Periodontal Procedures

Periodontal disease is one of the most prevalent diseases affecting the human race. Unfortunately, it is also one of the most misunderstood by the public. Even for those patients who undergo periodontal therapy, there is a lack of understanding. A well-educated patient will understand that once a periodontal patient, always a periodontal patient. Periodontal therapy is designed to manage your periodontal issues, not eradicate it. The dynamics of periodontal disease rely on host resistance, periodontal architecture, bacterial concentrations and type as well as the patient’s willingness to maintain excellent hygiene.

Many patients are not aware that periodontal maintenance is the only sure way to keep gum disease from returning. Periodontal maintenance is regularly performed at certain intervals after procedures such as scaling and root planning. Periodontal maintenance includes the removal of plaque and tartar, scaling and tooth planing and polishing. Your ability to maintain your tissues will determine the frequency the periodontal maintenance is needed.

Periodontal (Gum) Disease

Periodontal (gum) disease is insidious. It affects more than 90% of the population. Periodontal disease begins as a localized infection of the gums also known as gingivitis. Food debris left around the necks of the teeth form plaque that harbor vast amounts of bacteria. The body combats this infection and inflammation is the result. The tissue bleeds easily on probing and the swelling leads to deeper pocketing around the necks of the teeth. Gingivitis is reversible and if the plaque is removed daily, no permanent changes occur. Left unchecked however, the soft and easily removed plaque, eventually hardens into tartar or calculus. Like a splinter, this calculus irritates not only the tissue but the underlying bone and eventually results in periodontitis or bone loss. Except for bad breath and gums that bleed, there are very few early warning signals. The disease advances silently, often without pain, and before you know it, you are losing your teeth.

Tooth loss is the most obvious indicator of gum disease. Scientific research has discovered a linkage between gum disease and stroke, heart disease, diabetes – even an increased risk for pregnant women. When your gums become diseased, your entire immune system is weakened.

In the past, lack of understanding and fear have kept people with gum disease from seeking the care they needed. Today, there are a number of methods to combat periodontal disease. Foremost is education. Understanding how periodontal disease develops and it’s warning signs can lead to early intervention. Treatment is designed to assist the patient to avoid extensive surgery and make the most of home care. If you suspect that you may have some form of periodontal disease, call and make an appointment for an evaluation.

Root Scaling and Planing

Scaling and root planing is the initial therapy provided to a patient who has periodontitis or bone loss. Gingivitis is a reversible disease that is limited to inflammation and bleeding of the gums. Unfortunately, if left untreated, it will evolve into a degenerative disease commonly known as periodontitis and results in significant tooth and gum deterioration. One should understand that once periodontitis is diagnosed, routine brushing and flossing will not remove the hard calculus or plaque from the base of a pocket. Scaling and root planning will be necessary to assist in the decontamination of the tissues and root surfaces.

Over several visits, our hygienist will remove the irritating calculus from around the teeth and smooth the root surfaces removing the toxins contaminating the root surface. With time and proper home care, the inflammation caused by the irritants will diminish and the periodontal pocket will become more manageable. Recare will become a very important part of your care. This will allow us to maintain and improve on your oral hygiene. In most cases, improvement is widespread throughout the mouth. At recare appointments, more therapy resistant pockets will be scaled and planed. In the event that therapy resistant pockets continue to worsen, other periodontal therapies will be suggested. Regardless of the condition, exceptional home care is a must to keep periodontal disease at bay.

Pocket Reduction

Advancing periodontal disease can often leave a patient with deep pockets that, despite the best efforts of the patient to keep them clean, continue to worsen due to inaccessibility. Osseous surgery and pocket reduction are designed to allow the patient the accessibility needed for proper hygiene and maintenance of periodontitis. Osseous surgery is usually performed after diagnosis of periodontitis and following root scaling and planning. As the patient understands the cause and effect of periodontal disease and performs increasingly better home care, pockets that have not responded to therapy and continue to be an issue are most likely the result of inaccessibility and poor boney architecture.

The general procedure involves the use of local anesthetic for patient comfort. An incision is made in the affected area and the deep pockets are exposed. The boney architecture is evaluated for areas that make maintenance difficult. Once these areas are identified, the tissue and bone are “sculpted” to provide for easier access and maintenance. Sutures are placed and an intraoral bandage is positioned for comfort and healing. The sutures and bandage are removed in 7-10 days and complete healing occurs in about eight weeks. With easier access and proper maintenance, the advancement of the periodontal disease should be kept at bay.

Crown Lengthening

Why Is A Crown Lengthening Needed?

Occasionally, decay or a fracture in a tooth will extend below the gumline and approximate the boney crest. Under these circumstances, a periodontal surgical procedure, known as crown lengthening, allows the dentist access the area in order to expose tooth structure to properly restore the tooth. The dentist will evaluate the area in question and measure the amount of gum tissue around the tooth in question. A determination will be made as to the amount of tissue needed to be removed to provide for the proper final result. If there is sufficient gum tissue and some bone will need to be removed, a crown lengthening is the procedure of choice.

What To Expect During A Crown Lengthening Procedure

The general procedure involves the placement of local anesthetic followed by the exposure of the tooth sufficiently to restore the tooth. Sutures will be placed with a “bandage” to allow for healing. You will be instructed in proper post- operative instructions that should be followed carefully. If there are any questions or concerns, call our office immediately. You will return in 7-10 days for suture removal. A healing period of 6-8 weeks is usually sufficient prior to placing the final restoration.

Gingival/Gum Grafting

What Causes Gum Recession?

There are several causes of gum recession. Aggressive brushing, poor hygiene or a poor restoration are all culprits in gum recession. There is a limited amount of hard attatched gum around each tooth that acts like a gasket and inhibits food from migrating down the root surface. Without this protective area of gum tissue, the tooth is in danger of being lost. Most patients are unaware of this problem unless it becomes an aesthetic issue. Most patient’s first hint of recession is the occasional sensitivity to cold that accompanies it.

What is Gum or Tissue Grafting?

Gum or tissue grafting is the corrective procedure that restores the gum to its natural, healthy state. Using soft gum tissue from the roof of the mouth, or an allograft from a tissue bank, the area of recession is grafted. The goal of the graft is to cover exposed tooth and root surfaces with grafted tissue and restore both the aesthetics and protective nature of the attached gum tissue. This grafting encourages new tissue growth that will enable the gums to return to its original position around the teeth. The procedure is routine and entails a minimal amount of downtime and discomfort.

Periodontal Splinting Weak Teeth

Periodontally involved teeth are often loose or mobile.  This can inhibit healing and make it difficult to eat or talk and even premature tooth loss.  Splinting of teeth, allows a group of teeth to “help” one another out by splinting or “tying” them together.  Splinting of teeth is a provisional/transitional procedure that can help a patient hold onto their smile as they transition to a more permanent treatment.  Many individuals have used this method to avoid the embarrassment of a missing front tooth or to take the time needed to decide and prepare for more permanent solutions.  Although there are many different techniques to accomplish this, splinting the back of the teeth with a bondable ribbon is the most aesthetic and easiest to maintain.

Contact our office today for a consultation.

Cosmetic Periodontal Surgery

Cosmetic periodontal surgery is usually performed in conjunction with other restorative procedures like veneers but can be a stand-alone procedure. Cosmetic periodontal surgery refines the contours of the gums. In a person with a “gummy” smile, sculpting and refining the tissue will result in longer looking teeth and a more beautiful smile. In the case of veneers or another restorative procedure, cosmetic periodontal surgery can provide tissue symmetry which enhance the beauty of a smile. Your smile is the first thing someone notices about you.

People form their first impressions based on the appearance of your smile. Today, there is a wide range of cost effective and conservative cosmetic procedures available. If you have a gummy smile, uneven gum line or elongated teeth, cosmetic periodontal surgery is for you.

If you are unhappy with your smile, give us a call to discuss your options. After all, you only have one chance to make a first impression.