are a predictable way to cover unsightly, sensitive or exposed
root surfaces and to prevent future gum recession. If you are
unhappy with the appearance of short unsightly teeth this can
be greatly improved by a combination of periodontal procedures
by our doctors and cosmetic dentistry by your dentist.
teeth appear short, they may actually be the proper length. The
teeth may be covered with too much gum tissue. We can correct
this by performing the periodontal plastic surgery procedure,
During this procedure,
excess gum and bone tissue is reshaped to expose more of the natural
tooth. This can be done to more than one tooth, to even your gum
line, and to create a beautiful smile.
Another cosmetic procedure is the soft tissue graft. It is used
to cover unattractive tooth roots, reduce gum recession and protect
the roots from decay and eventual loss.
Tooth loss causes
the jawbone to recede and can lead to an unnatural looking indentation
in your gums and jaw, an appearance of a general aging. The original
look of your mouth may not be recaptured because of spaces remaining
under and between replacement teeth. They may appear too long
compared to nearby teeth.
Bone grafting following tooth loss can preserve the socket/ridge
and minimize gum and bone collapse. There is less shrinkage and
a more esthetic tooth replacement for either an implant crown
or fixed bridge around the replacement teeth.
All of us strive
to look and feel our very best. A critical part of our overall
appearance is our smile - it mirrors our personality, it is our
own unique calling card. Your dentist has the ability to offer
a wide range of services to enhance your teeth and beautify your
smile. As specialists in the treatment of the gums and supporting
bone, we support your dentist's efforts in ensuring the health
and stability of your teeth and smile.
Periodontal plastic surgery, or mucogingival surgery, involves
the management of gingival deficits and deformities that may be
preventing you from having the smile you always wanted. Among
- A "gummy"
- Uneven gum line
due to "short" teeth or receding gums ("long"
- Lost or "collapsed"
gums due to missing teeth
holes" between your teeth, crowns, bridges, or implants
- The exposure
of unerupted teeth
you be concerned?
Because the presence
of these conditions causes not only cosmetic concerns, such as
"long" teeth and "black holes" between teeth
and bridges, but also dental health concerns, like progressive
gingival (gum) irritation and/or bone loss, root surface sensitivity,
root caries, and in extreme cases, eventual tooth loss. Recent
advances in techniques and materials have resulted in significant
improvements in both comfort, predictability and esthetics.
Common Esthetic Problems
Below are just a few examples of some common esthetic problems
and how they were corrected. Please visit our Smile Gallery to
see even more satisfied patients!
Gummy Smile (Excessive Gingival
A gummy smile
can occur due to a number of reasons: a short upper lip, excessive
wear of the teeth due to grinding, vertical maxillary excess (a
long upper jawbone), and/or altered passive eruption.
Regardless of the cause, you do not have to live with a gummy
smile. Let us work together with your dentist to determine the
underlying cause and the proper treatment plan.
When the gums recede, the teeth appear much "longer"
than normal. Besides the fact that this does not look good, recession
exposes the sensitive root surface which can make it difficult
to enjoy hot or cold foods and drinks. Also, the exposed root
surface is much more susceptible to plaque accumulation and root
caries. In advanced cases, teeth can become loose because as the
gum recedes, so does the supporting bone.
In many cases, this situation can be corrected by transplanting
a small piece of gum tissue to cover the exposed root and thereby
correct the appearance of "long" teeth.
Probably the single
most challenging problem in Periodontal Plastic Surgery is the
reconstruction of the delicate tissue between the teeth, called
the interdental papilla. No one ever thinks about this small section
of the gums until it is lost, resulting in the presence of black
holes or black triangles between the teeth.
Important advances have been made in the reconstruction of lost
papillae but it is still the toughest task your dental team can
face, often requiring the expertise of a dentist, periodontist,
and/or orthodontist, among others.
Osseous Surgery is a type of periodontal (gum) surgery that involves
the removal and/or reshaping of the jawbone under the gum. The
phrase 'gum disease' is not a technically accurate description
because most of the damage occurs not in the gum but in the underlying
bone; osseous means bone. Our Periodontist performs this procedure.
A simple analogy
with carpeting may be used to describe the process of osseous
surgery; the overlying gum is the carpet and the underlying soft
matting is the bone. Bone is frequently irregularly destroyed
by the infection associated with gum disease. This irregular bone
will, like a bump in the soft matting under a carpet, prevent
the gum, or carpet, from laying down flat. Reshaping the bone
with osseous surgery by our Periodontist will allow the gum to
lay down flat in the areas between the teeth.
Osseous Surgery is designed to modify and reshape deformitis in
the alveolar bone surrounding the teeth. It is a common requirement
in effective treatment of more involved periodontal diseases.
In some instances, the bony support of the tooth assumes an unusual
configuration as a result of uneven progression of the disease.
When this occurs, modification of the altered bone support may
You Need Periodontal (Osseous) Surgery?
procedure is used by the Periodontist to smooth/correct defects
and irregularities in the bone surrounding the diseased teeth
with the ultimate goal of reducing or eliminating the periodontal
pockets. Of course the areas to be treated are anesthetized with
local anesthesia (Lidocaine or "Novocaine". Donít let
the word "surgery" scare you. Except in the most complex
cases, it feels like a thorough cleaning. If you must worry about
something, you can worry about possible post-surgical discomfort;
I must say though I give less pain medication now than I ever
have- perhaps itís the experience!
The average surgical
procedure takes about 1 hour, including the time to get numb.
We use an average of 3 anesthetic cartridges per quadrant. We
use a combination of two types of local anesthetic: 1. Carbocaine
and 2.Xylocaine with epinephrine; the "epi" is used
to control bleeding and to make the anesthetic last longer. If
you have problems getting numb, please tell Dr. Mao at the beginning
of the procedure, as Dr. Mao can usually give it in a different
location to make it work better and perhaps faster. Also, some
patients have problems staying numb; in these cases Dr. Mao must
start the procedure immediately after the "shot" before
it wears off. We aim to please!
What do we do exactly during surgery?
1. First, after
getting the area "numb" we FLAP the gum back so that
we can visualize the amount and type of bone loss. We can also
visualize tartar that may be attached to the roots.
2. We then remove
the tartar and clean out what we call granulation tissue from
the bone defects or craters. This granulation tissue is basically
infected/inflamed gum tissue that creeps into the craters and
defects as the bone resorbs or disappears.
3. Next, we use
hand instruments or a special diamond bur on a high speed handpiece
to smooth and recontour the bone so that the craters are reduced
or eliminated. Itís difficult to explain, but by doing this, the
pockets will be reduced or eliminated.
4. At this time,
in some cases where the craters or "holes" in the bone
are too deep we will then use a bone graft to fill them in. As
advances in periodontology have been made, additionally we now
use a special membrane (Guided Tissue Regeneration procedure)
to cover over the bone graft so that the gum does not grow down
into the crater and "sabotage" the bone regeneration
There are 2 types
of membranes currently being used:
5. After the bone
is reshaped or augmented (bone graft), we then replace the original
gum flap back over the bone and place sutures (stitches). The
stitches are usually nylon and must be removed in about one week.
Sometimes, however, if you canít get back here within a week we
place a different type of suture that wonít irritate or attach
to your gums; it must still be removed, but
you can wait as long as a month.
6. Lastly, we
then place a putty-like packing over the area. Unlike many patients
think, it is NOT important for healing. It is placed merely so
that you donít have to worry about getting food stuck in between
7. Post-Op instructions
are then give to you to teach you how to take care of the area
so that as little discomfort will take place as possible. Often
a prescription is given for any discomfort.