Osseous Surgery
Osseous surgery, also referred to as flap surgery, seeks to treat moderate to advanced cases of periodontal disease. To perform this procedure, the periodontist pulls back, or “flaps,” the gum tissue surrounding the affected tooth or teeth to access the underlying bone. Bacteria causing periodontal disease often create surface irregularities, or crater-like areas, on the bony surface. Osseous surgery provides the opportunity to smooth these discrepancies and eliminate tartar or plaque deposits found on the tooth root surfaces. A dental bone graft may be performed during this procedure to provide much needed support for areas in deficit. Infected gum tissue is excised and remaining healthy tissue sutured to begin the healing process following osseous surgery.
Ridge Augmentation and Ridge Preservation
The ridge of bone that supports the teeth becomes susceptible to deterioration when teeth are lost. Tooth roots naturally stimulate the bone whenever the chewing action occurs, helping to keep the bone healthy and dense. Tooth loss perpetuates bone loss, which in turn leads to changes in facial structure, difficulty with replacing missing teeth and other effects secondary to tooth and bone loss.
Two surgical procedures exist to address such bone loss. Ridge augmentation can restore bony tissue that has succumbed to the deterioration process. Tissue is added to the ridge through a dental bone graft procedure, reviving the shape and structure of the bone and gum tissues to a more favorable volume. Ridge preservation involves a dental bone graft at the time of tooth extraction, filling in the socket with bone tissue to preserve the ridge in anticipation of tooth replacement.
Sinus Augmentation (Sinus Lift)
The positioning of the maxillary sinus cavities often presents difficulty when replacing teeth with dental implants in the upper premolar and molar areas, as the floor of the sinus rests just above where the roots of these teeth used to be. Bone loss in this area makes replacing these teeth with dental implants even more challenging. In such cases, a sinus augmentation (or sinus lift) procedure may be necessary. Sinus augmentation typically occurs in one of two ways: the floor the sinus cavity is gently lifted and the space created filled with bone, or bone tissue is grafted to the floor of the sinus cavity to increase bone height. The manner in which this procedure is performed depends on a number of factors, such as existing bone height and density, positioning of the sinus cavity in relation to the anticipated implant site and individual considerations.
Bone Grafting
Bone grafting is the basis for a number of surgical periodontal procedures. Replacing bone lost to oral disease, injury or sustained tooth loss with a dental bone graft provides the necessary support the teeth require to remain stable and functional and facial features rely on to remain full. Often incorporated into a number of other procedures, a dental bone graft can be performed through the following variations:
Autogenous Graft: This dental bone graft sources the bone tissue sample directly from the patient’s own body. It is often preferred to improve the chance of successful tissue integration.
- Allograft: Using bone tissue provided by an outside source (such as a bone bank), this method enables patients to receive donated human bone without the need for a second surgical site on the body.
- Xenograft: A bovine (cow) or other non-human donor provides the sample for this dental bone graft procedure, also eliminating the need to undergo surgery for bone extraction.
Periodontal Plastic Surgery
Encompassing a number of procedures, periodontal plastic surgery enhances personal appearance and improves the function and health of periodontal tissues. These surgical treatments involve reshaping gum tissues and improving tooth-to-gum ratios, preserving tooth structure by providing necessary gum tissue coverage, enabling the placement of restorations, rebuilding bone structure to support facial structures and enhancing overall smile esthetics. Procedures falling into this category of treatment include:
- Crown Lengthening (Functional and Esthetic)
- Gum Grafting Procedures
- Chao Pinhole® Surgical Technique
- Ridge Augmentation/Ridge Preservation
- Periodontal plastic surgery solutions not only enhance the look of the smile, but also work to improve the relationship between the teeth, gums and bone and vitality of these structures
Crown Lengthening
When the tooth-to-gum ratio is unbalanced, crown lengthening can be performed to restore visual or functional harmony to the affected area(s). The procedure involves removing gum (and sometimes bone) tissue to improve the look and health of the mouth. Two forms of crown lengthening are commonly performed, each of which address a different oral concern:
Functional crown lengthening removes gum and bone tissue that hinders the process of placing a tooth restoration. For instance, if deep decay is detected on a tooth and inadequate tooth structure is available above the gum line to properly restore the tooth with a crown or filling, functional crown lengthening can be performed. The procedure increases the exposed surface area of the tooth, providing the necessary tooth structure a restorative dentist needs to place a crown, filling or other restoration.
Esthetic crown lengthening is a procedure for removing excess gum tissue on one or more teeth for the purposes of improving the look of the smile line and balancing the tooth-to-gum ratio. The procedure helps reduce the look of a “gummy smile,” making teeth appear longer and more proportioned. Crown lengthening procedures also help improve gum tissue health, particularly if periodontal pockets exist or excess gum tissue is present due to infection or medication-induced tissue overgrowth.
Gum Grafting
The process of restoring or adding lost tissue to existing areas is known as gum grafting. Gum recession can result from a number of factors, but occurs when the gum tissue recedes down the length of the tooth roots. Root exposure can present a number of problems, such as tooth sensitivity, damage and decay, and therefore requires treatment to prevent these oral complications. Gum grafting is often performed in one of three ways:
Connective Tissue Grafting: Gum tissue is sourced from the patient’s hard palate (roof of the mouth) by creating a flap and removing connective tissue from beneath the top layer. The tissue sample is sutured in place around the tooth in need and allowed to heal.
Free Gingival Grafting: Also sourced from the hard palate, gum tissue is taken directly from the top layer of tissue and sutured to the area in need.
Pedicle Grafting: When sufficient tissue exists in an area very near to the tooth in question, a flap of gum tissue can be created and stretched over the exposed root surface for proper coverage. The flap is sutured to allow for proper integration with existing tissue.
Treating areas of gum recession with gum grafting procedures is an important component of improving periodontal health and preserving fragile root surfaces.
Chao Pinhole® Surgical Technique
Developed by Dr. John Chao, DDS, the Chao Pinhole® Surgical Technique (PST™) offers a minimally invasive approach to treating gum recession. Performed with patented, specialized tools, PST™ gently restores receded gum tissues to healthier levels in minimal time. The procedure takes place through a small, pinhole sized opening in the gum tissue that surrounds the tooth or teeth requiring treatment. Through this entry point, gum tissue is gently repositioned to a more favorable level on the tooth surface and held in place with small strips of collagen. Consider the following benefits of this revolutionary periodontal procedure:
- Minimally invasive, requiring only a small entry point
- Sutures are not necessary
- Very little bleeding or post-operative inflammation
- Numerous sites can be treated in one appointment
- Minimal recovery time and discomfort
- Esthetic results are immediate
PST™ enables dentists to improve periodontal health and tooth preservation by returning gum levels to their natural positions.