These procedures are a predictable way to cover unsightly, sensitive, or exposed root surfaces and to prevent future gum recession. If you are unhappy with the appearance of short unsightly teeth this can be greatly improved by a combination of procedures by your periodontist, and cosmetic dentistry by your general dentist.
Although your teeth appear short, they may actually be the proper length. The teeth may be covered with too much gum tissue. We can correct this by performing the periodontal plastic surgery procedure called crown lengthening.
During this procedure, excess gum and bone tissue are reshaped to expose more of the natural tooth. This can be done to more than one tooth, to even your gum line, and to create a beautiful smile.
Before Crown Lengthening Procedure
After Crown Lengthening Procedure
Another cosmetic procedure is the soft tissue graft. It is used to cover unattractive tooth roots, reduce gum recession, and protect the roots from decay and eventual loss.
Tooth loss causes the jawbone to recede and can lead to an unnatural looking indentation in your gums and jaw. The original look of your mouth may not be recaptured because of spaces remaining under and between replacement teeth. They may appear too long compared to nearby teeth.
Bone grafting following tooth loss can preserve the socket/ridge and minimize gum and bone collapse. There is less shrinkage and a more aesthetic tooth replacement for either an implant crown or fixed bridge around the replacement teeth
Before Gum Grafting Procedure
After Gum Grafting Procedure
Crown lengthening (or crown exposure) is required when there is decay below the gum line and your dentist cannot properly seal the filling or crown. The edge of that restoration is deep below the gum tissue and not accessible. It is also usually too close to the bone or below the bone.
The procedure involves adjusting the level of the gum tissue and bone around the tooth in question to create a new gum-to–tooth relationship. This allows us to reach the edge of the restoration, ensuring a proper fit to the tooth. It should also provide enough tooth structure so the new restoration will not come loose in the future. This allows you to clean the edge of the restoration when you brush and floss to prevent decay and gum disease.
When the procedure is completed, sutures, and a protective bandage are placed to help secure the new gum-to-tooth relationship. You will need to be seen in one or two weeks to remove the sutures and evaluate your healing.
Gum Surgery (Osseous Surgery)
Traditionally, gum disease is treated by reducing and possibly eliminating the gum pockets. The infected gum tissue is trimmed away and uneven bone tissue re-contoured. In addition, when possible bone and gum regenerative procedures are utilized.
Major & Minor Bone Grafting
Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.
Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.
Major Bone Grafting
Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease, or injuries. The bone is either obtained from a tissue bank or your own bone is taken from the jaw, hip, or tibia (below the knee). Sinus bone grafts are also performed to replace bone in the posterior upper jaw. Special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.
Major bone grafts are typically performed to repair defects of the jaws. These defects may arise as a result of traumatic injuries, tumor surgery, or congenital defects. Large defects are repaired using the patient’s own bone. This bone is harvested from a number of different sites depending on the size of he defect. The skull (cranium), hip (iliac crest), and lateral knee (tibia) are common donor sites. These procedures are routinely performed in an operating room and require a hospital stay.
X RAY OF TOOTH BEFORE BONE GRAFTING
Arrow 1 shows a normal healthy bone level. Arrow 2 shows an unhealthy bone level.
X-RAY OF TOOTH AFTER BONE GRAFTING
The arrow shows the increase in bone level. The tooth has more bone support and is therefore more stable in the jaw.
Sinus Lift Procedure
The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.
There is a solution called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.
The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.
If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus augmentation will have to be performed first, then the graft will need to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.
In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material can be placed and matured for a few months before placing the implant.
Before Ridge Expansion Procedure
After Ridge Expansion Procedure (Front Profile)
After Ridge Expansion Procedure (Side Profile)
When teeth are lost, the bone will receed and shrink. It is important that when a tooth is removed appropriate steps (surgical bone grafting) are taken in order to preserve the bone and prevent further deterioration and bone loss. This in turn will greatly help in the placement of dental implants for tooth replacement purposes.
Bone regeneration for teeth
Bone regeneration procedures are surgical treatments performed when the teeth have lost bone and tissue supporting the teeth. Both bone graft materials and biological proteins are used to rebuild the lost bone, and create healthy teeth that can be maintained for a long time.
Bone regeneration for implants
Implant therapy requires adequate bone which acts as a foundation to anchor the dental implants. If there is not enough bone to support an implant, the bone can be regenerated using bone graft materials and biological proteins. A thorough assessment of your jaw bone will determine how much bone is present and if bone regeneration procedures are required. In many cases bone regeneration is preformed as a separate procedures, but occasionally it can be performed at the same time as the dental implant is placed.
Scaling and Root Planing
Although you may have recently had your teeth cleaned during your routine check-up appointment with your dentist, it may be necessary to have additional initial cleaning to remove any calculus or tartar that is present below the gumline. This may require two or more appointments.
The tooth roots will also be smoothed allowing the gum tissue to heal and reattach to the tooth. For your comfort, local anaesthetic (freezing) is provided.
Antibiotics or irrigation with anti-microbials (chemical agents or mouth rinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, antibiotic fibers may be placed in the periodontal pockets after scaling and smoothing. This may be done to control infection and to encourage normal healing.
When deep pockets between teeth and gums are present, it is difficult to thoroughly remove plaque and tartar. It is impossible for patients to keep these pockets clean and free of plaque. Pocket reduction procedures may be needed to restore periodontal health.
A bite is considered to be healthy when all or most of the teeth are present and not damaged by normal daily usage.
It is destructive when teeth show wear, looseness or when TMJ (jaw joint) damage is seen. Bite therapy helps restore normal function. No anaesthetic is necessary for bite adjustment appointments.
The therapy may include:
- Reshaping the biting surfaces of the teeth and eliminating spots of excessive pressures where the teeth are brought into contact. This is done by carefully dividing bite pressures evenly across all of the teeth.
- Bite splint therapy using a custom-fitted and adjusted plastic bite guard to keep the teeth apart, day, night, or both.
- Braces to reposition mal-aligned or drifted teeth.
- Replacement of old, worn out, or damaged fillings.
- Reconstruction of badly worn and damaged teeth.
A frenectomy is a surgical procedure that removes or loosens a band of muscle tissue (frenum) that is connected to the lip, cheek or floor of the mouth. It is performed under local anesthetic with uneventful healing.
What is a frenectomy used for?
There are people with large frenums beneath their tongues. This prevents their tongue from moving freely, and this will interfere with their speech. The condition of limited tongue mobility is referred to as ankyloglossia or “tongue tie”.
There are times where the frenum is attached between the two upper front teeth. This condition is usually seen in children after their permanent upper front teeth have erupted in their mouths.
Before Frenectomy Procedure
After Frenectomy Procedure
Chao Pinhole Surgical Technique
Gum recession results in the root structure being exposed. Once the root is exposed, the tooth is left in a vulnerable position and may experience rapid tooth decay. The solution is to repair the gums with Chao Pinhole Surgical Technique.
During this procedure, a small pinhole is created in the existing gum tissue. This pinhole is used as the entry point to gently loosen gum tissue. Special instruments reposition the gum line to repair and cover the exposed roots by adjusting the existing tissue. This innovative procedure removes the need for sutures resulting in a quick recovery and a long-lasting beautiful smile.