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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.
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.
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.
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
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
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.
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.
Gum Recession (Connective Tissue Grafts and Gingival Grafts)
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. There are two different types of soft tissue grafting procedures: Connective Tissue Grafts and Gingival Grafts. 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.
information about gum grafting, click on the link below to view a
video from the American Dental Association.
When a tooth requires restoration with a filling material or a
crown, the dentist must have adequate access to remaining tooth
structure. It is a common occurrence that the dentist will not
have adequate tooth structure to attach the restoration, and
preserve favorable gum tissue health. As a rule, simply trimming
back the gum is not sufficient, for the bone would be exposed.
Crown lengthening is a surgical procedure in which the
periodontist adjusts the gum and bone level to expose more of
the tooth, so it can be restored.
far under gum.
lifted to access decay.
and bone trimmed for access to decay and to allow room for
gum to reattach.
replaced with decay visible for dentist to restore with
filling or crown.
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.
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.
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.
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.
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.
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.
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 &
How safe is
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.
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.
Reestablish lost tooth attachment with GEM 21S®
GEM 21S® is a scientifically well-documented product that has been used to treat patients worldwide. It allows your body to rebuild the natural tooth attachment that is required to support your teeth.
A natural tooth
attachment consists of three basic elements:
Advanced periodontal disease with loss of tooth support resulting in the formation of a deep periodontal pocket.
Lost tooth support has been regained following treatment with GEM 21S®
GEM 21S® is unique because it utilizes a Growth-factor, to reestablish new tooth attachment previously lost due to moderate severe periodontitis. It promotes the reformation of tooth attachment 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.
GEM 21S® Growth-factor can promote more rapid healing of periodontal defects than other available therapies. Dr. Forrest will prepare the area to be treated by cleaning it out thoroughly, and then filling the space around the tooth with GEM 21S® where bone and other supporting structures have been lost.
Immediately, it begins signaling your body to actively begin to heal and regenerate healthy bone and tissue. It acts like a magnet, attracting the specific cells that your body needs to regenerate bone and the surrounding tissues, causing them to multiply in number. This increase in cellular activity results in a more rapid healing process. GEM 21S® Growth-factor Enhanced Matrix is gradually replaced with your own bone and other normal anatomic structures.
Completely unique and synthetic, GEM 21S® is an innovative highly purified growth factor (PDGF). It contains 1000 times more active growth factor (PDGF) than found in other bone growth materials.
Click here to view our post-surgical instructions.
Haga clic aquí para ver las instrucciones y cuidado post-operatorio en español.