Periodontitis is one of the most serious dental diseases.
It is the progress of gingivitis, an inflammatory disease of the gums, which if not treated promptly develops into periodontitis. The inflammation extends from the gums to the bone that supports the teeth, which slowly subsides.
When periodontitis is not treated, more bone is lost, so progressively teeth start to move and finally they are extracted .
Patients who have not received dental treatment on time observe severe symptoms such as mobility, migration and loss of teeth. Their frequent complaint is that the teeth lost, were as good as new. Teeth may had been cavity-free, but since theiy had suffered significant bone loss, it was inevitable for them to be lost.
It is quite common because of the disease, to loose posterior teeth that are designed for chewing purposes. When this happens, patients begin to chew with their front teeth, that are not made to receive chewing forces and weak as they are from the bone loss that has occurred, they start to migrate labially.
Periodontitis is succesfully treated from dentists and specialists that are called periodontists. With continuous monitoring and care, periodontal patients can keep their teeth for many years.
It is not uncommon though for periodontal patients to lose teeth before the start of treatment or during its course. In some cases teeth may migrate because of reduced bone support to new position. Some other times the dentition develops gaps between teeth and create aesthetic problems.
The need for prosthetic restoration of lost teeth and the aesthetic improvement of their smile in patients with periodontitis, is a common problem that we as Prosthodontists face.
A prerequisite for the prosthetic restoration is the succesfull treatment of periodontitis. Only after the treatment of the inflammation and the patient's commitment to continuous monitoring, we can start the prosthetic treatment of periodontal patients.
Many times, we work with orthodontists who help us moove the teeth to their correct position, in order to start a predictable prosthetic treatment.
Following is a series of prosthetic cases in periodontal patients that have been treated in our clinic, sorted according to the main patient concern.
1. Teeth migration outside the dental arch:
We start with a young patient who had been treated from a periodontist and was looking for an aesthetic solution for the lateral insicor who had moved out of the dental arch and affected the aesthetics of the smile.
In the pictures above, you see the original image of the smile and the corresponding intraoral image.
If we worked only on the lateral insisor, we should have grinded the tooth so much, that we would lose its greater part.
Combining the aesthetic improvement of the lateral area with an intervention in the adjacent canine, allows us to reduce the amount of tooth substance that has to be removed in order for the tooth to get the correct position in the dental arch.
We replaced the posterior cantilevered bridge with a new one that was supported by the canine.
That way we offered better support to an existing bridge and improved the appearence of the natural canine.
At the same time we worked on the lateral incisor, and made a new crown for the tooth that gave the lost harmony in the smile of the patient.
In the next case the smile esthetics had been significantly compromised by the migration of the central incisor due to the perio disease.
Bone loss around the teeth was so significant that it was necessary to extract the tooth.
In place of the missing tooth, we made an all ceramic zirconium bridge, that achieved to restore the problem both functionally and aesthetically.
In the last case, the patient was unhappy with the aesthetics of her smile because of the migration of all anterior teeth that created gaps between them.
After treatment of the periodontal disease we replaced the existing crowns on that patients anterior teeth, and with the new crowns we managed to close the gaps and give a better smile esthetic.
2. Black triangles between teeth
After periodontal treatment sometimes large interdental spaces are being formed. These black triangles can be treated with the help of porcelain veneers like 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 maxilla that replaced all the posterior teeth the patient had lost. Missing teeth were replaced by a screw retained prosthesis.
By acting on time we can improove mastication and esthetics but more importantly we can improove the prognosis of the anterior teeth that if not suported properly will collapse soon.
If you have gum problems, see a periodontist as soon as possible.
You can save your teeth and with the right prosthodontic care you can have a great esthetic and functional result.
intro image found here