Periodontics

Dental Implants (Single, Multiple)

Dental implants have become the standard recommendations for many restorative treatment plans. Individual or multiple implants can be utilized to replace missing teeth or to secure dental appliances such as dentures or removable partials. When placed and restored properly, dental implants can have success rates near 100%. In fact, the studies indicate a long-term success rate of 85-88% fifteen years after initial placement and integration. As discussed in the literature, most restorative options in Dentistry have an average life-span of up to 10 years.

Extractions (with or without ridge preservation)

We extract teeth for many reasons including Periodontal disease and advanced decay. Many times in our office the patient presents with severe pain and just wants immediate relief. All treatment options to replace the extracted tooth must be discussed prior to tooth removal. A tooth abscess could result in a large amount of infection at the end of the root which will leave a significant bone defect if the site is not preserved.

When a tooth is removed, immediate changes occur to the fresh extraction site. A blood clot forms on the bone and the site begins to heal. During the normal healing process, up to 50% atrophy or shrinkage can occur to the site within 3 months. The goal of ridge preservation is to reduce the amount of shrinkage to the site. If there is infection at the root apex, complete removal is needed prior to placement of bone graft material. The site will heal with less shrinkage and will provide greater support for a fixed bridge, partial, or dental implant.

There are many types of grafting materials utilized in our office. All products that are used in Dentistry are processed very meticulously and are very safe for our use. Your body uses these materials to build new bone but most of their function is to hold and maintain space. The extraction site is completely healed and ready for implants or restorative options within 3-6 months depending on the amount of original infection present.

Ridge Preservation

There are many techniques to preserve a ridge. Depending on the amount of infection or bone loss present, a variety of different materials can be utilized to achieve preservation or repair damage to the bone.

Careful management of extraction sockets after tooth extractions help prevent unsightly bone defects and will ensure better cosmetic outcome after tooth replacement. The surgical management of even simple extractions is extremely important to the ultimate success of dental implants.

Periodontal Disease

Periodontal disease is the leading cause of tooth loss in adults. The main cause of periodontal disease is bacterial plaque (sticky, colorless film that forms on your teeth). Secondary causes include smoking (tobacco use), genetics, prenancy, puberty, stress, diabetes, poor nutrition, auto-immune conditions, poor restorations, bad occlusion, and certain medications.

When plaque forms on your teeth, the bacteria become irritations to the gum. The mildest form of disease is Gingivitis which is completely reversible with proper brushing and flossing habits and regular hygiene appointments. Symptoms of Gingivitis may include redness, swelling, and/or bleeding gums. Left untreated, Gingivitis could progress to Periodontitis which is when the disease begins affecting the supportive bone around your teeth. The will begin to separate from the teeth causing increased periodontal pocketing (spaces). As periodontal disease progresses, the supporting gum tissue and bone further deteriorate. If left untreated, the end-point of disease is Tooth Loss. In addition to this, several studies have shown a direct and/or indirect relationship to diabetes, heart attacks, strokes, and some forms of cancer.

Scaling and Root Planing

Scaling and Root planing is a common non-surgical treatment for periodontal disease. Scaling involves a cleaning of the tooth above while root planing addresses deep below the gum line. The goal is to remove any plaque and calculus that have accumulated on the tooth surface. The root is planed until it is smooth.

A smooth and clean tooth surface provides a much better environment for the periodontal ligaments to reattach. This reattachment results in a reduced pocket size. This reduces the environment in which the bacteria can grow.

Periodontal Pockets 5mm or greater are great candidates for this initial Periodontal treatment. If the pockets do not resolve within 3-6 weeks then Definitive Periodontal procedures maybe needed.

Crown Lengthening

When tooth decay or a tooth fracture occurs below the gumline, it may be necessary to remove a small amount of bone and gum tissue prior to completing restorative care. This procedure becomes necessary so that the final crown would be placed in a healthy environment without impinging on either the gum or bone.

Crown lengthening is recommended because the decay or broken segment of the tooth extends below the gum line. Biological width is the distance between the crown margin and the bone. The distance between the crown margin and the marginal crest of the bone needs to be up to 3 mm. If the new crown margin violates this principle, then gingival inflammation or pain could occur.

The procedure can be completed without much discomfort and usually only takes a short while to complete. Within 6 weeks after crown lengthening, your Dentist can begin final impressions for your new crown.

Pocket Elimination

A pocket is the detachment of the gum from the root surface. Pockets over 5mm deep are difficult to clean with a normal toothbrush or even with regular hygiene cleanings. These pockets will lead to bone loss, tooth mobility and eventually the loss of the tooth as they progress.

Pocket Elimination surgery involves a small surgical procedure to help reattach the gum to the root surface. The infected gum is trimmed away and the uneven bone is re-contoured.

This is considered definitive Periodontal treatment. After healing is complete, the gingival tissue might shrink depending on the amount of gingival pocketing. Also, there could be initial Hot/ Cold sensitivity to the teeth which can be treated with fluoride rinses or toothpastes.

The end result is a tighter attachment of the gum to the tooth, no pocketing, improved cleansiblity with a normal toothbrush and an increased long-term prognosis of the tooth.

Guided Tissue Regeneration

This surgical procedure "regenerates" the previously lost gum and bone tissue. Depending on the topography of the defect, up to 80% regeneration of tissue can be accomplished, especially is Vertical bone defects. Horizontal defects can be "regenerated" very unpredictably. Following similar surgical protocols as Pocket elimination, the defect is completely debrided of all infected tissues, leaving good bleeding bone. Utilizing Bovine, Cadaver and/ or Autogeneous (patient's bone from second surgical site), the site is completely filled. The graft is then covered with either a Resorbable or Non-Resorbable barrier depending on the type of defect. A Non-Resorbable barrier requires removal after 6 weeks of healing. The healing process takes up to 3 months to demonstrate bone growth radiographically.

Soft Tissue Grafts (Free Graft, Subepithelial)

When recession of the gingival occurs, the body loses a natural defense against both bacterial penetration and trauma. The damage could be corrected/ reconstructed using soft-tissue grafting techniques.

When there is only minor recession, there is often times healthy gingiva present which is still protecting the tooth. No treatment is recommended other than modifying home care practices or occlusal adjustments to prevent further damage from occurring. If the recession reaches into the mucosa, the first line of defense against bacterial penetration is lost.

If gingival recession occurs, the teeth could become sensitive to hot and cold foods/ drinks as well as the gums and teeth become unsightly to appearance. When gingival recession becomes significant, the exposure of the root surface (softer than enamel) can lead to root caries and root gouging.

A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth, or gently removed from adjacent areas, to provide a stable band of attached gingival around the tooth. The gingival tissue is placed to either increase the amount of keratinized tissue and/ or to improve root coverage.

The gingival graft procedure is highly predictable. It enhances both the patients function and cosmetics.