Surgical Services

Crown Lengthening

When decay occurs, or if a tooth fractures below the gumline, crown lengthening may be needed. With this procedure, more of the tooth structure is exposed from under the gum. Both the gum and surrounding tissues are reshaped. This will allow your restorative dentist adequate room to place a quality final restoration.

Before Treatment
Crown Lengthening to save a fractured tooth
After Treatment Final Restoration placed in a healthy environment.

Pocket Depth Reduction

Surgical treatment is used for advanced infections and for pockets too deep to reach by scaling and root planing alone. The gum is gently separated from the tooth, creating a "flap" and access to the infected pocket. Deep deposits of plaque and tartar can then be removed. It also reduces the pocket and the areas where bacteria can grow. To achieve this goal, the gumline often must be lowered. This exposes more tooth.

Tartar forms in a deep pocket where scaling and planing can't reach. During surgery, the gum is lifted to allow removal of tartar and diseased tissue.

New gumline may be lower, which reduces the pocket and makes cleaning easier. New gumline may be at or near the original gumline to expose less of the tooth.

Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence.

Bone (Osseous) Surgery

More extensive surgery is needed when periodontal disease has advanced to the point where supportive tissue has been destroyed. These procedures reshape or actually restore lost bone and ligaments, increasing the chance of saving teeth that otherwise would have been lost. Sometimes, more than one type of procedure is performed on the same tooth. These techniques usually require the use of flap surgery to gain access to diseased tissue.

This procedure is used to smooth shallow craters in the bone due to mild or moderate bone loss. First, flap surgery is done to reach the damaged bone. Then Dr. Farber reshapes the bone around the tooth to decrease the craters. This makes it harder for bacteria to collect and grow.

Supportive bone around the root is diseased and partially destroyed. 1. First, plaque and tarter are removed from the infected pocket.

2. The bone is smoothed and reshaped, reducing spaces where bacteria can grow. A substance may be used to help the gum attach to the tooth. 3. The gum is then closed over reshaped bone at or below the original gumline.

Traditionally, gum disease is treated by eliminating the gum pockets by trimming away the infected gum tissue and by re-contouring the uneven bone tissue. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are used routinely today.

This surgical procedure "regenerates" the previously lost gum and bone tissue. Most techniques utilize membranes, which are inserted over the bone defects. Some of these membranes are bio-absorbable and some require removal. Other regenerative procedures involve the use of bioactive bone grafts and tissue-stimulating proteins.

Guided Tissue Regeneration

Periodontal science has developed new technologies that provide confidence and predictability in the restoration of the diseased periodontium or residual ridge. These advancements enable a patient to retain a healthy, stable periodontium or develop a permanent implant supported restoration, returning teeth to natural optimum function.

Therapies exist today which can help to save many of these previously hopeless teeth, through the regeneration of damaged bone and attachment apparatus, thus providing stability and significantly lengthening the lives of the teeth. Following reflection of the gum and all bacteria and bacterial plaque from the pockets, the root surface, and the bony defects, simple replacement of the gum flaps will allow the epithelial cells which cover the gum to grow down to the root, prevent any new bone attachment growth, and lead to redevelopment of the periodontal pockets and the further progression of the periodontal disease problem. However, if a membrane is placed over the bone and against the root surface prior to the replacement of the gum, the epithelial cells are not able to grow down the root surface.

By excluding these cells, the cells from the ligament between the bone and the root have a chance to grow up into the bone defect and along the root surface. The end result is the regeneration of the lost attachment, the rebuilding of damaged bone, the elimination of the periodontal pocket and the stabilization of the previously effected tooth. Various membranes are now available depending upon the specific clinical situation. Bone grafts or "synthetic calcium materials" may be placed underneath the membrane to provide minerals and help hasten regeneration of the lost bone. Other regenerative procedures involve the use of tissue-stimulating proteins, i.e. Emdogain. This procedure is called Guided Tissue Regeneration because it excludes certain cells from the healing site and "guides" other cells into the area.

Guided Tissue Regeneration, when performed in the appropriate situation, is highly predictable. The procedure itself is accomplished utilizing only "Novocaine", postoperative discomfort should be minimal, and the benefits are many.

Guided Bone Regeneration

Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, most patients are not candidates for placement of dental implants.

We now have the ability to grow bone where needed. This gives us the opportunity to place implants of proper length and width, and it also gives us a chance to more effectively restore aesthetic appearance and functionality.

Bone grafting is a surgical procedure that replaces missing bone with a material called a bone graft. This material not only replaces missing bone, but also helps your body regrow lost bone. This new bone growth strengthens the grafted area by forming a bridge between your existing bone and the graft. Over time the newly formed bone will replace much of the grafted material. GBR is a procedure in which a membrane further encourages new bone to grow and also prevents the growth of scar tissue into the grafted site.

Emdogain

Emdogain is an enamel martrix protein that mimics the processes which occur in normal tooth development. The enamel-related proteins mediate the formation of accellular cementum on the root of the developing tooth, providing a foundation for all the necessary tissues associated with a functional periodontal attachment. Therefore, Emdogain helps to re-create lost support in periodontal defects.

Learn more about Emdogain

Ridge Preservation and Enhancement/ Implant Site Development

Careful management of extraction sockets after tooth extraction prevents unsightly bone loss and a better cosmetic outcome of tooth replacement..

At the time the tooth is extracted, the area is filled with one of a number of reabsorbable "calcium materials", and the area is covered with a membrane barrier.

The barrier prevents the gum tissue from growing into the extraction area, and protects the underlying calcium materials and the forming bone.

The calcium materials encourage your own bone to grow into the area, and these materials are totally reabsorbed and eliminated by the body.

This treatment will often result in the complete regeneration of the lost bone in the area of the tooth extraction.

Regenerating damaged and lost bone at the time of extraction of the tooth provides the following advantages:

The bone between the extracted tooth and the adjacent tooth is preserved or regenerated. The health of the adjacent tooth is thus improved.
A ridge deformity does not develop, and the appearance of the ridge is more natural. The esthetics of the area is preserved or improved.
The regenerated bone allows placement of an implant to replace the missing tooth.

Careful management of extraction sockets after tooth extraction prevents unsightly bone loss and a better cosmetic outcome of tooth replacement.

Root Coverage Procedures (Gum Grafting Procedures)

Gum Grafting Procedures (Soft Tissue Grafts)

When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. When gum recession is a problem gum reconstruction using grafting techniques is an option.

Gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance to the gum and tooth. Also, gum recession, when significant, can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root caries and root gouging.

A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth, or gently moved over from adjacent areas, to provide a stable band of attached gingiva around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root.

This can be done for one tooth or several teeth. The procedure will repair the defect and help to prevent additional recession and bone loss.

A gingival graft procedure is highly predictable. The end result is a healthy band of attached gum tissue which reseals and protects the tooth and underlying bone.