Dental Implants, Gum Grafts and more

A dental implant is an artificial tooth root that a periodontist places into the jaw bone to hold a replacement tooth or bridge. Dental implants are an ideal option for people who have lost a tooth or multiple teeth due to periodontal disease, injury, and more. Implants are more tooth saving than traditional bridgework, since implants do not rely on neighboring teeth for support. They look natural and feel so good that patients often forget that they ever had a missing tooth. In highly visible / esthetic areas such as the front teeth, a custom-made temporary crown can be attached to the implant on the same day as the implant placement. This ensures the most esthetic final outcome and greatest patient comfort. Under proper conditions— placement by a licensed periodontist and diligent home care by the patient— implants can last a lifetime.

Connective tissue grafts are used to treat recession. Recession is a condition in which gum tissue has diminished, leaving tooth roots exposed. Recession is both an esthetic and a functional problem for patients. Around every tooth, we have 2 to 4 mm of thick tissue that resists damage during eating and brushing. When the recession extends beyond this thick tissue, we are left with a very thin tissue which can be easily damaged, even with the most gentle of brushing techniques. In a situation like this, a connective tissue graft is performed to re-establish the thick tissue and cover up the root. This helps protect and stabilize the tooth and also reduces sensitivity to thermal changes that occur in the mouth.

Scaling and root planing, often called a “deep cleaning,” is a procedure that removes plaque, calculus, and stains from all areas of the tooth, including the root. Calculus is calcified bacterial buildup, which can form destructive bacterial ecosystems. Left unchecked, calculus will damage gums, bone, and provide an entryway for bacteria into the bloodstream. It is recognized that cleaning the root surface of a tooth is a critical element in reducing inflammation. Periodontal scaling and root planing can be an arduous task and may require multiple visits for treatment, usually with the use of local anesthetic.

Advanced gum disease can cause deep pockets to form around teeth making it impossible to effectively clean out bacteria with regular brushing and flossing. On a localized level, this can lead to gum recession, bone resorption, and eventual loss of teeth. On a systemic level, uncontrolled inflammation can affect other parts of the body, such as the heart. Pocket reduction surgery consists of opening the gums around affected teeth and reshaping the bone in order to eliminate the damage caused by bacteria. This highly effective surgery is designed to turn deep pockets into shallow pockets that can once again be cleaned with normal brushing.

There are instances, such as a with a root fracture, extensive bone loss, or extreme decay, in which a tooth is non-restorable and needs to be taken out. Once a tooth is extracted, it is recommended that a bone graft and membrane be placed in the extraction site. The purpose of a bone graft is to restore proper bone contour and dimensions, making it especially important in an area where you want to place an implant. Implants must be placed in healthy bone with sufficient volume in order to be successful. In an area where a bridge is used to replace a missing tooth, a bone graft will help to restore optimum esthetics. 

For patients who are missing all of their teeth or have failing teeth, there is an alternative to dentures. Using as few as four implants, we can replace an entire arch of teeth with an implant bridge. In most cases, we can complete all of the extractions, implant placements, and attachment of a temporary bridge screwed to the implants, all on the same day. You will never have to deal with a denture even for one day!

There are two main categories of crown lengthening surgery: functional and esthetic.

When a tooth defect such as a cavity or a crack lies below the gum line, it will need to be exposed before repairs can be made. Crown lengthening-- functional in this case-- is the process of moving and/or removing gum and bone structure in order to reveal the defect. Functional crown lengthening may also used to prepare a patient for a new crown or bridge.

Esthetic crown lengthening is the same process, but used for a cosmetic result. Sometimes, as a result of an excess of gum tissue and bone, a patient will have a "gummy smile," where teeth appear unusually short. A portion of the gums and bone will be removed and/or repositioned in order to develop proper dimensions of the teeth and establish an esthetic lip-line. This can be transformative to a patient's smile and self-confidence.

LANAP/LAPIP is a non-surgical treatment of periodontal disease around natural teeth as well as implants. LANAP and LAPIP is a laser assisted disinfection and regenerative process. For patients who are not a good candidate for traditional pocket reduction surgery or for patients who prefer a non-surgical approach, LANAP/LAPIP is a great alternative. 

As we age our sinuses continue to grow, and can take over bone around the upper rear of the jaw. This presents a problem when upper back teeth are lost and need to be replaced by a dental implant. If the height of bone in the back of our upper jaw is insufficient, a sinus lift is required. During a sinus lift the bottom of the sinus floor is elevated to provide enough room for the implant. If just a few millimeters of additional bone height is needed then an internal sinus lift can be done at the time of implant placement. If more bone height is needed then an external sinus lift is required and has to be completed first, prior to implant placement.

In some cases of abscess formation and inflammation, an antibiotic may be placed directly at the site in question, delivering a greater punch. If a patient has a moderate to deep pocket in a single location, this therapy has been shown to be effective in “repairing” the affected site. Repairing a site is different from regeneration and remodeling. This type of treatment can be unstable and without a perfect follow up, it can lead to a return of the deep pocket. This is why it is reserved for isolated lesions with mild to moderate damage and is often used as an adjunctive treatment to surgery. It is not an alternative to surgical therapy.

If a suspicious lesion is found, a biopsy may be indicated. This is usually done under local anesthetic, where a numbed lesion is removed partially or fully depending on its location and extent. The biopsied tissue is then sent to a pathology lab and analyzed under a microscope to determine the nature of the lesion. This can lead to early detection and possible treatment.

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