Periodontal Surgery

Periodontal surgery is essentially a plastic surgical procedure with the purpose of restoring normal form and function to periodontal structures, which include gum tissue, ligaments, and bone. Periodontal disease can damage these structures over time, leading to a number of problems, and ultimately may result in loss of teeth.

While some patients can be treated by a dentist, others may have more advanced needs that are best met by a periodontist. In order to treat periodontal disease, surgical and non-surgical periodontal procedures may be suggested as part of a treatment plan.

Who Does Periodontal Surgery?

At our office, your periodontal surgery will usually be done by our Board-Certified Periodontist, Dr. Cecilia Perera, who is a dentist who specializes in only performing gum treatment. Periodontists complete extensive training in this specialty area, including an additional three years of education beyond dental school. They have knowledge of the latest techniques for diagnosing and treating periodontal disease and offer a wide range of treatments designed specifically for each patient. Dr. Cecilia Perera is a highly experienced and certified periodontist who comes to our office weekly to perform various periodontal treatments, for the comfort and convenience of our patients.

When I was told that I needed periodontal work I was not thrilled to go through any type of surgery; I had been living with multiple areas of sensitivity for almost five years and none of my previous dentists had discussed any options. I will say that the surgery was actually easy and with little discomfort, I clearly understood what was happening and what I could do to help the healing process. I have healed beautifully and have no sensitivity; the cosmetic appearance of my gums has impressed me as well. I highly recommend Creating Smiles for all your dental needs – they are extremely skilled and professional and truly care about their patients.

Ken S.

What is Dental Crown Lengthening?

You may have asked us about procedures to improve a “gummy” smile because your teeth appear short or your gum line may seem uneven. In all actuality, your teeth may be the proper lengths, but they’re covered with too much gum tissue. To correct this, we perform a dental crown lengthening procedure.

During this procedure, excess gum and bone tissue are reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.We may also recommend dental crown lengthening to make a restorative or cosmetic dental procedure possible.

Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.

Gingival (Gum) Graft

Gingival grafts are often recommended for those suffering from gum recession to prevent further damage to the teeth or their roots. Also, sometimes patients choose the procedure to improve the appearance of the patient’s smile. Gum Grafts are also used to treat sensitivity and chronic inflammation of the gums. If left untreated, the chronic inflammation can lead to bone loss.

Gum recession is sometimes treated via a gingival graft, which means the periodontist retrieves soft tissue from the roof (palate) of your mouth. This method is used in patients that have thin gums to begin with. However, removing a section of your palate creates unnecessary pain and discomfort as the tissue is removed directly from the roof of the mouth, and then attached to the area of gum that needs treatment.

Healthy gum tissue protects your teeth from periodontal disease, and sensitivity while giving you a great smile. While routine dental check-ups paired with proper brushing are essential for maintaining healthy gums, some patients may require treatment.

Before

After

Why Treat Gum Recession?

Aggressive tooth brushing and periodontal disease are two primary causes for recession. Although proper brushing and flossing are crucial to a healthy smile, it can lead to receding gums. Always use a “soft” labeled toothbrush, and brush, not scrub. If it hurts, back off the intensity of your brushing habits.

Periodontal disease can also result in gum recession. Genetics can compound the problem, as naturally thin or fragile gums can be more prone to recession. Teeth grinding, called bruxism, can also worsen existing periodontal disease, and stomach acid damage from self-induced vomiting can also lead to recession.

No matter the cause, gum recession can lead to the following negative effects:

  • Teeth appear longer
  • Teeth appear widely spaced apart
  • Root sensitivity
  • Loss of supporting bone
  • Tooth decay
  • Plaque build-up*
  • Risk of future recession*
  • Tooth movement
  • Tooth loss

* Clinical Evaluation of 3 Techniques to Augment Keratinized Tissue Without Root Coverage. Harris RJ. J Periodontology 2001; 72: 932-938.

Before and After

Why Consider Bone Grafting?

While you might think that bone is made of a rigid material that is static and never changing, it’s actually in the business of remodeling itself all the time. During the body’s normal maintenance cycle, specialized cells in the blood continually enter your tissue to remove damaged cells and replace them with new, healthy cells. This includes the bones that surround your teeth.

In the case of periodontal disease, that bone that surrounds your teeth can take a beating as well, whether you’ve already lost a tooth or not. This can not only affect your smile, but it can affect your facial structure, causing your features to sag.

If this happens, you periodontist has options for repair. Bone grafting is one of those options. Grafting procedures place a framework of material in the areas of missing bone into which these cells can enter and start the rebuilding process. Over time your cells will remodel the graft material into your own functioning bone.

Bone grafting not only allows for a more effective tooth replacement if you’ve suffered tooth loss or trauma, but it can also work to maintain or restore your facial structures.

About Bone Grafting

During the body’s normal maintenance cycle, specialized cells in the blood continually enter your tissue to remove damaged cells and replace them with new, healthy cells.

Grafting procedures place a framework of material in the areas of missing bone into which these cells can enter and start the rebuilding process. Over time your cells will remodel the graft material into your own functioning bone.

Surgery_bonegraft_1

 

Cross-section of a jaw that has lost volume following tooth loss. There is not enough bone to safely place a dental implant.

Surgery_bonegraft_2

 

The patient’s cells migrate into the allograft material and remodel it into new bone. Over time host bone will remodel to replace the allograft.

Surgery_bonegraft_3

 

Restored jaw now has adequate room for placement of adental implant to replace the missing tooth.

Where Does Bone Grafting Material Come From?

Bone grafting material comes from several sources. Autograft bone is material that is taken from another point in the patient’s body and transplanted to the desired site. It is a good graft material since it contains the patient’s own cells, and carries no risk of disease transmission. The chief drawbacks are that it requires a second surgical procedure and enough harvestable bone that may not be easily available.

Alternatively, allograft bone is material that was taken from an organ donor and processed to ensure its safety and improve the handling characteristics. The advantages of allograft bone are that it is readily available and does not require a second surgical site. Allograft bone has been well documented in clinical trials and has an excellent safety record.

The advantages of allograft bone are as follows:

  • Readily available
  • No second surgical site
  • Clinically proven effectiveness
  • Great track record of safety

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