Q: My dentist wanted me to be evaluated by a periodontist for possible bone loss. I went for an evaluation and he said I had bone loss and recommended osseous surgery 4+ per quad. I have no pain, no bleeding while brushing, but chronic bad breath. I thought periodontal scaling and root planing would be done first before osseous surgery. Also, I was advised that I needed crown lengthening to prep a tooth for a crown. I am hesitant to have the surgery without trying the scaling and root planing. What are your thoughts? Thank You.
A: This question seems to come up quite often from patients, doctors, students and residents, so I will try to explain how things have changed over the last 29 years in our approach to treating gum disease.
First, an accurate diagnosis is necessary. Once we review the clinical information and full set of quality digital radiographs, we can determine how to treat the disease in the least invasive but most effective way possible with the best long term results.
We utilize laser therapy, which eliminates the need for separate scaling and root planing appointments and aggressive surgery (see our web site for more detailed information). We try to eliminate the need for conventional osseous surgery, when possible, and treat the entire mouth with the FDA-cleared laser approach (LANAP).
The advantages of this are to:
- Eliminate scaling and root planing as a separate procedure and eliminate the need for multiple appointments involving local anesthesia.
- Utilize the laser surgery instead of the conventional osseous surgery, where possible.
- If crown lengthening is needed, the area of conventional surgery is limited to the area in question.
We find that we can treat about 85% of our patients with the laser approach and in many cases, eliminate the need for cutting, suturing, scaling and root planing. In a worst case scenario, we can just do the conventional osseous surgery in very limited areas for crown lengthening. This comprehensive approach in treating periodontal disease makes for a pleasant post-operative experience for the patient with excellent results.
I would suggest a second opinion with a Periodontist trained in LANAP surgery.
Best of luck,+
Dr. Eric Linden
