During the first, consultative visit, the periodontist evaluates the degree of disease progression and determines treatment goals. Together with the patient, stages of treatment are determined. A prelude to more advanced treatments is a special, non-surgical cleaning of the root surfaces called scaling and smoothing of the tooth roots. It is aimed at removing bacterial plaque and tartar deposits from the tooth surface, and most of all – from its roots. These procedures help the gums to heal and the periodontal pockets to become shallow.
At the next visit (usually after 1-6 weeks from the first visit), the dentist will check the depth of periodontal pockets to assess the effectiveness of the initial treatment and make any adjustments. At this stage, in many cases it turns out that remission of periodontal disease has been achieved and the patient does not require further active therapy, but only maintenance treatment (so-called secondary prevention!). However, if periodontal pockets are deep and bone loss occurs, the doctor may decide to perform surgical treatment to prevent tooth loss.
Periodontal surgery (known as flap surgery or open curettage) is performed to remove inflamed tissues and shallow the bone loss. Surgical access allows the dentist to reach hard-to-reach areas below the gingival margin and tooth root surfaces and to replace missing bone tissue with bone replacement material or enamel matrix proteins.