Periodontist and Dental Implant Specialist

Periodontal disease is a bacterial infection that penetrates into the gums and into the bone around your teeth, causing inflammation. Periodontal inflammation leads to bone loss and possibly tooth loss and may contribute to other medical conditions.

The periodontal infection must be removed and the area given a chance to heal. There are generally two levels of treatment for this condition depending upon the severity of your infection.

Upper Level Infection Removal

The upper level of infection in the pockets around your teeth can be removed using specialized instruments. This procedure is called, “Scaling and Root Planing", “Phase One Treatment" or “Initial Therapy". It is done under local anesthesia and is quite different from the routine dental cleaning or “deep cleaning" that is traditionally done in the general dentist's office.

Upper Level Infection Removal
(Scaling and Root Planing)
Severe plaque and calculus accumulation
Tissues will respond to the accumulation by becoming swollen, red and bleeding.
Note that the bone has not been affected. In this case, scaling and root planing is a viable option.
Ultrasonic scaling instruments can be used to dislodge the calculus above the gum.
Hand instruments can be used to clean below the gums.
The gums then shrink and reduce the pocket depth. The pockets and teeth can now be maintained with proper care.


Lower Level Infection Removal (Gum Surgery)

If your infection has spread into the bone that supports your teeth, and is below the level that can be reached in "Upper Level Infection Removal", then a surgical procedure must be performed to retract the gums and remove the lower level infection

Lower Level Infection Removal
(Gum Surgery)
Normal looking gingiva (gums).
Normal bone levels.
Bone loss and increased pocket depths.
Pocket depth evaluation shows unmanageable results.
Incisions are made to separate gingiva from the teeth.
The flap is retracted and the teeth are cleaned and scaled.
The flap (gum tissue) is placed back against the teeth and bone, but at a lower level than before.
The flap is sutured into place.
The gums heal in the new position.
Pocket evaluation reveals pocket reduction.
Bone levels recorded.
This procedure decreases pocket depths without any tissue removal.


Brian N. Hollander, DDS, MS
Diplomate, American Board of Periodontology
1615 Hill Road, Suite 4, Novato, CA 94947
Tel: (415) 898-6660 • Get DirectionsContact Us

A key to dental implant safety and success is advanced radiography. A CT scan we can be sure that every precaution has been taken.

Click to learn more..

Dr. Hollander is a periodontist in Novato, CA who specializes in dental implants and in treating periodontal disease.
He also services the surrounding areas of San Francisco, San Raphael and San Anselmo.
Designed by Dentist Design