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Periodontal Treatment


Mucogingival (Grafting) Procedures - Recession is commonly caused by normal daily activities including brushing and eating.  Depending on the type of defect the periodontist will recommend the most appropriate treatment.  The three most common treatment are outlined below.

  • Connective tissue Graft:  A connective tissue graft provides the most esthetic result.  Connective tissue graft is used when root coverage is desired.  Connective tissue graft is most commonly performed when one or two teeth in an area are involved.
  • Free gingival graft (autogenous gingival graft):  This is the most common type of grafting.  This is very similar to a skin graft.  A thin layer of tissue is taken from the roof of the mouth and placed to augment or reinforce the area next to the teeth where recession has occurred.  A free gingival graft does not typically provide root coverage, but can help prevent future recession and increase comfort in this area.  One advantage to a free gingival graft is that it can be used to treat several teeth simultaneously.  This is a very predictable procedure and usually heals in just a few days.
  • Pedicle graft:  A procedure where there is enough healthy neighboring tissue that can be easily repositioned.  When this is possible, it eliminates the need for a donor area.

Crown Lengthening - Crown lengthening is one of the most commonly performed procedures in a periodontal office.  When tooth decay extends below the gum line, it is very difficult for your dentist to gain access to place a restoration and usually a crown.  Crown lengthening will provide an ideal foundation for your dentist to make a good crown.  This simple procedure of crown lengthening is to expose additional tooth structure. Crown lengthening requires a combination of restorative access providing appropriate biologic width, and also exposing enough tooth to grab onto.  Crown lengthening typically has three goals in mind.

  • Restorative access:  When a cavity extends below the gum line, it is very difficult for your dentist to see or gain access in this area to place a good restoration.  Gums will bleed, which can interfere with restorative material.
  • Biologic width:  This very important concept means that the edge of the crown must be an average of 3 mm away from the bone level.  In other words, there needs be a “buffer zone” of soft tissue below your crown.   Also, in order to make a good crown reaching deep below the gum line, it is difficult to take an impression when bleeding or moisture occur during taking an impression, which can lead to an inaccurate impression.  An inaccurate impression means that the final crown may not fit properly.  When a cavity extends below the gum line it is typically very close to the bone level, and does not leave room for biologic width.  If this biologic width is invaded, chronic irritation commonly results.
  • Crown retention (ferrule effect):  In order for a crown to stay in place and remain stable for several years, it needs enough natural tooth structure to grab onto.  The process of crown lengthening will provide additional tooth structure for the crown to grab onto.  Typically the amount of ferrule necessary is around 1 1/2 mm.
     

Periodontal Disease - Periodontal disease is a disease which affects the bone which supports the teeth.  Disease and infection around the teeth causes this bone to melt away.  As the disease progresses, the bone which supports the teeth is lost, resulting in teeth being loose or painful.  Periodontal disease is basically caused by three factors:

    • Plaque and bacteria:  Plaque and bacteria can be controlled with good oral hygiene unless the periodontal pockets have been extended to the point where normal daily home care cannot achieve the desired benefits.  Then often specialized care is required to control the disease.
    • Periodontal pockets:  Pockets which form when bone is lost under teeth.  This is usually caused by a combination of factors including
      • Bacterial accumulation (lack of perfect home care, flossing, or extensive existing dental work, crowns and bridges etc.)
      • Smoking: This is the most significant non-bacterial factor which causes gum disease.  Any patients who are currently smokers are all encouraged to quit.  Quitting smoking will help with healing and always achieve a better result with healthier gums after surgery.
      • Systemic factors: Including Diabetes and other immune suppressive diseases.  Stress and genetic factors can also play a major role in the progression of disease.

 

What to expect after periodontal procedures:

Discomfort:  Some mild discomfort is usually expected after most periodontal procedures.  It is recommended that most people take it easy the day of surgery (perhaps go home and rent a movie).  In the day’s following surgery, most people are able to carry out there daily activities without interruption.  The soreness of the mouth is usually well controlled with pain medicine.  The pain medicine works best when taken on a consistent basis every few hours.  There will be mild swelling.  The area will feel mildly swollen, but swelling on the outside of the mouth is not usually apparent.  The area may be a little bit tender on the day or two after surgery because this is when the most active healing begins.

Bleeding:  Following periodontal surgery sutures may be placed.  Mild bleeding and oozing might be present.  This bleeding may mix with saliva and appear when the patient spitsworse than it actually is.  If bleeding becomes excessive or seems unusually, please contact the clinic immediately.  After hours, calling the clinic number will allow the answeringpaging service to reach the doctor on call.

During the procedure:  During the procedure you will first receive a local anesthetic to completely numb the area.  If desired Nitrous oxide (laugh gas) can be supplemented to help you relax., sedation is available to make the procedure more comfortable.

Length of the procedure:  The majority of periodontal procedures do not take extensive amounts of time.  While patients may be in the chair longer thanabout an hour, the typical working time is usually only around 30 minutes for most procedures.  Very routine procedures, even including implants, can even take less time.  Because our doctorsDr. Song only does two types of procedures, dental implants and periodontal surgery, we have perfected these two procedures and can generally complete them very efficiently.

 

Services offered:

Patient Comfort:  Patient comfort is our primary concern.  We realized that it is normal for people to be anxious prior to having periodontal procedures or implants done.  Your comfort is our utmost importance.  Primary to creating a comfortable environment, is making sure every patient understands exactly what is being done and what type of results to expect (this is one of the reasons we published this website).

Local anesthesia:  All procedures are performed with local anesthesia.  Routine dental anesthetic adequately eliminates most pain sensations during any procedure.  However, there are two types of nerves, one for pain and the other one is for pressure.  The pain sensations will be completely eliminated.  However, you may feel a very slight amount of pressure or pushing during a procedure, but this will not hurt.

Sedation options:  Our clinic is licensed and certified to provide a variety of sedation options to our patients.  These options range from Nitrous oxide (laughing gas) to IVoral sedation for a deeper state of relaxation.  These procedures provide a very safe and comfortable experience for our patients.

Nitrous oxide:  Nitrous oxide is inhaled through a nose piece to create a very mild state of relaxation.   Nitrous oxide can be used during a dental visit, and patients are still able  to safely drive home.  Nitrous oxide is commonly used in conjunction with other means of sedation.

Oral sedation:  For the majority of surgical procedures, patients are offered the option of  oral sedation using some type of tranquilizer.  This creates a deep state of relaxation.  However, since this is an oral medication patients are required to have an adult escort  to give them a ride to and from their appointment.  Oral sedation provides a very predictable state of relaxation.  Additionally, oral sedation helps people to go home and relax the afternoon after procedure, and possibly even take a nap.



Definitions:

Pontic: The portion of a bridge (linked to bridge definition) which replaces the missing tooth.

Bridge: A traditional way to replace a missing tooth.  Typically the teeth are reduced in size and preparation for a crown is done on the teeth next to the empty space.  Then a single three-unit structure is used to place crowns on these two teeth, along with a pontic in place of the missing tooth.

Conventional Bridge:  A conventional bridge is commonly used when both adjacent teeth have deep decay or very large fillings, and are in need of crowns.  When adjacent teeth are not in need of crowns and there is sufficient bone quantity present, a dental implant is usually the recommended treatment.

Bone Graft:  A bone graft placed in the mouth (usually artificial bone) is designed to serve as a matrix.  This matrix or scaffolding, is used by your body to encourage growth of your own natural bone.  The use of a high-tech membrane  can help to encourage a greater proportion of the bone graft to heal well.  Over time this artificial bone is typically resorbed and replaced with your body’s own natural bone.

Membrane: A membrane is used in ridge augmentation procedures to aid in healing of the bone graft.  The membrane creates a separation between the soft tissue (gums) and the bone graft/hard tissue.  Because hard tissue (bone) heals more slowly than soft tissue (gums), the theory is that this membrane will help retard the growth of soft tissue into the bone graft, and allow improved hard tissue healing.

Connective Tissue Graft: A connective tissue graft is where tissue is taken from the “underneath layer” from the roof of the mouth.  By using an underneath layer the healing is much faster and much more comfortable.  This tissue is most commonly used for root coverage to treat and correct recession defects.  It is also very common to use connective tissue for ridge augmentation procedures to add thickness and esthetics to the ridge prior to a bridge.