Can Periodontal Bone Loss Be Reversed? Exploring Treatment Options

How to address alveolar bone loss caused by periodontal disease?

Hello Dr.
Tseng, I have a question regarding the bone loss between the left upper canine and the premolar due to periodontal disease.
The pocket has exceeded 10mm.
A specialist endodontist has examined it and confirmed that this is not due to poor root canal treatment of the premolar, so further root canal therapy would be ineffective.
It is entirely a periodontal issue.
The periodontist informed me that the bone loss in the alveolar bone cannot regenerate.
I don't understand! Why does the alveolar bone heal and regenerate after tooth extraction?
Q1: Is it true that the alveolar bone loss caused by periodontal disease cannot regenerate? I don't understand why the alveolar bone can heal and regenerate after tooth extraction.

Q2: Are there any other methods to address a 10mm pocket? I do not want to give up on this premolar that has undergone root canal treatment and has a crown.
Thank you.

Jason, 40~49 year old female. Ask Date: 2016/03/31

Dr. Zeng Guanghui reply Dentistry

1.
In the above situation, after examination, it was determined that the issue is not related to root canal problems but rather periodontal disease.
If the alveolar bone loss is of a narrow and deep type, there is a higher chance of successful bone grafting.
However, if the alveolar bone loss is both wide and deep, the success rate of bone grafting is low.

2.
It is advisable to have a periodontal specialist evaluate the condition; only after the periodontal disease is under control can the teeth designated for crowns effectively perform their occlusal function.

Reply Date: 2016/03/31

More Info

Periodontal disease is a significant dental health issue that can lead to bone loss around the teeth, particularly in the alveolar bone, which supports the teeth. The situation you described, with a periodontal pocket exceeding 10mm, indicates advanced periodontal disease, which can complicate treatment options and outcomes.

Q1: Can Bone Loss from Periodontal Disease Be Reversed?
The short answer is that while some aspects of periodontal disease can be managed and improved, complete reversal of bone loss is often not possible. When periodontal disease progresses, it leads to the destruction of the supporting structures of the teeth, including the alveolar bone. This bone loss is typically irreversible because the body does not regenerate bone in the same way it does soft tissue.
However, there are treatment options available that can help manage the condition and potentially improve the situation. For instance, if the bone loss is localized and the periodontal disease is controlled, bone grafting procedures can be performed. Bone grafting involves placing bone material (either from the patient, a donor, or synthetic sources) into the area of bone loss. This can stimulate new bone growth and help restore some of the lost support for the teeth.
The reason why extraction sites can heal and the bone can regenerate after tooth removal is due to the body's natural healing processes. When a tooth is extracted, the surrounding bone undergoes a remodeling process, which can lead to some degree of healing and bone formation. However, this process is different from the regeneration of bone lost due to periodontal disease, where the underlying cause (the infection and inflammation) must also be addressed.

Q2: Are There Other Treatment Options for a 10mm Pocket?
For a periodontal pocket of 10mm, it is crucial to first control the periodontal disease through professional cleaning and possibly surgical intervention. Scaling and root planing (deep cleaning) can help remove plaque and tartar from below the gum line, which is essential for reducing pocket depth. If the disease is severe, surgical options such as flap surgery may be necessary to access the roots of the teeth and clean the area more effectively.

In addition to these treatments, the use of bone grafting materials can be considered to help fill in the areas of bone loss. This can be done in conjunction with other periodontal therapies. Furthermore, regenerative techniques, such as guided tissue regeneration (GTR), can also be employed. GTR involves placing a barrier membrane to direct the growth of new bone and gum tissue at the site of the defect.

It is also essential to maintain good oral hygiene practices at home and to attend regular dental check-ups to monitor the condition of your gums and teeth. If you are concerned about losing your premolar, discussing these options with a periodontist is vital. They can provide a tailored treatment plan based on the severity of your condition and your specific needs.

In conclusion, while complete reversal of bone loss due to periodontal disease may not be achievable, there are several treatment options available that can help manage the disease, improve the health of your gums, and potentially restore some of the lost bone. Early intervention and consistent care are key to preserving your teeth and maintaining oral health.

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