-retained prosthesis.

If we act in time, we can improve chewing and aesthetics, but more importantly we can improve the prognosis of the front teeth which, if not properly supported, will soon collapse.

If you have gum problems, see a periodontist as soon as possible.

You can save your teeth and with the right prosthetic care you can have a great aesthetic and functional result.