North Shore Periodontics in Sydney, Australia | Doctor

North Shore Periodontics

Locality: Sydney, Australia

Phone: +61 2 8026 0400

Address: Suite 104A, 22 Clarke St Crows Nest 2065 Sydney, NSW, Australia

Website: http://Www.nsperiodontics.com.au

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• Periodontist

22.01.2022 I was treating a patient who came in for management of the gingival recession around her lower incisors. Apart from showing the roots, the other problem was that there was a lack of keratinisation of the gingival tissues around the 31 and 41. She also had a very thin soft tissue biotype and roots of the 31 and 41 were buccally positioned. This makes the procedure of recession coverage more difficult as the tissues are more difficult to work with and there is a reduced blood s...upply to the soft tissue graft. So what I decided to do was use this technique called a free gingival graft. Free gingival grafts are popular for improving the soft tissue thickness and keratinisation around teeth, however, unfortunately it is unpredictable at best when it comes to root coverage. Nevertheless, my clinical technique involved preparation of the 31 and 41 with a split thickness buccal flap. Then the soft tissue graft is harvested form the hard palate. In this clinical situation, I decided to treat the root surface with EDTA gel and Emdogain, prior to stabilising the graft with PTFE sutures. The initial healing at 2 weeks was looking favourable, and then at 8 weeks the graft was quite mature. The outcome is a well integrated soft tissue graft, and as a bonus, root coverage was additionally achieved. Although this soft tissue technique is not as aesthetic as a tunnelling procedure, this type of graft will be highly stable and will provide protection from further future recession. My lessons and advice from this case is that success with soft tissue grafting can be achieved if we follow biological principals, and that there are various techniques and we should know when and where to use them. In saying that, it is also up to the patient's individual biology as to how well they heal and this is usually the most unpredictable thing for me.

19.01.2022 Extract or save the tooth? My advice is to give teeth a chance. A patient was referred to me for managing an abscess at the lower right molar (46). There was tenderness around the gums but no pain on percussion. The tooth was negative to pulp sensibility testing. Radiographically, a deep radiolucency was present at the distal of the 46. My first impression was that it was a vertical root fracture in which the tooth needed to be extracted. However, I could not be certain thi...s was the case. There is a chance it could be an isolated periodontal defect. In some selected situations exploratory surgery will allow a confirmed diagnosis. Following elevation of mucoperiosteal flap, I could confirm that there was no fracture. Instead, there was gross calculus deposits and an intrabony defect. The diagnosis was a localised advanced periodontal infection. The site was carefully debrided and was then augmented with my regeneration protocol which includes the use of Bio-Oss and Emdogain. The outcome has been the successful management of this infection and the patient will be able to retain this tooth. If the tooth had been extracted, this would have resulted in a large bony defect that would have been difficult and costly to manage with dental implants. Give teeth a chance!

17.01.2022 When performing labial frenectomy on children consider 3 things: 1. Speed of recovery 2. post operative bleeding and pain and 3. predictability of the technique. Historically, frenectomies were carried out with scalpels. Although it was a quick procedure, often there could either be a relapse and recurrence of the frenum if the frenectomy was done too superficially, or if the incisions were too deep, there may be post operative swelling of the lip. Instead of scalpel, use of ...a diode laser has improved patient acceptance and allowed speedier recovery time with no bleeding. The intra oral photograph shows the initial clinical situation and then healing two weeks later. No bleeding, no sutures, no pain.

14.01.2022 Removal of this implant was the the unfortunate consequence of peri-implantitis in this patient. In addition to implant surface and macro design, patient factors also play a significant role in the aetiology of peri-implantitis. A history of periodontitis can lead to an increased risk of peri-implantitis developing. In the paper by Karoussis 2003, the incidence of peri-implantitis in patients with a history of periodontitis to be 29% vs only 6% in patients who were periodonta...lly healthy. The case in the clinical images shows the loss of implant unfortunately after only 3-4 years from the time it was placed. This patient had untreated periodontal disease so it is no surprise then that peri-implantitis developed within a short time. Following the removal of the implant, it is interesting to inspect the implant threads and observe the biofilm formation on the implant surface and between the threads. In this case, we can see hardly any calculus formation, but the implant surface is covered in biofilm. The sad fact is that now the future rehabilitation of this site now would post a difficult task, given how much bone resorption has occurred in the area. For all patients undergoing implant treatment, my suggestion is to include a full periodontal examination and chart. As a general rule of thumb, I will only proceed with implants if they have pockets <5mm or 5mm if there is no bleeding on probing.

08.01.2022 Intrabony defects and the role of orthodontic treatment. Periodontal disease may result in the formation of intrabony defects. These are angular bone defects where the inflamed connective tissue is located apical to the crest of the alveolar bone. These defects are often not treated adequately when using a conventional approach of non-surgical periodontal debridement. One reason is the inability of ultrasonics and curettes in reaching the apical areas of these 'intrabony' poc...kets. The issue of leaving these sites untreated with residual pockets is they have a high risk of further progression leading to a periodontal abscess and tooth loss. In the 1st case, the treatment of the advanced periodontal lesion is via a surgical approach, while the 2nd case was managed with a combined non-surgical debridement and orthodontic treatment. The role of orthodontic treatment in the management of periodontal disease is certainly an interesting area. In this 2nd case, the initial presentation of the lateral incisor has both mesial and distal intrabony defects. Following non-surgical periodontal therapy, orthodontic forces were directed to bodily move the tooth into the intrabony defects with the aim of eliminating this defect. This was achieved with light forces to intrude the tooth. The periapical radiographs show radiological bone fill and gain of attachment. This was also confirmed clinically with a reduction in probing depth. This case is not yet finished, but the progress so far appears favourable. Histological studies in animals support the findings that orthodontic intrusion may lead to new connective tissue attachment of the periodontally compromised tooth, with the possibility of new cementum layer formed on the previously infected root surface. This type of treatment modality can help adult patients with a periodontally compromised dentition who are also suffering aesthetic issues of spacing and over eruption of their anterior teeth. However, the orthodontic treatment should not commence until after the periodontal treatment is carried out. It also requires the proper biomechanics, and of course proper patient selection, compliance and maintenance.