Periodontists are dentistry's experts in treating periodontal disease. They receive up to three additional years of specialized training in periodontal disease treatment in both non-surgical treatments and periodontal plastic surgery procedures. Periodontists are also experts in replacing missing teeth with dental implants.
- Gum Graft Surgery
A gum graft is a type of dental surgery performed to correct the effects of gum recession. It is a quick and relatively simple surgery in which a periodontist removes healthy gum tissue from the roof of the mouth and uses it to build the gum back up where it has receded.
Gum recession occurs when gum tissue wears away, exposing more of the tooth at the root. This may cause increased sensitivity, especially when eating or drinking hot or cold foods. Because gum recession tends to happen slowly, many people do not realize it is happening to them.
If left untreated, gum recession could eventually lead to tooth loss.
Some people choose to have a gum graft for cosmetic reasons, such as to have a better smile; while for others, a gum graft is necessary to protect the exposed tooth from damage and repair any damage already done.
There is a variety of gum grafts available, and the type of surgery undertaken depends on the extent and severity of damage and a person's individual needs.
A periodontist will discuss the different types of surgery available with the person to decide which option is the most suitable.
Before starting the gum graft, the periodontist will administer a local anesthetic to numb the area so that the procedure does not hurt.
They may also lift some of the existing gum away to expose the root of the tooth and clean it.
The three different types of gum graft surgery are:
Connective tissue grafts
In this procedure the periodontist:
removes tissue from the roof of the mouth by making a flap and taking tissue from underneath the top layer
stitches the tissue onto the existing gum tissue to cover the exposed tooth root
stitches the flap on the roof of the mouth from where they took the tissue
Free gingival grafts
This is the preferred method for people with thin gums who require extra tissue to enlarge the gums.
In this procedure the periodontist:
removes tissue directly from the top layer of tissue on the roof of the mouth
stitches this tissue to the existing gum area
Pedicle (lateral) grafts
This is the preferred method for people who have lots of gum tissue growing near the exposed tooth.
In this procedure the periodontist:
grafts tissue from the gum around or near the tooth requiring treatment
only partially cuts away this tissue, keeping one edge attached
stretches the tissue over or down, covering the exposed tooth root and holding it in place with stitches
A periodontist may source the tissue from a tissue bank rather than removing gum tissue from a person's mouth.
Preparing for a gum graft surgery
Once the person and their dentist have considered all the options and decided on the type of surgery, there is not much that a person needs to do to prepare for the procedure.
However, it is essential to ensure a family member or friend is available to drive to and from the appointment.
This is important because the pain medication prescribed to manage the discomfort means it is unsafe for a person having gum graft surgery to drive.
People getting gum grafts will be able to go home right away after the procedure. A periodontist will discuss all the aftercare instructions to ensure the graft heals successfully.
A person can aid recovery by:
The pain and discomfort a person experiences will vary. If the periodontist is using tissue from a tissue bank, for example, a person should feel minimal pain. If they remove the tissue from the roof of the mouth a person may feel pain for a few days.
- avoiding flossing or brushing at the treatment site
- using a special mouthwash which controls plaque build up
- taking antibiotics to reduce the risk of infection
- avoiding strenuous exercise
- avoiding foods that are hard to eat
- eating soft, cool foods, for example, ice cream, pasta, eggs, yogurt, and soft cheese
- avoiding smoking
The healing process is often quick, taking 1 to 2 weeks for the mouth to heal fully but may take longer. People can take over-the-counter (OTC) pain relievers or prescription medications to help manage any discomfort.
After the procedure, teeth may feel more sensitive than usual, particularly to hot and cold foods, and people may benefit from using desensitizing toothpaste or mouthwash.
Most people can return to work the following day.
A person will probably have a follow-up appointment with their dentist after surgery to check the healing process is progressing as it should. The dentist may also remove any stitches if necessary.
The gums will not only look different after surgery but may feel tighter and firmer too.
- Laser Treatment
Medical professionals use lasers, which are extremely focused light beams, to alter or remove tissue in small amounts. Laser surgery is not limited to dentistry, but many people have never heard of laser dentistry before having it done. Dentists use lasers in a variety of procedures involving the inside of the mouth, be it to remove overgrown tissue, to reshape the gums, or to whiten teeth. Sometimes, laser dentistry is ideal for children who become anxious or afraid when having dental work done.
What Laser Dentistry Can Treat
Most issues laser dentistry treats are related to the gums. Some of these include:
- Canker sore and cold sore pain treatments.
- Treating root canal infections.
- Treating gum disease.
- Removing gum inflammation.
- Gum reshaping.
- Exposing wisdom teeth.
- Removing throat tissue that causes sleep apnea.
- Regenerating damaged nerves.
- Removing benign oral tumours.
Benefits of Laser Dentistry
Dentists choose laser dentistry because of distinct benefits that make the procedures go more smoothly, and also reduce discomfort and healing time for patients.
- Patients are less likely to require sutures
- Anesthesia may not be necessary
- The laser will sterilize the gums, making infection less likely
- Less damage to gums shortens the healing time
- Patients lose less blood than traditional surgery
The Types of Lasers Used in Dentistry
The two main types of lasers dentists use during laser procedures are hard tissue and soft tissue lasers. Each laser uses a different wavelength that makes it appropriate for cutting into that specific type of tissue. This works because each kind of tissue absorbs wavelengths of light in different ways. By altering the light’s wavelength (and sometimes pulse) scientists have figured out how to craft lasers with light wavelengths compatible with the tissues in your mouth.
Hard Tissue Lasers
A hard tissue laser is used primarily for your teeth. The wavelength of one of these lasers cuts through both water and bone, specifically the calcium phosphate that’s in your bones and your teeth. These lasers can very accurately cut into your teeth, removing small amounts for shaping purposes or in preparation for procedures. Hard tissue lasers are used for:
Soft Tissue Lasers
- Detecting cavities.
- Dealing with tooth sensitivity.
- Preparing teeth for dental fillings.
The soft tissue lasers use a light wavelength that hemoglobin and water absorb easily. Hemoglobin is the molecule found in blood, which makes soft tissue lasers ideal for gum work. Some soft tissue lasers are diode lasers, which is a type of continuous-wave laser.
These lasers are ideal for cutting into soft tissue and sealing the exposed blood vessels at the same time. This is the reason you don’t bleed very much during laser dentistry and why healing is quicker after laser dentistry. Soft tissue lasers are great for cosmetic procedures because you can begin to see results right away. Soft tissue lasers are used for:
Whether you’re having laser gum surgery or hard tissue work, expect an easier procedure and a shorter recovery time. Laser dentistry is a convenient solution to many oral and dental problems, whether serious in nature or simply cosmetic. Ask your dentist about laser dentistry the next time you need dental work completed.
- Lengthening crowns.
- Dealing with restricted tongue movement.
- Reshaping the gums to create a more pleasing smile.
- Removing folds in oral soft tissues caused by dentures.
- Regenerative Procedures
Procedures that regenerate lost bone and tissue supporting your teeth can reverse some of the damage caused by periodontal disease.
Your periodontist may recommend a regenerative procedure when the bone supporting your teeth has been destroyed due to periodontal disease. These procedures can reverse some of the damage by regenerating lost bone and tissue.
During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts or tissue-stimulating proteins can be used to encourage your body's natural ability to regenerate bone and tissue.
Eliminating existing bacteria and regenerating bone and tissue helps to reduce pocket depth and repair damage caused by the progression of periodontal disease. With a combination of daily oral hygiene and professional maintenance care, you'll increase the chances of keeping your natural teeth – and decrease the chances of other health problems associated with periodontal disease.
- Dental Crown Lengthening
Crowns are tooth-shaped caps that fit over a natural tooth for aesthetic or structural reasons. A crown may be recommended when a tooth is cracked, broken, or misshapen. A crown can also be used to complete dental procedures, such as bridges, root canals, and dental implants. Crowns must be able to firmly affix to an existing tooth.
Crown lengthening can help. Dental surgeons perform crown lengthening by recontouring gum tissue, and sometimes bone, to expose more of a tooth’s surface for a crown. It’s a common procedure and often takes less than an hour to complete.
The purpose of a crown lengthening procedure
Crown lengthening can be necessary if there isn’t enough of the tooth in place to hold the crown on its own. Teeth that are broken or affected by tooth decay may prohibit a crown from firmly attaching.
Crown lengthening reduces gum tissue and shaves down bone when necessary so more of the tooth is above the gum’s surface. A properly fitted crown allows for better oral hygiene and comfort.
Some people seek crown lengthening to alter a “gummy smile,” in which the gums are visible above the teeth when smiling
How to prepare for a crown lengthening
Your dental surgeon may fit you with a temporary crown until you can have your procedure. The temporary crown can protect your tooth in the interim and can make the fitting of your new crown easier.
Before your surgery, you will meet with the periodontist to give a medical history and for them to view your X-rays. During this appointment, you should talk to your surgeon about any medications you take. They’ll let you know if you need to discontinue any of them for the procedure.
What happens during a crown lengthening procedure
Your periodontist will perform the crown lengthening during an outpatient procedure. This means you can go home afterward. The time the procedure takes varies depending on the number of teeth that need the procedure and if both soft tissue and bone need to be removed. If you have a temporary crown on any of your neighboring teeth, your periodontist may remove them before the procedure and replace them afterward.
Most people receive local anesthesia and may receive a sedative as well. The periodontist cuts the gums to pull them away from the teeth, exposing the roots and bone. In some cases, only the gum tissue needs to be removed. The surgeon then washes the surgical area with salt water before suturing. They suture the gums back together, sometimes placing a bandage over the area for additional protection.
You will feel some pain after the local anesthesia wears off, so your surgeon will prescribe you pain relievers and a specialized mouth rinse to help your gums heal.
There is some risk of infection with crown lengthening, but no more than with other surgical procedures. You should follow all postoperative care instructions to help prevent infection. Contact your dental office with any questions during your recovery.
You might experience bleeding at the surgical site after the procedure, and your teeth may be sensitive to hot and cold temperatures. The sensitivity will ease with time. Your tooth might look longer than the neighboring teeth, and if bone was removed, the tooth may feel looser. If you lose your tooth in the future, the crown lengthening might make it more difficult for the surgeon to place a dental implant.
The recovery process
The recovery time for this procedure is approximately three months. However, you’ll be able to resume normal functions as your gums heal. You only need to avoid strenuous activity for the first two to three days. A physically demanding job, heavy lifting, and heavy exertion could inhibit your healing and cause more bleeding.
Talk to your surgeon about the specifics of your recovery. In general, follow these guidelines:
Take OTC or prescription medication: In your aftercare instructions, you’ll most likely be told to take ibuprofen or Tylenol at regular intervals. The doctor may prescribe antibiotics, as well as extra-strength painkillers such as acetaminophen-hydrocodone (Vicodin), Tylenol with codeine #3, or acetaminophen-propoxyphene (Darvocet).
Use an ice pack: Using a pack on your face for the first few hours after the procedure can reduce swelling. Alternate use of the ice pack, following 20 minutes on and 20 minutes off. You may switch to moist heat a couple days after surgery.
Avoid hot foods for the first 24 hours: Also, don’t rinse your mouth. Both can make the bleeding last longer. If bleeding continues, use a moistened tea bag or moistened gauze to apply slight pressure to the area for 20 to 30 minutes.
Leave dressings in for 7 to 14 days: The doctor may replace the dressing once or twice during this period.
Brush carefully: Gently brush only your biting surfaces where the dressing has been applied. Brush and floss normally in other areas. Chew on the opposite side of your mouth from the dressing.
Wear your stent or denture: If wearing a clear stent or upper denture was included in your instructions, don’t remove it for 24 hours. If your mouth pools with blood, rinse with lukewarm saltwater or Chlorhexidine rinse, without removing the stent or denture. After 24 hours, you may wear it as desired.
Eat a soft food diet: Avoid the surgical area when you eat. Also, don’t eat anything hard, brittle, acidic, spicy, sticky, or highly seasoned. Avoid nuts and small seeds. Drink plenty of fluids.
Avoid alcohol: Refrain from drinking until after your post-op appointment.
Avoid smoking: Refrain from smoking for the first 7 to 10 days or longer.
Avoid prodding the area: Avoid using straws and playing with the surgical site with your tongue or finger. Don’t pull down your lip to check the site, as the pressure can cause damage.
- Dental Implants
What are Dental Implants?
Dental implants are metal posts or frames that are surgically positioned into the jawbone beneath your gums. Once in place, they allow your dentist to mount replacement teeth onto them.
How do Dental Implants Work?
Because implants fuse to your jawbone, they provide stable support for artificial teeth. Dentures and bridges mounted to implants won't slip or shift in your mouth — an especially important benefit when eating and speaking. This secure fit helps the dentures and bridges — as well as individual crowns placed over implants — feel more natural than conventional bridges or dentures.
For some people, ordinary bridges and dentures are simply not comfortable or even possible, due to sore spots, poor ridges or gagging. In addition, ordinary bridges must be attached to teeth on either side of the space left by the missing tooth. An advantage of implants is that no adjacent teeth need to be prepared or ground down to hold your new replacement tooth/teeth in place.
To receive implants, you need to have healthy gums and adequate bone to support the implant. You must also commit to keeping these structures healthy. Meticulous oral hygiene and regular dental visits are critical to the long-term success of dental implants.
Implants are usually more expensive than other methods of tooth replacement, and most insurance carriers typically cover less than 10 percent of the fees.
The American Dental Association considers two types of implants to be safe. They are:
Endosteal implants — these are surgically implanted directly into the jawbone. Once the surrounding gum tissue has healed, a second surgery is needed to connect a post to the original implant. Finally, an artificial tooth (or teeth) is attached to the post-individually, or grouped on a bridge or denture.
Subperiosteal implants — these consist of a metal frame that is fitted onto the jawbone just below the gum tissue. As the gums heal, the frame becomes fixed to the jawbone. Posts, which are attached to the frame, protrude through the gums. As with endosteal implants, artificial teeth are then mounted to the posts.
Posts are surgically placed below the gums. Artificial teeth, grouped on a bridge, are mounted to the posts.
Implants offer a very stable and secure fit. Implants serve as a base for single replacement teeth.
- Pocket Reduction Procedures
Pocket reduction surgery (also known as gingivectomy, osseous surgery and flap surgery) is a collective term for a series of several different surgeries aimed at gaining access to the root of the teeth in order to remove bacteria and tartar (calculus).
The human mouth contains dozens of different bacteria at any given time. The bacteria found in plaque (the sticky substance on teeth) produce acids that lead to demineralization of the tooth surface, and ultimately contribute to periodontal disease.
Periodontal infections cause a chronic inflammatory response in the body that literally destroys bone and gum tissues once they invade the subgingival area (below the gum line). Gum pockets form and deepen between the gums and teeth as the tissue continues to be destroyed.
Periodontal disease is a progressive condition which, if left untreated, causes massive bacteria colonization in gum pockets can eventually lead to teeth falling out. Pocket reduction surgery is an attempt to alleviate this destructive cycle, and reduce the depth of the bacteria-harboring pockets.
Reasons for the pocket reduction surgery
Pocket reduction surgery is a common periodontal procedure which has been proven effective at eliminating bacteria, reducing inflammation and saving teeth. The goals of pocket reduction surgery are:
Reducing bacterial spread – Oral bacteria has been connected to many other serious conditions such as diabetes, heart disease and stroke. Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize. It is important to decrease bacteria in the mouth in order to reduce the risk of secondary infection.
Halting bone loss – The chronic inflammatory response induced by oral bacteria leads the body to destroy bone tissue. As the jawbone becomes affected by periodontal disease, the teeth lose their rigid anchor. When the teeth become too loose, they may require extraction.
Facilitate home care – As the gum pockets become progressively deeper, they become incredibly difficult to clean by the patient. The toothbrush and dental floss cannot reach to the bottom of the pockets, increasing the risk of further periodontal infections.
Enhancing the smile – An oral cavity that is affected by periodontal disease is not attractive to the eye. In fact, smiles may be marred by brown gums, rotting teeth and ridge indentations. Pocket reduction surgery halts the progression of gum disease and improves the aesthetics of the smile.
What does pocket reduction surgery involve?
Before recommending treatment or performing any procedure, Dr Packman will perform thorough visual and x-ray examinations in order to assess the condition of the teeth, gums and underlying bone. Pocket reduction surgery is performed under local onesthetic.
The usual type of gum surgery ( flap surgery ) involves gently separating the gumline back from the teeth . Scaling and root planing will generally be required to fully remove the tartar from the surface of the tooth root. If the root is not completely smooth, a planing procedure will be performed to ensure that when the gums do heal, they will not reattach to rough or uneven surfaces.
The final part of the treatment is usually the administration of an antimicrobial liquid to eliminate any remaining bacteria and promote healing. The gum is then sutured with tiny stitches that usually dissove in 10-14 days.
Soft tissue Laser is used by Dr Packman for pocket reduction, either alone or in combination with flap surgery When a laser is used, no stitches are neede and ther is virtually no bleeding.!
Though the gums and teeth may be slightly more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums.