In order to remove plaque, tartar, and calculus deposits from your teeth, a tooth scaling must occur. In some cases plaque and tartar are present below the gum line and a sub-gingival tooth scaling must occur.
Sometimes after a tooth scaling, the roots of a tooth must be planed in order to create a smooth surface for the gum tissue to re-attach to. In addition to the planing, your dentist may also prescribe medication in order to control infection and pain.
When deep pockets between teeth and gums (6 millimeters or deeper) are present, it is difficult for a dentist to thoroughly remove the plaque and tartar. Gum flap surgery is a procedure where the gum flap is lifted away from the tooth. Diseased tissue and sometimes bone is removed. The rough surfaces of the tooth are then smoothed by root planing. The area is medicated and the gum flap is replaced and sutured allowing the bone and gum tissue to heal. One of the goals of gum flap surgery is to reduce the depth of the periodontal pockets to make them easier to keep clean.
Bone grafting is commonly performed by an oral and maxillofacial surgeon to replace or augment bone in areas of tooth loss. Bone grafting to the jaws and facial structures may be necessary in a wide variety of scenarios. The most common bone grafts are facial skeleton and jaw procedures. Other common procedures include tooth extraction site graft, bone graft reconstruction and for a sinus lift. Shrinkage of bone often occurs when a tooth is lost due to trauma, severe caries, or periodontal disease. Additionally, bone loss may have already occurred due to infection or pathology around a tooth. There are many artificial biocompatible bone substitutes available; however, the best material for a bone graft is your own bone, which most likely will come from your chin, the back part of your lower jaw or your hip bone. The hip is considered to be a better source because the hip bone has a lot of marrow, which contains bone-forming cells. There are also synthetic materials that can be used for bone grafting. Most bone grafts use a person's own bone, possibly in combination with other materials.
To place the removed bone in the recipient site, little holes are drilled in the existing bone to cause bleeding. This is done because blood provides cells that help the bone heal. The block of bone that was removed will be anchored in place with titanium screws. A mixture of the patient's bone marrow and some other bone-graft material will then be placed around the edges of bone block. Finally, a membrane is placed over the area and the incision closed.
The bone graft will take about 6 to 12 months to heal before dental implants can be placed. At that time, the titanium screws used to anchor the bone block in place will be removed before the implant is placed.
A frequent periodontal condition is known as gum recession. This means the existing gum tissue has receded up or down the root of the tooth exposing various amounts of the root. Root exposure can create root sensitivity especially to hot and cold, an increased potential for root decay, and/or esthetic concerns. Gum grafting procedures are the treatment of choice to prevent the recession from continuing further. There are many different types of recession and hence many different types of gum grafting. Some are aimed at covering the root of the tooth and other procedures are focused on providing an excellent new zone of gum tissue to halt the recession.
Tooth loss occurs for many reasons, including: dental decay, root canal problems, fractures, periodontal disease, and trauma. Additionally, in some cases teeth never develop. As a result of tooth loss, the bone melts away. If there is inadequate bone to support surrounding teeth and future possible dental implant(s), bone grafting materials are used to rebuild and regenerate the bone. This process aims to provide sufficient bone quantity and quality for implant placements and supporting tooth structure.
If a patient has an excess amount of tissue that connects the lower and upper lips to the jaw and gum line, a frenectomy procedure is performed to remove the excess tissue. A frenectomy is either performed inside the middle of the upper lip, which is called a labial frenectomy, or under the tongue, called a lingual frenectomy. Frenectomy is a very common dental procedure in the dental world and is performed both on children and adults.
Decay can frequently be found below the gum line. In order to gain access to the decay, it is necessary to reduce some of the bone surrounding the area of decay so the gum tissue can be positioned either higher up or lower down on the tooth making access to repair decay feasible. In other circumstances, the tooth may fracture below the gum line. Often the tooth requires a crown (cap) to cover over the fracture line. In order for the crown to fit over the fracture line, it is necessary to raise or lower the gum and reshape the bone accordingly so that the fracture line now becomes visible above the gum. The tooth is now ready for a crown (cap). When smiling, ideally there should be a display of upper teeth and a slight amount of gum displayed as well. In many circumstances there is an excessive amount of gum displayed (this is known as a gummy smile). In order to reduce the gum display so that there can be an ideal amount of tooth and gum showing, it is necessary to move both the gum and bone higher up on the teeth. The bone is gently sculpted to create room for the gum tissue to be ideally positioned. Hence the correct proportions of the teeth and gum are now visible.
When a tooth is lost and not immediately replaced, the bone reacts to this event by 'shrinking back'. The bone becomes thinner from a width perspective and the bone height is frequently reduced. This process is known as bone resorption. In order to place implants, it is necessary to rebuild the bone width and height through regenerative surgical therapy. Bone grafting of the ridge is almost always required to enable accurate placement of dental implants. The grafting is completed utilizing tissue bank and/or synthetic bone particles combined with collagen membranes. It is a highly predictable procedure.
In the back of the upper jaw bone dental implants are frequently needed. In order for a dental implant to be successful in this area of the mouth there must be sufficient bone height and width to connect (integrate) to the dental implant. When the upper back teeth are lost and not replaced the sinus cavity becomes enlarged destroying any bone that is left behind. This very large sinus is like a "giant air pocket" and not capable of supporting an implant. A procedure known as sinus grafting (sinus lift) is performed to create bone that will ultimately hold the implants within the sinus. Sinus grafting is an extremely common form of bone grafting.
When a tooth is extracted and an implant is to be placed (either simultaneously or in the future) it is always necessary to complete bone grafting within the residual sockets that are left behind after the roots of the tooth are removed. The shape of the tooth root is always different from the shape of a dental implant and hence there are always residual socket defects (holes) that must be filled in so that there can be excellent contact of the implant to the newly formed bone.
Thomas Hoover, DDS PA would love to meet you and your family to provide you with the periodontal dental care you need and give you all the smiles you deserve at our St. Louis Park periodontics office!