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Periodontal Procedures

• Non-Surgical Treatments

• Periodontal (Osseous) Surgery

• Treatment of Gum Recession

• Crown Lengthening

• Cosmetic Periodontal Procedures

• AlloDerm® Gum Grafts

• Lost Tooth Attachment

• Post-surgical Instructions

Non-Surgical Treatments
Periodontal health should be achieved in the least invasive and most cost-effective manner. 

This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins). Sometimes, there is also a need for adjunctive therapy, such as local delivery antimicrobials and host modulation. This is determined on a case-by-case basis.

Dr. Forrest and most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

Periodontal (Osseous) Surgery

If you're diagnosed with periodontal disease, Dr. Forrest may recommend periodontal surgery. Periodontal surgery is necessary when Dr. Forrest determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. The two types of surgical treatments most commonly prescribed are Pocket Reduction Procedures and Regenerative Procedures.

In advanced cases of periodontal disease, the first line of treatment, scaling and root planing, combined with excellent home care to keep new bacterial deposits from forming, is sometimes not enough to bring the disease under control. In some cases, periodontal surgery is necessary.

When is periodontal surgery necessary? 
Surgery is only rarely needed to control periodontal disease, a disease that affects almost everyone. Most people can keep their teeth and gums healthy by careful daily removal of the bacterial film which causes the disease, in combination with periodic visits to a dentist or dental hygienist for the removal of bacterial deposits below the gum line. However, when there is periodontal disease, and the gum has unzipped so far down the root of the tooth that dental instruments are no longer effective (about 5-6 millimeters), periodontal surgery may be necessary. If not done, the bacterial deposits will remain on the tooth and cause further bone destruction; ultimately causing the teeth to develop painful abscesses or simply to loosen and fall out.

What exactly is periodontal surgery? 
It is a minor surgical procedure generally done in the dental office with a local anesthetic. It involves folding the gum back away from the tooth just enough so that a Periodontist, a dentist specializing in the treatment of gum diseases, can see the tooth root surfaces. Once they are seen, the deep bacterial deposits crusted on the tooth can be removed. In this way, the root surfaces can be made once again acceptable to the body, and the gum can reattach, at least to a degree. Surgical access also makes it possible to graft bone into defects to repair some of the damage. After root preparation, the gum is closed back with sutures and a dressing is often placed to keep the area undisturbed, especially for the first week.

Is periodontal surgery a cure for periodontal disease? 
No, it is not. The bacteria which cause the disease are normally in the mouth, and continually form on the teeth as a thin film, requiring meticulous personal removal on a daily basis. Periodontal surgery can achieve a complete cleansing of deeply hidden bacterial deposits at a point in time. If the bacteria are kept off of the teeth long enough afterward for re-attachment and healing to occur, then a healthy and maintainable periodontal attachment can be achieved, and the teeth can be saved. However, if the bacterial film is allowed to build up during the healing period when the gum is actually less resistant to the destructive effects of bacteria, the result may be less than desired. Many people have undergone periodontal surgery to little avail when bacterial deposits have been allowed to quickly accumulate afterward, and consequently further extensive treatment has been necessary. To prevent a poor result, Periodontists are extremely choosy as to which patients receive periodontal surgery. Excellent home care is a strict requirement, and numerous postoperative visits are insisted upon to ensure frequent and complete removal of bacteria.

How much will it hurt? 
Of course, some soreness is normal the first day or so after periodontal surgery. Many persons, however, have very little discomfort. A more common complaint afterward is sensitivity to hot or cold liquids. This is caused by exposure of more of the tooth root surface, and may last for a short period of time.

Finally, what else do I need to know about periodontal surgery? 
Depending on exactly what types of defects or problems are present, many techniques may be used. These may include grafting of gum tissue and bone if needed, the correction of gum contours to improve their appearance and the ability to be cleaned more easily, the placement of dental implants, and the use of recent techniques for guided tissue regeneration. By the appropriate use of these of surgical procedures, as well as proper use of antibiotics, antiseptics, and anti-inflammatory agents, much can be done to control periodontal disease and save teeth from otherwise certain loss.

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Treatment of Gum Recession
Exposed tooth roots are the result of gum recession. There are many causes of gum recession including periodontal disease, aggressive brushing, anatomic susceptibility, and tooth position. If recession progresses without treatment, it can lead to esthetic compromises, tooth sensitivity, tooth decay on roots, or even tooth loss. Recession does not always need to be treated. Therefore, it is important that an examination be completed to identify the potential risks for future progression. Soft tissue grafting is the most common treatment for recession. During this procedure, Dr. Forrest will move healthy gum tissue from the roof of the mouth (palate), and restore the tissue in the area of recession.

For more information about gum grafting, click on the link below to view a video from the American Dental Association.

ADA Video ADA Video on Gum Grafting

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This procedure remodels the contour of the gum tissue and surrounding bone around one or more teeth providing the exposure of previously covered healthy tooth structure. Crown lengthening is often used as part of a treatment plan for a crown needing more tooth structure. This provides the necessary space between the crown margin on the tooth and the bone level, thus preventing damage to the gum tissue.

Crown lengthening is also recommended for making certain restorative procedures possible. If part of a tooth is broken down below the gum line, whether due to fracture or decay, a crown lengthening procedure adjusts the level of the gum and bone around the tooth or teeth involved, thus providing for more tooth structure and allowing for the final crown restoration to be constructed.

The restorative dentist should wait about 8 weeks following crown lengthening before taking final impressions. This ensures that the gum, which shrinks slightly as it reattaches to the tooth during healing, is in its final healed position.

The benefits of crown lengthening are important for the overall strength of the final crown, and provide for better health, comfort, and function. With periodontal gum health, one will be able to smile, eat, and speak with comfort and confidence.

In addition to procedures to treat periodontal disease, Dr. Forrest also performs cosmetic procedures to enhance your smile. Cosmetic Periodontal Procedures include: Esthetic Crown Lengthening, Soft Tissue Grafts, Gum Reshaping, and Ridge Augmentation.

Before

After

Periodontal procedures are available to lay the groundwork for restorative and cosmetic dentistry, and/or to improve the esthetics of your gum line. You may ask Dr. Forrest about procedures to improve a "gummy" smile because your teeth appear short. Your teeth may actually be the proper length, but they're covered with too much gum tissue. To correct this, "esthetic" crown lengthening is performed. During this procedure, excess gum and bone tissue are reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.

Soft Tissue Grafts are available to stop further gum recession, and/or to improve the esthetics of your gum line. Exposed tooth roots are the result of gum recession. Perhaps you wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or, you may not be bothered by the appearance of these areas, but you cringe because the exposed roots are sensitive to hot or cold foods and liquids. Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. Once these contributing factors are controlled, a soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss.

Sometimes when you lose one or more teeth, you can get an indentation in your gums and jawbone where the tooth used to be. This happens because the jawbone recedes when it no longer is holding a tooth in place. Not only is this indentation unnatural looking, it also causes the replacement tooth to look too long compared to the adjacent teeth. Dr. Forrest can fill in this "defect" with a procedure called ridge augmentation, recapturing the natural contour of your gums and jaw. A new tooth can then be created that is natural looking, easy-to-clean, and attractive.

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AlloDerm® Gum Grafts

Healthy gum tissue protects your teeth from disease and helps produce a great smile. However, when you experience gum tissue loss around your teeth, it can be the beginning of serious oral health problems. Fortunately, Dr. Forrest can perform a predictable procedure for reversing this tissue loss. In the past, this procedure has required that a piece of tissue be harvested from the roof of the mouth to serve as the graft material. Unfortunately, not everyone has enough tissue available, or wants to have tissue taken from this sensitive area.

Now however, you have a choice. AlloDerm is a dermal matrix that allows Dr. Forrest to give you the tissue graft you need, without the limitations associated with harvesting the graft material from somewhere else in your mouth. AlloDerm provides the missing components needed to restore health to damaged or receding tissue. It leads to fast healing with no second surgical site, and delivers great cosmetic results. Thousands of doctors and patients have made it their choice too.

AlloDerm Regenerative Tissue Matrix is processed from donated human tissue that must pass the same stringent screening criteria as any other implantable tissue or organ (heart, lungs & kidneys, etc.).

How safe is AlloDerm®?
Besides its use in dental applications, AlloDerm has been used extensively in Burn Reconstruction and Plastic Reconstructive Surgery. In its history of over 10 years and 500,000 procedures, there has never been a reported case of viral disease transmission from AlloDerm tissue.

How does AlloDerm® work?
AlloDerm provides the collagen structure and proteins that help your body's own tissue grow and remodel. The collagen serves as a scaffold into which your cells can grow. The proteins act as recruiters, drawing your cells into the graft, and telling them how to remodel it. As the body's natural processes take over, your own cells move into the AlloDerm. Over time, your cells transform the AlloDerm into your own healthy gum tissue. You should experience significant healing within the first week. Complete healing may take 2 to 6 months depending on the type of surgery. Once recovery is complete, you won't be able to tell the AlloDerm was ever there!

You have the freedom of choice: to use tissue harvested from another part of your mouth, or to use AlloDerm.

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Re-establish lost tooth attachment with Emdogain^®

Emdogain^® is a scientifically well-documented product that has been used in over 400,000 patients worldwide.  Emdogain^® allows your body to rebuild the natural attachment that is required to support your teeth.  

A natural tooth attachment consists of three basic elements:

• Root surface

• Tiny fiber bundles connecting the root surface and jawbone

• The jawbone itself

Emdogain^® is unique because it utilizes a matrix protein, to reestablish new tooth attachment previously lost due to moderate severe periodontitis.  It promotes the reformation of tooth attachment (root surface, fiber bundles and bone) starting immediately and continuing for an extended period of time - in some cases more than a year.  During this time, you can help to ensure a positive and long lasting result by visiting our office  regularly and by carefully following Dr. Forrest's recommendations.

Illustrations and text courtesy of Straumann^®.

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