Free Autogenous Gingival Graft
A graft is a thin piece of tissue that is taken from another area of your mouth (usually the palate) and placed in an area where there is no firm attached gum tissue. The main purpose of this graft is to provide a good base of firm attached gum tissue around the tooth to prevent the progression of gum recession. It is a stabilizing gum graft and does not cover the root of the tooth. It is not necessary to cover the root of the tooth for good oral health. This procedure is done in the periodontal office using regular dental freezing. You should think of this appointment like any other dental visit. You need to plan to rest for approximately 24 hours after the procedure and a mild pain medication is usually required afterward for a few days up to a week. Sutures may be used and you need to return to the office sometime after the procedure (your periodontist will inform you of the appropriate time) to have the healing assessed. With this type of gum graft, several teeth can be treated in one sitting. This type of gum graft is very predictable.
Root Coverage Graft (sub-epithelial connective tissue graft)
A root coverage graft (also called a connective tissue graft) is a procedure used to treat areas of deficient gum tissue. The procedure involves taking a thin piece of tissue from the palate and placing it in an area where the gum tissue is deficient with the goal of covering the root of your tooth. The root of your tooth can sometimes be covered in areas where the esthetic demands are great or when tooth roots that are exposed are very sensitive. This procedure is done in the periodontal office using regular dental freezing. You should think of this appointment like any other dental visit. You need to plan to rest for approximately 24 hours after the procedure and a mild pain medication is usually required afterward for a few days up to a week. Sutures may be used and you need to return to the office sometime after the procedure (your periodontist will inform you of the appropriate time) to have the healing assessed. The success rate of this graft is variable depending on several factors including the severity and extent of the gum recession, the anatomy of the bone around the tooth and the position of the tooth in the jaw. Healing for this type of gum graft may be compromised in smokers. It is not always possible to cover all root surfaces. To treat multiple teeth with root exposure, more than one graft may be required.
Pocket Reduction Surgery
Pockets accumulate bacteria and are difficult to clean at home and professionally. Without adequate and efficient removal of the bacteria plaque from the gum pocket, the pocket can become deeper due to bone loss around the tooth and with less bone support the tooth can eventually become mobile and be lost. To improve the ability of you and your oral health care provider (usually your dental hygienist) to remove the bacteria around your teeth that causes bone loss, pocket reduction surgery may be recommended.
This is the most commonly used approach in reducing pocket depths. After a small collar of diseased gum tissue is removed from around the tooth, the residual healthy gum is pushed closer to the new bone level. Usually, the bone that surrounds the tooth needs to be adjusted somewhat in order to allow the gum tissue to sit closer and tighter to the tooth and to prevent rebound of the deep pocket. The gum tissue is held in its new position with stitches and a periodontal dressing, both of which are removed after approximately 1 week. This procedure is completed using regular dental freezing and one should expect some mild discomfort during the first day. Some side effects of this procedure include longer teeth, possible root exposure, possible tooth sensitivity (usually of short duration) and increased spaces between the teeth. The benefits of periodontal surgery outweigh the side effects and without periodontal surgery, periodontal disease can progress and lead to tooth loss.
Another approach to reduce pockets is called regeneration. Regeneration is a procedure used to regenerate bone that was lost due to periodontal disease. During this procedure, the bony defect around the tooth is thoroughly cleaned and a material is placed in the defect, which stimulates bone growth. This procedure is only predictable in certain shaped defects and there are limitations with this technique. Your periodontist will recommend this procedure in areas where it is predictable.
Crown Lengthening
Large restorations can have negative effects on the periodontal health of your gums and this procedure enhances gum health by allowing the dentist to place a properly contoured restoration that does not impinge on the gum tissue. After a small collar of gum and bone tissue is removed from around the tooth and the remaining healthy gum tissue is pushed closer to the new bone level. The gum tissue is held in its new position with stitches and a periodontal dressing, both of which are removed after approximately 1 week. This procedure is completed using regular dental freezing and one should expect some mild discomfort the first week of healing. You should be able to resume your normal daily activities the following day. Some side effects of this procedure include longer teeth, possible root exposure, possible tooth sensitivity (usually of short duration) and increased spaces between the teeth.
Esthetic Crown Lengthening
Crown lengthening (see previous description) can also be completed, not to enable the restorative dentist to restore a tooth properly, but also to improve esthetics. The technique is essentially the same, however, the objective is different and can be accomplished to improve the esthetics of the soft tissue around one tooth or may be done to improve the appearance of several teeth.
Dental Implants
While the goal of periodontal therapy is to save your teeth, sometimes a tooth is lost due to periodontal disease or another cause (cavity, fracture). There are several ways to replace missing teeth including dental implants. Dental implants can be used to support a single tooth, a bridge or a denture.
Dental implants are made of titanium, which is very strong, inert metal. In the appropriate candidate, the titanium implant(s) is inserted into the bone and acts like an artificial root. After a healing time, a tooth is made by your restorative dentist to fit on top of the implant fixture (root).
Dental implants can be placed into the bone after a tooth is extracted. There are times when this can be accomplished immediately after extraction (same day), however, the traditional approach is to allow some bone healing to occur prior to implant installation.
If there is not enough bone to support am implant, you may require a procedure called bone grafting (bone augmentation/ridge augmentation). This can sometimes be done as a simultaneous procedure (same time as implant fixture placement) or may need to be completed as a separate procedure (if there is not enough bone to place the fixture on the same day). Your periodontist will advise you as to the most appropriate treatment for you.
Sinus Augmentation
If there is inadequate bone to support your dental implant(s) of adequate length in the upper posterior (back) part of your mouth, you may require sinus augmentation. This is a procedure that can be done in the dental chair using regular dental freezing and may be done in conjunction with the implant fixture placement or done as a separate procedure depending on your circumstances. Essentially, this is carried out by lifting the floor of the maxillary sinus (done inside your mouth) and bone material is placed that eventually forms hard bone that is adequate for implant fixture placement and strong enough to support your dental implant. The bone material that is used can come from a number of different sources and your periodontist will advise you as to what material is right for you.
Ridge Modification
Deficiencies in the bone may make it difficult and sometimes impossible to place dental implants or may result in compromised esthetics when implants are placed. Bone grafting of these deficiencies can increase the thickness or height of the bone in some cases to improve the success and esthetics of your dental implant. Often, bone grafting can be accomplished during implant fixture placement; however, if the bone deficiency is large, the bone graft may need to be completed as a separate procedure 4-8 months prior to implant fixture placement. The material used for bone grafting can come from a number of sources and your periodontist will recommend one that is appropriate for you. This procedure is completed in our office using regular dental freezing. Some discomfort should be expected after this procedure and a mild pain medication is usually prescribed afterward. This procedure can also be done to improve the esthetics of your ridge (gums) prior to the placement of a dental bridge, whether it be implant-supported or tooth-supported.