Periodontal health
Causal diagnosis and staged treatment of periodontal disease, the precondition for any implant-prosthetic rehabilitation. By Dr. Gaetano Calesini, prosthodontist.
Periodontitis is a chronic inflammatory disease of the tooth-supporting tissues, gum, periodontal ligament and alveolar bone, triggered by bacterial biofilm and sustained by the body’s inflammatory response. It is one of the leading causes of tooth loss in adults. Its clinical hallmark is the progressive loss of supporting bone: once it has occurred it is not spontaneously reversible, but the disease can be halted. Early diagnosis, before bone loss reaches a critical level, is the main determinant of prognosis. Treating periodontitis is also the precondition for any rehabilitation: no implant or prosthesis is stable on a diseased periodontium.
Gingivitis is inflammation confined to the soft tissues, with no bone loss. It is reversible with adequate treatment and rigorous oral hygiene. Periodontitis, instead, involves the bone: loss of support is already under way and, unlike gingivitis, it does not resolve on its own.
The distinction is clinically relevant because the strategies differ. Gingivitis is managed with professional hygiene and home-care instruction. Periodontitis requires measurement of probing depth, assessment of radiographic bone level and, in residual cases, surgical treatment.
Probing depth, bleeding on probing, gingival recession and clinical attachment level are the fundamental parameters. Deep pockets with bleeding, in the presence of radiographic bone loss, meet the diagnostic criteria for periodontitis under current international classifications.
A full intraoral radiographic status quantifies the extent and distribution of bone loss. It establishes stage and severity and serves as the reference for assessing the response to treatment over time.
Smoking and poorly controlled diabetes are the main modifiable risk factors; genetic predisposition, inadequate hygiene, stress and certain systemic conditions also contribute. Identifying them and, where possible, controlling them is an integral part of therapy, not an accessory detail.
Periodontitis is classified by stage, the extent and severity of loss of support, and by grade, the rate of progression and individual risk. Staging guides the intensity and sequence of treatment.
Treating periodontitis is not a single act but a sequence of phases, in which each step depends on the response to the one before it.
Removal of biofilm and supra- and subgingival deposits, with instrumentation of the root surfaces, combined with home-care instruction, is the first phase and in most cases the most decisive. It reduces inflammation and halts the progression of the disease.
After several weeks the response is reassessed: probing depth, bleeding, attachment level. It is the reassessment, not a fixed calendar, that determines whether and where a surgical phase is needed.
In deep residual pockets, surgery provides access to clean and decontaminate the root surfaces. Depending on the morphology of the defect, the approach may be resective or regenerative. On natural teeth, periodontal regeneration is more predictable than around implants.
Periodontitis is controlled, not eliminated once and for all. A personalised recall programme, supportive periodontal therapy, is what preserves the results over time. Without maintenance, the disease tends to recur.
Periodontitis and rehabilitation
An implant placed in a diseased periodontium is exposed to the same bacteria and carries a high risk of peri-implantitis; a prosthesis on teeth with compromised support has an uncertain prognosis. For this reason, in the treatment plan, treating and stabilising the periodontium comes before the implant-prosthetic phase. A history of treated and maintained periodontitis is not a contraindication to implants, but it calls for careful selection, rigorous monitoring and constant maintenance.
Studio Calesini, at Via della Croce 77 in the historic centre of Rome, assesses the periodontal condition as an integral part of planning complex cases.
Periodontitis is controlled, not eliminated once and for all. With causal therapy and a regular maintenance programme the disease is halted and the tissues stabilise; without maintenance it tends to recur. The realistic objective is to stop bone loss and keep the teeth over time, not a return to the pre-disease condition.
Bleeding is a sign of inflammation, gingivitis, which is reversible. If the inflammation progresses and involves the supporting bone it becomes periodontitis, which does not resolve on its own. An assessment with probing and radiographs distinguishes the two conditions and measures their severity.
Not before treating it. An implant placed in a diseased periodontium is exposed to the same bacteria and carries a high risk of peri-implantitis. The periodontium is treated and stabilised first, then the implant is assessed. Treated and maintained periodontitis does not rule out implants, but it requires constant monitoring over time.
Yes, significantly. Smoking is the main modifiable risk factor: it promotes the progression of the disease, masks bleeding, and reduces the response to both non-surgical and surgical therapy. Stopping smoking is an integral part of treatment.
It depends on the individual tooth. Some teeth with advanced bone loss are retained with therapy and rigorous maintenance; others, with support compromised beyond treatment, are extracted to protect the neighbouring teeth and the rehabilitation plan. The decision comes from an individual clinical and radiographic assessment, not from a fixed scheme.
Studio Calesini · Via della Croce 77, Rome
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