During scaling and root planing, the roots of the teeth are cleaned below the gums, removing bacteria and mineralized calculus deposits. The roots are smooth to help reduce the buildup of bacteria again on the root surfaces. The purpose of root planing is to lessen the irritation to the gums caused by these deposits and to make the tissues healthier prior to surgery. This makes any recommended surgical procedure shorter and makes the healing process faster. In some shallower pockets, it may be enough to postpone or eliminate the need for surgery.
In cases of moderate to severe chronic periodontitis (gum disease) there is significant loss of gum and bone attachment from the teeth. As a result a space develops between the teeth and gums called a pocket. Not only are deep pockets an indication of bone loss, but they are a risk factor for further bone and attachment loss which could lead to the loss of teeth. With periodontal surgery the gums are temporarily separated from the involved teeth. The exposed roots of the teeth are thoroughly cleaned. The irregularities in the bone caused by the disease may be smooth out so the gums can lie more evenly over them. This leads to reduced pocket depths, healthier gums, and give you a better chance at keeping your teeth clean and your gums healthy.
Periodontal regeneration is another way to reduce pockets depths and increase supporting bone around the teeth. Periodontal regeneration stimulates your body to rebuild bone and attachment to the teeth.<.p>
Some people have a “gummy smile.” Excess gingival display (gummy smile) has more than one cause. If the teeth are of normal size and position, but too much of the teeth are covered by the gums, this can be fixed with a simple procedure called crown lengthening. During this procedure the excess gum tissue is removed along with any excess underlying bone. The gums are replaced at the proper height. Healing is quick and result can be profound.FUNCTIONAL CROWN LENGTHENING:
Fuctional crown lengthening is used when a tooth is fractured or has a cavity that extends below the gums. Crown lengthening removes just enough bone and gum tissue to allow your dentist to restore the tooth with a filling or crown.
Gingival grafting is used to correct areas of gum recession or gum loss when teeth have been lost. People at risk for gum recession are those with a thin biotype (genetically thin gum tissue), aggressive brushing habits, tooth grinding habits, tension from the lip, or trauma to the gums. Recession can lead to tooth and soft tissue sensitivity, and bone loss, and in rare circumstances even tooth loss. Gingival grafts are usually taken from the side of the roof of the mouth. These are called autografts. There are two types of auto grafts.
Where possible the connective tissue graft is used. This graft takes only the inner lay from the roof of the mouth. There is a single incision on the roof of the mouth that closes with a few stitches. The connected tissue is grafted at the site needing more tissue and will blend in very nicely with the surrounding tissue.
Although it is not used as often at the connective tissue graft, the free gingival graft is an excellent method for increasing the amount of resilient gum tissue around teeth in areas that lack it. This graft takes connective tissue and epithelium from the roof of the mouth.
A frenum or frenulum is the narrow soft tissue attachment of the lip to the gums next to the teeth. When this attachment is too close the edge of the gums it can pull the gum attachment from the tooth and lead to recession and bone loss. Sometimes this attachment attaches to the tissue between teeth. The dense fibrous attachment between the teeth can prevent teeth from coming together. If spaces were present between your teeth prior to orthodontic treatment (braces) you may need to remove a frenum attachment to help prevent the spaces from returning. The release or removal of a frenum is called a frenectomy. This is a short procedure that has minimal post-operative discomfort.
Dental implants offered an excellent alternative for replacement of a single missing tooth or multiple missing teeth. Single tooth replacements feel much like your natural teeth. If you have a loose denture, two to six implants can greatly improve the stability of your denture.
Often times the easiest way to have adequate bone to support a dental implant is to prevent the bone loss in the first place. When a tooth is extracted some of the jaw bone is lost during normal healing. A ridge preservation graft is a bone graft placed at the time of tooth extraction and will reduce the amount of bone loss during healing. A bone graft material fills the hole left in the bone from the missing tooth. Your body will use this bone as a scaffold to grow new bone onto. By grafting at the time of the extraction there is a much great chance of having adequate bone for implant placement down the road. There is virtually no increased pain with ridge preservation grafting vs the extraction without grafting.
Ridge augmentation is necessary when there is inadequate bone for the placement of dental implants. Bone is harvested from another site in your mouth or donated bone may be used. The gums are temporarily separated from the bone at the site of the defect and the graft material is placed to augment the site. Screws, tacks, and membranes may also be needed to stabilize the graft. As the bone heals there will be an increase in bone width and/or height allowing for implant placement. Ridge augmentation usually required 6 months for healing prior to implant placement.
When the upper molars are lost the maxillary sinus enlarges and reduces the amount of bone available for dental implant support. A sinus lift is used to raise the floor of the maxillary sinus and increase bone height for implant placement.
Minor sinus lifts can be performed at the time of implant placement. A hole is created in the bone for the implant but stops just below the sinus. An osteotome is used to tap up the floor of the sinus a few millimeters. The implant is then placed. The implant will hold up the floor of the sinus and bone will fill in around the end of the implant.
A direct sinus lift is used when there are only a few millimeters of bone remaining below the sinus. Within the mouth, a small window is made in the bone covering the maxillary sinus. The lining of the sinus is elevated and a bone graft material is placed below the floor of the sinus membrane. The surgical site is closed and you are allowed to heal for 6 months. Sinus lifts are a predictable way to increase the height of bone which will support dental implants.
We do our best to make you comfortable receiving treatment in our office. We want you to feels relaxed. If you have anxiety about your upcoming periodontal treatment, do not hesitate to ask about sedation options. We offer nitrous oxide (laughing gas), antianxiety medication, and moderate (conscious) intravenous (IV) sedation.