What to do if there are dental pockets. Causes of inflammation of the gum pocket and methods of treatment

Periodontal pocket contents:

gram-negative microflora,

subgingival calculus,

granulation,

strands of vegetative epithelium.

Spontaneously, without treatment, the periodontal pocket does not disappear. It is necessary to remove its contents and turn the inner surface of the periodontal pocket into a clean wound surface covered with a blood clot, which organizes and after 21 days turns into mature collagen fibers, and the outer wall of the pocket grows to the surface of the tooth root with the formation of the periodontal junction and even the epithelium of attachment.

Method selection criterion surgical intervention in the treatment of periodontitis is the depth of the periodontal pocket.

closed curettage is performed with a pocket depth of up to 4 mm,

open curettage is performed with a pocket depth of 6 mm,

at a pocket depth of more than 6 mm, a flap operation is performed.

Contraindications for curettage of a periodontal pocket:

suppuration from the pocket,

sharp thinning or fibrotic change the outer wall of the pocket,

tooth mobility of the III degree.

Closed curettage of the periodontal pocket (O.D.)

	Actions	Facilities	Self-control criteria
	Preoperative preparation.
		Chlorhexedine solution 0.2%
		Iodine solution.
		Gloves, syringe, anesthetics.
			With a curette, we remove the subgingival calculus from the surface of the tooth. We polish the surface.

		Gloves, excavator.	Insert the excavator into the periodontal pocket with the cutting surface towards the gum, press the gum against the excavator with the pad of the end phalanx of the index finger of the other hand through a gauze ball. Remove the excavator from the periodontal pocket, removing granulation tissue and pocket epithelium from the inner wall of the pocket. Repeat the procedure around the entire perimeter of the tooth root.
	Irrigation of the periodontal pocket.
	We create a blood clot.	Gloves, excavator.	Use a clean excavator to cause capillary bleeding in the surgical wound. Press the gum against the tooth surface with a gauze ball.
	Apply a periodontal bandage.	Gloves, artificial dentin powder and zinc oxide powder, oil: corn oil, sea buckthorn oil, rosehip oil, oil solutions, vitamins A and E. the necessary medicinal substance.	See above for the blending technique.
Postoperative period.
	Keep the periodontal dressing for 2 to 5 days, limiting brushing in this area. Carry out oral baths with an antiseptic solution 2 times a day for 3-5 minutes while maintaining the dressing. After removing the dressing, you must return to using the toothbrush. Further, the local application of keratoplastic drugs is prescribed.

Open curettage of the periodontal pocket (O.O.D.)

	Actions	Facilities	Self-control criteria
	Preoperative preparation.		We train the patient in oral hygiene, We carry out the sanitation of the oral cavity, We carry out professional hygiene, We prescribe anti-inflammatory therapy.
	Antiseptic treatment of the oral cavity.	Chlorhexedine solution 0.2%	Active rinsing of the oral cavity with an antiseptic solution in the volume of one sip: oral bath with an antiseptic solution for 3 minutes.
	Antiseptic treatment of the mucous membrane at the site of local anesthesia.	Iodine solution.	Treat the curettage site with a swab soaked in solution.
	Conducting local anesthesia.	Gloves, syringe, anesthetics.	We provide application and infiltration therapy.
			Cut the interdental isthmus with a scalpel, separating the vestibular papilla from the oral; 2. Separate the gingival papillae from the surface of the teeth to the bottom of the pocket with a narrow raspator or sickle-shaped trowel.
	Removal of subgingival dental plaque.	Gloves, zone-specific curettes for removing tartar and polishing the root surface.	With a curette, we remove the subgingival calculus from the surface of the tooth.
	Irrigation of the periodontal pocket.	Gloves, a syringe with a blunt needle, antiseptics.	Insert the needle of a syringe with an antiseptic solution into the pocket and rinse the wound under pressure (repeat on each tooth surface).
	We clean the periodontal pocket from granulations and epithelium.		We remove granulation tissue and pocket epithelium with an excavator and scissors.
	Irrigation of the periodontal pocket.	Gloves, a syringe with a blunt needle, antiseptics.	Insert the needle of a syringe with an antiseptic solution into the pocket and rinse the wound under pressure (repeat on each tooth surface).
		Gloves, isolation bandage, suture material. Dressing.	Place the flap in place, secure with an insulating periodontal bandage. Instead of an isolating dressing, you can complete the operation with a simple interdental suture, bringing the separated papillae closer together.
Postoperative period.
	Keep the periodontal dressing for 2 to 5 days, limiting brushing in this area. Carry out oral baths with an antiseptic solution 2 times a day for 3-5 minutes while maintaining the dressing. Remove the seam for 7-10 days. After removing the dressing, you must return to using the toothbrush. Further, the local application of keratoplastic drugs is prescribed. Prescribing anti-inflammatory therapy at the discretion of the physician.

The main stages of the flap surgery (O.O.D.)

	Actions	Facilities	Self-control criteria
	Preoperative preparation.		We train the patient in oral hygiene, We carry out the sanitation of the oral cavity, We carry out professional hygiene, We prescribe anti-inflammatory therapy.
	Antiseptic treatment of the oral cavity.	Chlorhexedine solution 0.2%	Active rinsing of the oral cavity with an antiseptic solution in the volume of one sip: oral bath with an antiseptic solution for 3 minutes.
	Antiseptic treatment of the mucous membrane at the site of local anesthesia.	Iodine solution.	Treat the curettage site with a swab soaked in solution.
	Conducting local anesthesia.	Gloves, syringe, anesthetics.	We provide application and infiltration therapy.
	We open the gingival flap.	Gloves, surgical scalpel, sickle trowel or narrow raspator.	1. Make two vertical incisions with a scalpel from the edge of the gums to the mucous-gingival border (the incisions limit the operating area); 2. The next incision is made along the orifices of the periodontal pockets, advancing the tip of the scalpel between the tooth surface and the gum to the bone surface, bordering each tooth in the area of operation (garland-shaped). 3. Dissect the gingival isthmus, separating the vestibular gingival papilla from the oral papilla. 4. With a dispenser, peel off the mucoperiosteal flaps on the vestibular and oral surfaces along the bone surface in such a way as to expose at least 0.5 cm of the alveolar bone.
	Removal of subgingival dental plaque.	Gloves, zone-specific curettes for removing tartar and polishing the root surface.	With a curette, we remove the subgingival calculus and infected cement from the surface of the tooth.
	Antiseptic treatment.	Gloves, a syringe with a blunt needle, antiseptics.	Remove tartar fragments and infected chips from the surface of the teeth with a stream of antiseptic solution.
	We remove the granulation tissue surrounding the tooth.	Gloves, excavator, dressings.	With an excavator, we remove the granulation tissue with scraping movements.
	Irrigation of the periodontal pocket.	Gloves, a syringe with a blunt needle, antiseptics.	Insert the needle of a syringe with an antiseptic solution into the pocket and rinse the wound under pressure (repeat on each tooth surface).
	We remove the gingival epithelium that has grown into the periodontal pocket.	Gloves, excavator, scissors, dressings.	With scissors we remove the epithelium of the pockets from the inner surface of the muco-periosteal flaps.
	Polishing the root surface, smoothing the edge of the bone.	Finishing burs, periopoly.	At low speed with constant irrigation of the wound with saline, smooth the sharp edges of the bone and bone protrusions. Polish the tooth root.
	We put the flap, fix it.	Gloves, sutures. Dressing.	Place the flap in place. Complete the operation with a simple interdental suture in the interdental spaces, bringing the separated gingival papillae closer together. Suture the vertical incisions that delimit the surgical area.
Postoperative period.
	On the day of surgery, on skin, dry cold within 1-2 hours after the operation (10-15 minutes, at the same intervals. For 7 days, exclude brushing the teeth at the site of the operation. Assign oral baths with an antiseptic solution 2 times a day for 3-5 minutes. Exclude physical activity for 3 days, chewing rough and irritating food on the side of the operation for a week Removal of stitches for 7-10 days. Medication: NSAIDs, antihistamines. antibacterial drugs.

Output control:

Situational task number 1.

Patient A., 35 years old. Has been ill for 10 years with periodic deterioration. She has a history of diabetes mellitus.

Complaints about the mobility of the teeth, suppuration from the gums, the periodic appearance of abscesses on the gums, bleeding of the gums when brushing teeth and while taking solid food, bad breath.

Objectively: edema and hyperemia of the marginal gums and papillae. Periodontal pockets with a depth of 4-5-6 mm, suppuration from the pockets, abundant supra and subgingival calculi, soft plaque, tooth mobility of II-III degrees. On the roentgenogram in the area of all teeth, a decrease in the height of the interdental partitions by 1 / 3-1 / 2 of their height is determined.

Make a diagnosis. Make a local treatment plan for this patient. Write down the recipes.

Situational task number 2.

Patient S., 48 years old. Complaints about the mobility of the teeth, recurrent suppuration from the gums, pain and bleeding of the gums, bad smell from mouth.

Ill for 15 years. Previously not treated. Notes the recurring deterioration in the course of the disease. History of gastric ulcer.

Objectively: the presence of a large amount of soft plaque, supragingival and subgingival calculus is determined on all teeth. Edema and hyperemia of the marginal gums and gingival papillae in the area of all teeth, and in the area of 31, 32, 41, 42 teeth periodontal pockets with a depth of 4-6 mm with purulent discharge and abundant granulations protruding from the pockets are determined. The mobility of these teeth is I-II degrees. In the area of 14, 15, 24, 25 teeth, when probing the gingival groove, periodontal pockets with a depth of 6-8 mm are determined, the mobility of teeth of II-III degrees. In the area of 31, 32 teeth and in the area of 24, 25 teeth, premature closing of the teeth is determined. On the roentgenogram in the area of 31, 32, 41, 42 teeth, a decrease in the height of the interdental partitions by 1 / 3-1 / 2 of their height is determined; and in the area of 14, 15, 24, 25 teeth, a decrease in the height of the interdental partitions by 1/2 or more than 1/2 of their height is determined.

Make a diagnosis. Make a treatment plan. Write down the recipes.

Analysis and summing up.

Homework:

1. Explore general treatment periodontal diseases.

2. Describe the mechanism of action, method of application and recipes of "Tizol-complexes".

Main literature:

Therapeutic dentistry Textbook / Ed. E.V. Borovsky - M.: MIA.-2003; 2004 r.

Additional literature:

Periodontal disease. Edited by prof. L.Yu. Nut .: Poly Media Press, 2008.-318s.

Therapeutic dentistry: textbook: 3 hours / ed. G.M.Barera. - M .: GEOTAR-Media, 2008. - Part 2 - Periodontal diseases. - 224 p.

Diagnostics, treatment and prevention of periodontal diseases. L.M. Tsepov, A.I. Nikolaev, E.A. Mikheeva .: MEDpress-inform, 2008.-272 p.

From this article you will learn:

what is periodontitis - symptoms, photos,
modern methods of treatment,
is it possible to treat periodontitis at home, folk remedies.

The article was written by a dentist with over 19 years of experience.

Periodontitis is an inflammatory disease of the gums, which is accompanied by increasing destruction of the attachment of teeth to the bone and soft tissues of the gums, which leads to the appearance of tooth mobility and the need to remove them. Periodontitis can appear in the area of only 1-2 teeth - in this case it is called localized, or it can be generalized.

Most often, patients with chronic generalized periodontitis, in which the gums are inflamed around almost all teeth, turn to doctors. Most of these patients have a long history of self-treatment of painful and bleeding gums, i.e. symptoms of catarrhal gingivitis. Moreover, it is the ineffective treatment or no treatment of gingivitis at all that leads to its transformation into generalized periodontitis.

Periodontitis: generalized (Fig. 1) and localized (Fig. 2-3)

Localized traumatic factors are the causes of localized periodontitis. This can be an overhanging edge of a filling or an artificial crown (injuring the gums in the interdental space). The reason may be "premature contacts" between the upper and lower teeth, which can appear both from natural causes, and if the filling on the chewing surface or the crown is made a little higher than necessary.

Another common reason: when a dentist, when restoring a damaged tooth with a filling, incorrectly forms a contact point between the teeth in the interdental space. The lack of tight contact leads to constant food stuck in the interdental space and the development of inflammation. In the localized form (as opposed to the generalized form), the symptoms of periodontitis occur only in teeth exposed to the action of a traumatic factor.

Chronic periodontitis symptoms:

In almost all cases, patients with chronic generalized inflammation of the gums turn to the periodontist. Insufficient oral hygiene leads to the accumulation of microbial plaque on the teeth, pathogenic bacteria in the composition of which toxins are released, which trigger inflammation in the gums. The inflammation is at first only superficial, and is manifested by bleeding and soreness when brushing the teeth, as well as swelling and redness or cyanosis of the gingival margin.

At this stage, there is still no destruction of the tooth-gingival attachment, destruction bone tissue or destruction of periodontal fibers, due to which the tooth is attached to the bone tissue. This is called gum disease. With him improper treatment or no treatment - gingivitis sooner or later transforms into the next form of gum disease, i.e. periodontitis. The starting point for the development of periodontitis is the destruction of the gingival attachment (i.e., the attachment of the soft tissues of the gums to the neck of the teeth).

The gingival attachment is an anatomical barrier that prevents pathogenic bacteria from entering below the gum line. As soon as this barrier is destroyed, inflammation captures not only soft tissue gums, but also the periodontium, as well as the bone tissue around the teeth, which leads to the gradual destruction of the latter. The symptoms and treatment of periodontitis will depend on the severity of the periodontitis (i.e., the degree of tissue destruction around the teeth). There are mild, moderate and severe forms of this disease.

With a mild form of periodontitis, firstly, all the symptoms of catarrhal gingivitis will persist, i.e. the patient will continue to complain of intermittent soreness and bleeding when brushing their teeth. In addition, there will still be swelling, cyanosis or redness of the gingival margin, as well as accumulation of microbial plaque or tartar in the area of the necks of the teeth (Figure 4-5).

What periodontitis looks like: photo

The main diagnostic criterion, which distinguishes the symptoms of the initial stage of periodontitis from the symptoms of catarrhal gingivitis, is the formation of periodontal pockets up to 3.5 mm deep. They are formed as a result of the destruction of the attachment of the soft tissues of the gums to the necks of the teeth, which leads to the penetration of pathogenic bacteria below the level of the gums. As soon as this happens, inflammation and pathogenic bacteria lead to the destruction of the periodontium and bone tissue next to the tooth root (Fig. 6).

On the surface of the tooth root (in the depth of the periodontal pocket), there are hard dental deposits, and the lumen of the pocket is filled with serous-purulent discharge. During the period of decreased immunity, the patient may notice that pus is released from the periodontal pockets. In patients with this stage of periodontitis, it is possible to notice a decrease in the level of bone tissue (interdental septa) - up to 1/3 of the length of the roots of the teeth, and there can be 2 types of inflammatory bone resorption:

Horizontal bone resorption -
typical for the elderly and relatively elderly people, there is usually a slow progression of the disease, with a uniform decrease in the height of the bone tissue in the area of all teeth. Thus, in this group of patients, it is sometimes possible not to see periodontal pockets of 3-3.5 mm, but there is a uniform decrease in the level of bone tissue in the area of all teeth.

Vertical bone resorption -
typical for young and relatively young people. The nature of the course of inflammation is usually aggressive (with rapid progression). Bone destruction takes place only in the area of periodontal pockets formed along the surfaces of the tooth roots. At the same time, as such, a decrease in the height of the interdental bone septa is not observed. This form is the most difficult to treat.

Important : with periodontitis of mild severity, teeth mobility is not yet observed, as well as their displacement under the influence of chewing pressure (all this is characteristic of moderate and especially severe periodontitis).

This stage of the inflammatory process is distinguished by the fact that the number of periodontal pockets increases significantly, and their depth can already reach 5 mm. An increase in the depth of the pockets creates excellent conditions for the reproduction of pathogenic pyogenic bacteria, and therefore the discharge of serous-purulent exudate from the pockets becomes more pronounced (which is especially visible when pressing on the gum in the projection of the periodontal pocket).

In parallel, there is a further decrease in the height of the level of bone tissue - by about 1 / 3-1 / 2 the length of the roots, which leads, among other things, to a noticeable decrease in the gingival margin relative to the necks of the teeth and the exposure of the roots. In addition, with such a degree of bone destruction, there is: 1) tooth mobility of 1-2 degrees, 2) some teeth may be tilted, 3) fan-shaped teeth may begin to appear. The latter is especially typical for patients with the absence of a large number of chewing teeth.

At this stage of inflammation, patients often complain of a deterioration in their general condition - increased fatigue, weakness appear, and a decrease in immunity also occurs + frequent colds. This is due to the fact that in the periodontal pockets there is always a serous-purulent discharge, from which toxins and pathogens are absorbed into the bloodstream and spread throughout the body, affecting primarily the immune system.

Very important : Once again, we draw your attention to the fact that at this stage of periodontitis, secondary deformities of the dentition already occur, i.e. the teeth begin to "move apart", changing their position depending on the direction of the usual chewing pressure. Therefore, the treatment of periodontitis here is much more complicated, and will require very significant financial costs for splinting and dental prosthetics ..

Severe periodontitis is characterized by a further worsening of all symptoms. The depth of periodontal pockets can already reach 6 mm or more. The decrease in the level of bone tissue in the area of interdental septa reaches 2/3 or more of the length of the root. Mobility is observed in most teeth, and in some teeth it already reaches 3-4 degrees. With this form, exacerbations often occur, which are accompanied by the formation of abscesses, a sharp swelling of the gums, pain in them, and a sharp increase in the mobility of the teeth.

It should be noted that in severe cases, patients begin to suffer not only from local symptoms in the oral cavity, but also complain of weakness, malaise, poor sleep, and appetite. Heavy chronic inflammation gums can also affect the frequency of flare-ups chronic diseases internal organs... The condition of patients worsens especially diabetes mellitus, cardiovascular, hormonal, rheumatoid diseases.

Exacerbations of periodontitis –
there is also such a thing as "the course of the disease." Periodontitis is characterized by a chronic course, when the symptoms are smoothed out (without acute inflammation), but exacerbations of the inflammatory process may periodically occur. During exacerbations, the symptomatology becomes "acute", ie. symptoms become pronounced. The development of an exacerbation can be associated with both the depletion of the local defense mechanisms of the oral cavity, and with a decrease in the body's immunity. Next, we will discuss how to treat periodontitis.

How to treat periodontitis correctly:

Treatment of periodontitis (as well as the severity of symptoms) will depend primarily on the severity of the inflammatory process in a particular patient. The more significant the level of bone loss and the degree of tooth mobility, the more missing teeth you have, the more difficult, longer and more expensive the treatment will be. It all starts with a consultation, and you need to apply for it not to an ordinary dentist-therapist, but to a periodontist.

1. Consultation with a periodontist -

The first thing to do is to write a treatment plan. This is not as easy as it might seem in reality. If the disease is mild, then only a periodontist's consultation may be required. However, with mobility and divergence of teeth, malocclusion, when there are already missing teeth or those that will certainly have to be removed, a joint consultation with an orthopedic dentist (prosthetist) is necessary.

X-ray diagnostics –
for a full consultation, you will need an X-ray, which will allow you to assess the level of destruction of bone tissue, the localization and depth of periodontal pockets, and make the correct diagnosis, which will include the severity of your disease. In a patient (whose panoramic image is shown below), the diagnosis will be as follows: "Chronic generalized periodontitis, severe."

If you pay attention to the picture, you can notice that the level of bone tissue (it looks like a light, fine-looped mesh tissue in the picture) is reduced from 1/4 to 4/5 of the length of the tooth roots. The patient has decayed teeth for extraction, as well as carious teeth that require treatment. It is especially noticeable that the bone level is maximally reduced precisely in the anterior teeth of the upper and lower jaw... This was due to mechanical overload of the anterior teeth, which arose from the absence of lateral groups of teeth.

In similar situations, if a decision is made to preserve the front teeth, it is necessary to make a temporary removable prosthesis as soon as possible, which will replace the missing teeth and relieve the increased chewing load from the front teeth. An important point is that it is best to seek advice from (these specialists specialize in treating gums), and not to banal dentists-therapists. Moreover, it is best to get advice from different specialists in several clinics in order to form an opinion and choose the best one.

2. Removal of supra- and subgingival dental plaque -

Periodontitis is caused by soft microbial plaque and hard supra- and subgingival dental plaque. No treatment can be effective without removing the causative factor, and therefore the mainstay of treatment inflammatory diseases gums - high-quality removal of dental plaque. Today there are 2 main scale removal systems that can be used in patients with periodontitis -

Ultrasonic Teeth Cleaning Video –

There are fundamental differences between ultrasonic scalers and the Vector-Paro system. The Vector system allows for much better removal of subgingival dental deposits, which are localized in deep periodontal pockets. At the same time, the cost of processing 1 tooth will cost 5-6 times more - compared to the cost of ultrasonic cleaning of teeth. In what cases is it worth paying big money for the Vector system? - you ask. It's hard to explain, but we'll try.

To begin with, it is impossible to remove 100% of subgingival dental plaque, especially if there are middle and deep periodontal pockets. This is due to the lack of visual control below the gum line, i.e. removal of deposits in periodontal pockets is carried out by the doctor as if "by touch". But without removing 100% of the deposits, it is impossible to stop the progression of periodontitis. Therefore, in patients with moderate to severe forms of periodontitis, one of the main methods of treatment is (see below), in which all granulations and dental deposits are scraped out of the periodontal pockets.

So, if a patient has indications for surgical treatment of periodontitis (open curettage or flap surgery), but he refuses to do it because of cost or other reasons, then it is better to use the Vector-Paro system. If the patient agrees to the operation, ultrasonic cleaning of the deposits can be dispensed with, and all the remaining deposits will be removed during the curettage. With a mild form of periodontitis, ultrasound can be dispensed with. But, if the financial side of the issue does not interest you at all, in any case it is better to choose the Vector-Paro system.

Important : it is impossible to remove dental plaque in patients with periodontitis in 1 visit. Usually patients have to be prescribed 3-5 times. This is due to the fact that the search and removal of subgingival dental plaque is time consuming. In addition, when you remove the bulk of dental deposits, the patient comes to the next appointment with less swollen and inflamed gums. A decrease in edema leads to a decrease in the volume of the inflamed gums, which makes it possible to detect new dental deposits (and so on several times).

In addition, it is important not only to remove the subgingival calculus, but also, if possible, to polish the exposed surface of the tooth root in the depths of the periodontal pocket. The latter is done by gentle movements of the ultrasonic handpiece tips in a certain plane or the Vector-Paro apparatus. Otherwise, the rough rough surface of the root will facilitate the rapid formation of a new portion of tartar. In general, the removal of dental plaque with periodontitis is very difficult, long and requires the patience and perseverance of the doctor.

3. Anti-inflammatory therapy -

The course of anti-inflammatory therapy for periodontitis usually lasts 10 days. He is appointed by a periodontist immediately after the first dental plaque removal session. The course will definitely include drugs for topical application in the oral cavity - various antiseptic rinses and gels for the gums that the patient will use at home. In addition, in the presence of purulent or serous-purulent discharge from periodontal pockets, antibiotics are prescribed inside.

a) Local anti-inflammatory therapy –

It is not difficult to carry out such an anti-inflammatory treatment of periodontitis at home, and the standard course of treatment lasts only 10 days. The gum treatment should be carried out by the patient 2 times a day - in the morning and in the evening. It looks like this ... After breakfast, you first need to brush your teeth, and only after that, rinse your mouth with an antiseptic solution. It is best to use 0.2-0.25% concentration as an antiseptic.

The usual 0.05% Chlorhexidine solution, which is sold in pharmacies for 40 rubles, is only good for treating superficial gum disease (gingivitis). For the treatment of periodontitis, it is better to use higher concentrations of this antiseptic. You should take 10-15 ml of the solution into your mouth (1 sip) and, without spitting out anything, rinse your mouth for 1 minute. Below we will tell you which gargles contain such a concentration of chlorhexidine.

The second stage of morning processing –
consists in applying a therapeutic anti-inflammatory gel to the gingival margin. It goes without saying that the best choice with periodontitis, there will be a gel containing very effective anti-inflammatory components (choline salicylate and cetalkonium chloride). In addition, unlike many others, this gel acts not only on the surface of the mucous membrane, but also penetrates deeply into the inflamed tissues.

Because the mucous membrane in the oral cavity is always wet, then for better fixation of the gel, it is advisable to slightly dry the gums before applying it with a dry gauze swab. The gel should be applied in front of the mirror (grinning so that the gums are clearly visible in the mirror). First, squeeze the gel onto your finger and then apply the gel to the gingival margin around the teeth. Usually, the gel is applied only from the front surface of the dentition, unless the doctor said otherwise.

Keep in mind that during the application of the gel, saliva is always released, and you do not need to accumulate or spit it out. It should be swallowed as usual. After processing, it is important not to eat anything for 2 hours, and not drink anything or rinse your mouth for 30 minutes. In the evening, you must repeat the treatment - after dinner, brush your teeth, then rinse your mouth again with an antiseptic and apply the gel to the gums. And so all 10 days.

What means is better to choose –
for rinsing the mouth with periodontitis, it is better to choose chlorhexidine solutions with 0.2-0.25% concentration, and not containing alcohol. This concentration of this antiseptic is contained in rinses - Parodontax Extra, Lacalut Activ and PresiDent Antibacterial. The last 2 products additionally contain other active ingredients. For example, aluminum lactate or herbal extracts, which will reduce bleeding and inflammation even faster.

b) Systemic antibiotic therapy –

With periodontitis, you can't just take and start drinking any antibiotic, because it is necessary to take into account the nature of the microflora in the periodontal pockets. There are 2 options here: either prescribe a broad-spectrum antibiotic, or first sow the contents of the periodontal pocket on the microflora. The latter is recommended for patients with an aggressive course of periodontitis and vertical type of bone resorption. For more information on the choice of antibiotics and their dosage regimens, see the article:

4. Sanitation of the oral cavity and tooth pulping -

In parallel with the removal of dental plaque and anti-inflammatory therapy, it is necessary to begin the treatment of carious teeth, the removal of decayed teeth. At this stage, temporary splinting of mobile teeth can be performed, as well as restoration of missing teeth with temporary removable denture(to urgently relieve the mobile teeth). In addition, very important point is the need for tooth pulp.

It must be said that this is one of the most important methods used in the complex therapy of periodontitis, the use of which can really stop the progression. this disease... There are several techniques surgical treatment, which include - open curettage, as well as patchwork operations. The goal of the surgery is to remove all dental deposits from under the gums, clean out all inflammatory granulations (which form at the site of the destroyed bone tissue), and ultimately eliminate periodontal pockets.

Such operations are performed by dental surgeons specializing in periodontics. Operations are complex, require diligence and skill from the doctor, so there are very few good specialists in this area. In Fig. 13-14 you can see a fragment of the open curettage operation. The gums are detached from the teeth, the edge of the bone tissue is slightly exposed, the inflammatory granulations have already been cleaned out, but at the same time the deep periodontal pocket in the canine area is clearly visible (which in the second photo is filled with osteoplastic material, which will partially restore the bone level).

7. Prosthetics for periodontitis -

Orthopedic treatment of periodontitis is carried out in those patients who have missing teeth, or the method of splinting mobile teeth using artificial crowns is chosen. This stage of treatment is essentially the final one (not counting the subsequent periodic maintenance therapy), and the prognosis of the teeth will largely depend on it. The goal of the orthopedic stage of treatment is to restore the chewing efficiency of the dentition, to reduce the chewing load on weakened teeth, thereby preventing displacement, protrusion or fan-shaped separation of the teeth.

As we said above, prosthetics can be temporary and permanent. Temporary prosthetics with a removable denture is necessary when a large group of teeth is missing. Such a prosthesis will reduce the load on the remaining teeth, increase the effectiveness of anti-inflammatory therapy, reduce tooth mobility, and stop bone destruction. In addition, if curettage or flap surgery is planned, ignoring the need for temporary prosthetics in such a situation can lead to an increase in tooth mobility, as well as stimulate horizontal bone resorption of the teeth in the operation area.

Treatment options with folk remedies –

To understand: how effective is the treatment of periodontitis with folk remedies at home, it is enough to refer to the personal experience of patients. The patient first tries for years to treat bleeding gums / gingivitis at home - with various rinses, gels, folk remedies, toothpastes. As a result, gingivitis turns into mild periodontitis. The patient continues this treatment, and periodontitis ... progresses. So is this treatment effective?

For 13 years as a periodontist, I have consulted many patients who come to me with periodontitis. They asked me how to cure periodontitis, but most of them required me to quickly and simple treatment- no more difficult than what they are used to at home. For example, recommendation of super rinses or miraculous toothpaste, or magic anti-inflammatory gel. With difficulty agreeing to the removal of dental plaque (the main cause of periodontitis), they nevertheless considered it a pointless procedure, and firmly believed that the only correct treatment- when the doctor will smear his gums with a special ointment.

Information about the need for teeth splinting, the use of surgical methods of treatment, the skills of using dental floss and the rules of hygiene - such patients were ignored. They said that they didn’t need it, it was expensive, that they were sure of the ineffectiveness of such and such a method (“It didn’t help Uncle Kolya,” they said). And then they disappeared for several years or a little more. All this time, they still used their usual folk ways- they rinsed their mouths, smeared their gums with advertising means, believed in toothpastes for periodontitis, and most importantly, they still did not brush their teeth well.

After a few years, they always returned with high mobility and / or fan-shaped separation of the front teeth, purulent discharge from periodontal pockets ... They were already ready for anything, and they were much less interested in the question of price. But often the moment was already missed, and with severe periodontitis, it is no longer possible to radically change something. Naturally, rinsing with chamomile or oak bark will not make you worse. The main harm from these remedies is that the person believes that he is being treated ... while the disease continues to progress. We hope that our article on the topic: Symptoms and treatment of periodontitis at home - turned out to be useful to you!

Sources of:

1. Add. professional,
2. Based on personal experience work as a periodontist,
3. National Library of Medicine (USA),
4. American Academy of Periodontology (USA),
5. "Non-surgical periodontal treatment" (Roncati M.).

The gingival pocket is the area of the indentation between the tooth and the gum. In such a place, the elements of the gums form a kind of neck around the tooth. Such a pocket is a frequent epicenter of the accumulation of food particles, desquamated epithelium, and microorganisms. This can provoke inflammation.

The gingival pocket should normally be up to 3 mm deep. This size allows it to self-clean and be accessible for cleaning with a toothbrush. An increase in the depth of education is a dangerous condition. Too deep a pocket in the gum loses its ability to completely cleanse. It accumulates food particles, elements of the epithelium and microbes, which provoke serious damage to the periodontal ligaments.

As long as the depth of the pocket formation affects only the root and does not reach the connective structures of the tooth tissues, the ailment is reversible. Simple medical procedures are enough for recovery.

With the involvement of the periodontal ligaments in the process, the pockets in the gums are already called periodontal. The process of destruction and erosion of the epithelium is accompanied by severe local inflammation. Even minimal manipulations provoke severe pain and bleeding.

The dental pocket is an excellent medium for bacteria to grow and reproduce. Simple antibiotic therapy has only a temporary effect. With such treatment, the main basis of the disease is not eliminated - the size of the defect. Damaged gingival pockets will continue to accumulate harmful factors. Altered gingival structures make it much more difficult to clean teeth from all kinds of deposits.

The only radical way to combat inflammation is surgery (resection), which allows you to remove the exfoliated part of the gum.

Signs of gum pockets

The main signs of periodontal disease are:

loose teeth;
bleeding gums;
the appearance of gaps between the teeth;
purulent processes in the periodontal spaces;
sore teeth.

An abscess is one of the factors that provoke the formation of a gingival pocket

According to experts, the formation of altered pockets is based on poor oral hygiene. Incorrect, irregular cleaning leads to hardening of the plaque. Particles of food go deep under the gums, provoking inflammation in which connective tissue is affected. Such changes cause detachment of the gums from the tooth. Further progression of the disease leads to the spread of infection, damage to the periodontium, bone structures and the root.

Anna Losyakova
Dentist-orthodontist
Detachment of the gums is different. In severe cases, the entire tooth is exposed to the very apex of the roots. A tooth without gum support cannot stay in the mouth and falls out. In order to prevent such phenomena, it is important to consult a dentist in a timely manner.
Primary gum lesions are easier to heal. Pastes and rinses alone will not improve gum health. It is important to carry out more serious treatment aimed at the internal tissues. oral cavity.
Changes in the gum pocket require professional assistance. Treatment of the disease begins when a significant depth of the pocket is identified. Often this is the very first and brightest. The disease progresses rapidly. If the changed structures are not removed, a person may lose several teeth at once.
Professional medical assistance

Curettage is one of the most popular and effective methods of treating pockets between the gum and the tooth. The technique is based on a thorough mechanical cleaning of the oral cavity from various types of deposits. Curettage is applicable in the following cases:
with detachment of the gums;
in the presence of petrified sediments;
with inflammation of the gum cells.

Stages of curettage
Anna Losyakova
Dentist-orthodontist
Curettage aims to eliminate all deposits between the tooth and the gum. It effectively fights tartar, altered tissues (granulation, soft dentin).
Depending on the severity of the disease, it is customary to use one of the types of cleaning:
Closed curettage - cleaning with a specialized instrument, laser, ultrasound. Suitable for gingival pocket depths up to 5 mm.
An open procedure is a surgical procedure performed under general anesthesia... During the intervention, the gum is dissected, the pocket is thoroughly cleaned at the base of the depression, a special solution is applied for rapid growth and suture the wound.

The video simulates the closed curettage process:
Anna Losyakova
Dentist-orthodontist
After a few weeks, the results of therapy can be judged. Patients note a significant improvement in their condition immediately after the procedure: redness, swelling disappears,. The pocket becomes less deep, the gums stop hurting.
Altered gingival structures are removed only in dental facilities. If you have any concerns about your teeth, you need to go to the doctor immediately. Adequate professional help will stop the process, preventing various complications.
In the video, the doctor talks about how to treat a periodontal pocket:
Traditional therapy

Exists folk remedies to combat various dental ailments. Gum disease is no exception. For therapy, wound-healing agents are used. The most common of them are:
Green peel walnut... It needs to be crushed and poured over with warm olive oil. The solution is mixed and placed in a refrigerator. After a week, the product is ready for use.
Plantain. The leaves are poured with boiling water, insisted and filtered. Rinse your mouth with infusion up to 5 times a day. The juice of this plant has an excellent effect. To obtain it, the grass is crushed and squeezed. Experienced people recommend simply chewing the leaves of the plant until the mass loses its taste. The results are noticeable after a few days of therapy.
Eucalyptus oil. It is mixed with hot water and used for rinsing for one week. The therapy is fortifying.
Warm water with hydrogen peroxide. The solution is rinsed out of the mouth twice a day for a week.
Fresh red beets. The vegetable is chopped. The gruel is wrapped in gauze and applied to the affected gingival structures.
Propolis and calamus. The herbs are poured with vodka and infused for 2 weeks in a dark place. With this remedy, you need to rinse your mouth daily before bedtime. A similar medicine is widely used for inflammatory changes, tooth pain and granulomatous changes in the gums.

With inflammation of the gum pocket, you can use the following folk recipes:
The grass of the mountaineer is poured with boiling water. After half an hour, a cotton pad is moistened in the infusion and applied to the affected structures twice a day. The course of therapy is a week. Before reuse, the infusion must be warmed up to a warm state.
Comfrey root is poured with hot water, insisted overnight. The resulting infusion is used for rinsing. Often the tool is used for lotions. A cotton pad is soaked in infusion and applied to the area of inflammation for 10-15 minutes. The duration of therapy is 10 days.
The leaves of the golden mustache are applied to the inflamed areas for a quarter of an hour daily before bedtime. The course of treatment lasts a month. In parallel, an infusion from this plant is used. The mustache is poured with boiling water and insisted for half an hour. The medicine is used for rinsing three times a day.
Lemon peel is crushed and poured with boiling water. The infusion is used for rinsing.
Fresh aspen sawdust is mixed with birch tar, wrapped in gauze and applied to the inflamed areas.
A clove of garlic is thoroughly chopped, honey, salt and hydrogen peroxide are added. The tool is used to clean teeth after meals.
The oak bark is poured with boiling water, infused for 2 hours. The product can be used in the form of applications.
Aloe leaf is placed in the refrigerator overnight, and used in the morning. The duration of therapy is 3 days.
Fresh sea buckthorn berries are crushed, wrapped in a bandage and applied to the affected area twice a day for 15 minutes. The duration of treatment is at least a week.
Viburnum berries are poured with dark honey and alcohol, insisted for half a month. The mixture is taken orally daily before meals for a month. The medicine improves immunity, relieves most dental problems. Often this tool is used for applications. A cotton pad is moistened with a solution and applied to the lesion site. The duration of the procedures is one week.

Knotweed Comfrey root Plant "Golden mustache" Lemon peel Birch tar Peroxide with garlic, honey and salt Oak bark
Aloe Sea Buckthorn Viburnum
Application of herbal cathedrals
Especially popular are special herbal preparations for rinsing. Among them:
Chamomile, sage, nettle. The herbs are poured with boiling water, insisted for one hour. The solution is recommended to rinse your mouth every 50-60 minutes. It reduces pain and inflammation.
Chamomile, calendula, sage. Plants are mixed, poured with boiling water and insisted for 10-12 hours. The infusion is used three times a day.
Sage and oak bark are mixed in equal parts. The mixture is poured with water and boiled over low heat for half an hour, and then insisted for another half hour.
Combine one part of plantain, chamomile and calamus root. The collection is poured with water and boiled in a water bath. Insist 2-3 hours.

Anna Losyakova
Dentist-orthodontist
During the use of such funds, it is important to monitor your well-being. If there is no improvement within 3 days, you must definitely contact a specialist.
For the prevention of complications after curettage, it is recommended:
brush your teeth regularly;
use dental floss if necessary;
buy pastes with abrasive properties, which, due to mechanical action, quickly remove deposits and polish teeth;
regularly visit the dentist;
perform preventive hygiene with a doctor.

The gingival pocket is the notch that separates the gum from the tooth. In case of periodontal tissue disease, it increases, due to which food particles get into the recess, there is an accumulation of soft plaque and the deposition of tartar. These adverse factors cause inflammation of the gums and, if untreated, lead to loosening and gradual loss of teeth. You can prevent their loss by seeking medical help in time.

Normally, the pocket in the gum is deepened by no more than 3 mm. The small depth of the neck formed from the soft tissues does not interfere with its self-cleaning. Progressive deepening and inflammation of the gingival pockets is a characteristic symptom of periodontal disease. The gum between the teeth swells, begins to hurt, and pus may appear from it. The initial stage of the development of the disease is gingivitis. At this stage, it is quite easy to remove inflammation - you need to carefully monitor oral hygiene, regularly undergo professional teeth cleaning with the removal of soft and hard plaque, rinse your mouth with antiseptics and herbal infusions.

Further development of the inflammatory process is accompanied by a significant increase in the number of bacteria. The enzymes secreted by them negatively affect the periodontal fibers, gradually causing their destruction. At this stage, the gingival pockets undergo a number of changes and become periodontal. The activity of the inflammatory process increases, the soft tissues affected by it bleed when touched, erosion occurs on the gums.

The cavity between the tooth and the gum becomes deeper, the connective tissues that ensure the integrity of the dentition are affected by inflammation and weaken.

In the absence of treatment and cleaning of gingival pockets, the process will spread not only to the fibers of the periodontal ligaments, but also to the bone tissue of the jaw.

The decrease in the gums leads to a gradual exposure of the tooth. The destroyed tissues are not able to ensure the attachment of the root apex in the hole and at a certain moment it falls out.

At the initial stage of the disease, the pockets in the gums are washed once a year antibacterial agent... Additionally, daily application to the affected areas is prescribed. drugs, rinsing the mouth with medicinal compositions. With periodontitis moderate the curettage method is effective, with severe course diseases are photodynamic, surgical techniques and cable-stayed splinting.

Types of curettage, indications for the procedure

There are open and closed types of curettage. This technique effectively removes calculus, food debris, diseased gum tissue and softened tooth cement. For closed curettage, a diode laser or an ultrasonic scaler is used. This method of treating pockets in the gums is used in cases where the depth of the cavity surrounding the tooth does not exceed 5 mm. The depression is cleaned, the tooth root is processed and polished, the affected tissue is removed. This helps to restore the connection of the teeth with the gums.

Open curettage is a surgical procedure using local anesthesia. During the operation, the tissue in the area of the interdental papillae is dissected, tartar is removed, and the gingival pocket is thoroughly cleaned of deposits. Then a drug is applied that accelerates the growth of the epithelium and suppresses the vital activity of pathogenic microbes. The dental root is polished to make the mucous membrane fit more tightly and the wound is sutured. The rehabilitation period after the procedure is two weeks, after its expiration, patients note positive results - the gum does not bleed, does not hurt, hyperemia and swelling go away, the depth of the pocket decreases.

Indications for curettage are:

the depth of the pocket of exfoliated gingival tissue exceeds 3 mm;
a large amount of solid deposits has accumulated;
the gum is affected by the inflammatory process.

Photodynamic method

In a non-surgical way, an advanced or severe form of periodontal disease can be treated with photodynamic therapy. Before the procedure, it is performed, after which the gums are treated with chlorophyll obtained from the spirulina alga. In response to its application, epithelial cells begin to produce photosensitizing substances. After 30 minutes, the doctor directs a laser beam at the diseased tissue. Its radiation leads to the decomposition of photosensitizers with the release of active oxygen.

Under the influence of the oxidative process, the microbes that caused the inflammation are completely destroyed. The doctor removes the damaged tissue and closes the gum pocket. The advantage of this method of treatment: gentle painless effect and high efficiency - a single procedure is enough to eliminate inflammation and bleeding. A film forms on the gums, which prevents the penetration of infection and the recurrence of the disease. The use of osteogenic preparations and amino acids helps to restore the affected tissues.

When the depth of the periodontal pocket is more than 4–5 mm, the patchwork method is used. During the operation, the gum is separated from the surface of the tooth, the contents of the pocket are removed, the cleaned cavity and root are treated with an antiseptic. Then the soft tissues of the gums are fixed in the correct position with sutures. In most cases, the method gives positive results. Its disadvantages include the stress experienced by the patient and the long recovery period.

Cable-stayed splinting

This method of treatment strengthens teeth that have begun to loosen. The splinting technology consists in tying the movable units of the dentition with aramid thread, which is particularly durable. Thin grooves are drilled along the perimeter of the adjacent teeth, after laying the thread is covered with a reflective material. The color of the filling matches the shade of the teeth, so it is almost invisible.

The cable-stayed splinting method prevents loosening of the dentition, while at the same time providing natural mobility of the teeth, preventing the jaw bones from atrophy. Bonding with aramid thread does not disturb diction and does not cause discomfort in the patient. To restore the cavities of the dentition in place of the lost teeth, it is advisable to use dentures not made of cermet, but combining ceramics and glass or titanium, so as not to overload the jaw.

At the initial stage of periodontal disease, to improve the condition of the gums, you can use preparations made from herbal ingredients according to recipes traditional medicine... They suppress bacteria and improve wound healing. In addition, it is useful to massage the gums with a soft-bristled toothbrush, followed by rinsing the mouth with infusions of chamomile, oak or sage bark.

A good therapeutic effect is provided by the following means:

The peel of unripe walnuts, infused with olive oil(1 tbsp. L. 250 ml). For infusion, the mixture should be placed in the refrigerator. From time to time you need to take out the jar and shake it. After a week, strain and use to lubricate the gums 3-5 times a day.
Plantain infusion or juice. To prepare the infusion, you need to pour 20 g of leaves with a glass of boiling water. Use as a mouthwash. The juice squeezed from fresh leaves of the plant is applied to the affected areas of the gums 3 times a day.
Compresses from grated fresh beets. The mass, without squeezing, is wrapped in gauze and kept on the gum for 15 minutes. The frequency of use is 3 times a day.
Infusion of herbs highlander pochechuyny. Pour a spoonful of chopped vegetative parts of the plant with a glass of boiling water. Let it brew for 15 minutes. Use 2 times a day, applying tampons moistened with warm infusion to the gums.
Gruel made from chopped sea buckthorn berries. Wrap the mass of fruits in a two-layer piece of gauze and apply to the affected areas 2 times a day for 20 minutes.
Viburnum fruit tincture with honey. You need to mix 500 g of berries with the same amount of buckwheat honey and 500 ml of 70% ethyl (medical) alcohol. Place in a dark place for 2 weeks. Method of use: 1 tbsp. l. 3-4 times a day for 20 minutes. before meals. Taking the drug helps to strengthen the immune system and cure periodontal disease. Additionally, you can apply cotton swabs moistened with tincture to the gums.

Prevention of the development of periodontal disease

To prevent inflammation of the gums and deepening of gingival pockets, regular brushing of the teeth, rinsing the mouth after each meal, and the use of floss (special thread) to clean the interdental gaps can be used. Periodically, but not constantly, pastes containing abrasive substances should be used to remove solid deposits. High-quality dental calculus removal will be ensured by professional teeth cleaning using ultrasound.

For the timely detection and elimination of pathological processes occurring in the oral cavity, it is recommended to visit the dentist 2 times a year.

Periodontal disease: definition, causes, symptoms

A small periodontal pocket is considered the norm, due to the physiological characteristics of the dentoalveolar system. Sometimes, under the influence of certain diseases and factors, it increases. This not only complicates oral hygiene, but also leads to the accumulation of microbes, food debris, provoking the development various diseases or aggravating their course. Today we will talk about the causes and methods of treating pockets in the gums.

A pocket in the gum is a slot-like indentation. It forms between the tooth and the gum. Due to the difficulty of cleaning, bacteria develop in them, small particles of food are deposited, which often leads to the most unpleasant consequences. A small periodontal pocket up to 3 mm is considered normal. At this depth, it can be easily cleaned with a regular toothbrush. If it is deeper, then cleaning is difficult, and therefore medical intervention is imperative. In some cases, the depth of the pocket can reach 5 mm, and then surgical intervention with detachment of the mucoperiosteal flap may already be required.

Improper or insufficient hygiene is considered to be the main cause of the formation and inflammation of the gum pockets. If you do not take care of your teeth, then the soft plaque that forms on them hardens very quickly to the state of a stone. It only takes a few days for it to be deposited. Also, due to lack of care, food particles accumulate in natural pockets. This leads to active multiplication of bacteria and inflammation of the gums.

The deposits penetrate deeper under the gum, and the area of the inflammatory process expands, affecting the connective tissues. As a result, detachment of soft tissues from the tooth begins. Pockets form in the gums, which gradually enlarge, as they create favorable conditions for the growth of bacteria. Epithelial cells penetrate into the periodontium, gradually surrounding the tooth root. Inflammation can reach the bone tissue, causing it to shrink. All this leads to an even greater deepening of the gingival pockets.

If you do not start the treatment of periodontal pockets in a timely manner, then the inflammatory processes in them can lead to the destruction of the connective tissue ligament and the loss of connection with the natural cement of the teeth. Resorption of the cement occurs, the periodontal bone tissue is replaced by epithelial cells. All this leads to loosening of teeth and their loss. The formation of pockets between the teeth and gums often indicates the presence of periodontitis.

Methods for the treatment of gum pockets

The elimination of the periodontal pocket must be carried out as soon as possible. To remove it, you need to spend complex treatment consisting of professional cleaning and elimination of inflammatory processes. First of all, the curettage of the periodontal pocket is performed.

This procedure refers to the scraping of diseased tissue, food particles and other foreign matter from the gum pocket. Depending on whether you have to resort to closed or open curettage of the periodontal pocket, the procedure is performed with or without anesthesia. Since the appearance of gum pockets in most cases is associated with periodontitis, after cleaning, measures are taken to restore the health of the gums.

Closed curettage

Closed curettage of periodontal pockets is performed without incisions and the use of anesthesia. It is advisable in cases where the pocket is not too deep - up to 5 mm. During the procedure, deeply located tartar and abnormal tissues are removed.

This method is very often used in the treatment of various periodontal diseases. It is indicated for periodontal disease, periodontitis and other gum diseases. The procedure is unpleasant but not painful, so it is usually done without anesthesia. But pain relief can be performed at the request of the patient.

Open curettage

If the pockets are more than 5 mm deep, then open curettage of periodontal pockets is performed. The procedure is performed under local anesthesia. For deep cleansing of tartar and inflamed tissues, the gums are dissected. After cleaning, the tooth root is polished and the gums are sutured.

Thanks to this technique, tartar, granulation tissue and other deposits are completely eliminated. It allows you to bring the pockets back to normal and quickly improve the patient's condition with severe periodontitis. By replanting bone tissue, they reduce its atrophy and reduce the mobility of the teeth. Open curettage is not done very often. If the pockets are not too deep, then closed curettage is preferred as a simpler procedure.

Cleaning periodontal pockets is one of the essential components of treatment. Scraping eliminates the main cause of pocket formation - deep tartar deposits. Therefore, the gums quickly return to normal.

Prevention measures

In order to avoid the formation of periodontal pockets and their inflammation, it is recommended to follow simple preventive measures aimed at maintaining the health of teeth and gums.

Provide complete dental care. Clean them thoroughly daily with a toothbrush and floss.
It is advisable to periodically remove the formed tartar and carry out professional cleaning.
All diseases of the teeth and gums must be treated in a timely manner, preventing their transition to a chronic form. Therefore, in case of bleeding, swelling of the gums, be sure to contact your dentist.

If you constantly monitor the condition of your teeth and gums, you will be able to avoid many serious problems, including those associated with gum pockets. To give you a more detailed understanding of the mechanism of the formation of periodontal pockets and their treatment, we suggest you watch the final video.