The chronic infection that causes gum inflammation and bone loss can be successfully treated with osseous surgery. The procedure lasts approx. one hour per quadrant, and involves removal of infected tissues and re-contouring of bone to reduce cratering around affected teeth. This leads to healthy gums with shallower periodontal pockets, allowing removal of bacterial plaque using regular oral hygiene techniques at home.
When natural teeth are lost it is possible to replace them with titanium posts that are surgically placed in the jaw bone. Once healing is complete, and the posts are integrated in the jaw bone, restorations such as fixed crowns or removable dentures can be placed
The picture above shows four dental implants fitted with abutments designed to support a removable denture.
An upper denture that is supported by dental implants doesn’t need to cover the palate, as a typical denture would. The four round inserts are anchors that snap on and off the supporting dental implants.
SINUS LIFT BONE GRAFTING
This procedure is necessary when dental implants are placed in upper molar and premolar areas of the mouth, and there is insufficient bone between the floor of the maxillary sinus and the alveolar crest.
The floor of the sinus is raised, and sometimes bone grafting material is placed under the lining of the sinus to create additional supporting bone for a dental implant.
This surgery is performed when there is excess gum tissue, and there are no bone defects that need to be repaired. The shape of the gum tissue is changed to a normal level, improving access for removal of bacterial plaque.
CROWN LENGTHENING SURGERY – RESTORATIVE
Crown restorations are placed on teeth so they are supported by solid tooth structure for good retention, and to cover all the other restorative materials used in the reconstruction of the tooth. To avoid placement of a crown with the margin too close to, or even touching the jaw bone, a space is created between the edge of the crown and the bone level by surgically removing a small amount of bone around the tooth. This space allows the gum tissue to adhere to the root of the tooth, forming a seal that stops bacteria from using the new crown as a pathway to infect the jaw bone.
CROWN LENGTHENING SURGERY – AESTHETIC
Sometimes healthy teeth have crowns that are partly covered by gum tissue, making them appear too short. Following local anesthesia the gum can be sculpted to an ideal level. However, if bone covers part or the crown of a tooth, aesthetic crown lengthening surgeries also involve removal of this bone, exposing more of the tooth crown.
CONNECTIVE TISSUE GRAFT
The connective tissue graft surgery involves removal of a small amount of fibrous (connective) tissue from the roof of the mouth, and placement of this graft in a pocket created by an incision made at the site of recession. The graft is then sutured in place, and following healing the gum tissue in this area becomes more fibrous, thicker and healthier, preventing further recession.
When bone is lost due to tooth extraction or periodontal disease in certain situations it is possible to regenerate the lost bone by placing specially designed granules or powders at the bone loss sites. These bone grafting materials can be artificially formulated or are particles that are of human or animal provenience, and are dissolvable to allow the patients’ own bone cells to make bone in the grafted areas. Most bone grafting procedures done in our office use artificial materials that contain the same minerals that are found in bone, such as calcium, phosphate, silica.
SAVING FAILING DENTAL IMPLANTS
Bone loss around dental implants is more problematic than bone loss around teeth, since the exposed threads are a trap for bacterial plaque. This causes further bone loss and more threads to be exposed, ultimately leading to the loss of the dental implant. Dental implant threads are impossible to clean not only because of their shape, but also because the surface of most dental implants is treated by particle blasting and acid etching, making it rough so that bone making cells ( osteoblasts ) can adhere to this modified surface.
Unfortunately, once this rough surface is exposed above the bone level, bacteria also adheres to the surface of dental implants in a way that makes it impossible to remove. Even when the bacteria is killed by antibiotics the endotoxin in the bacterial wall triggers an inflammatory process and bone loss. Therefore, the only predictable treatment is to surgically treat bone loss around dental implants by removing the contaminated surface area of dental implants , including removal of threads, when necessary. Grafting the bone craters that have formed during the bone loss process is also necessary in most cases.
The goal of treatment is the creation of a cleanable environment around dental implants that prevents inflammation and further bone loss. In addition to the initial treatment all patients are given special home care instructions and are seen periodically in our office for follow-up and maintenance dental cleanings.
Dental implants are a significant investment both financial and time in a dental chair, so their maintenance is just as important as the initial treatment. Regular maintenance cleanings in an office that is familiar with dental implants can prevent the need for expensive treatments in the future. Our doctor has experience with placement of many dental implant systems since 1998, and we’d be glad to see you when you need help with your dental implants.
BIOPSY OF SOFT AND HARD TISSUE Abnormal looking oral tissue is examined, monitored, and, if necessary, biopsied to help with diagnosis and treatment of the lesion, or to rule out the presence of malignancy. Most biopsy procedures are done under local anesthesia, and require removal of a very small sample of tissue which is preserved and sent to a pathology laboratory. The sample is processed and analyzed under the microscope by a doctor who specializes in Oral and Maxillofacial Pathology. A report with a diagnosis is sent to our office within a few days.