Guided Bone Regeneration
When healthy, your bone and gum tissue should fit snugly around your teeth. Untreated periodontal disease will destroy these supporting tissues causing the development of deep pockets around the teeth. Your periodontist may recommend a bone graft to replace some of the lost support allowing the teeth to be retained. After the patient has been numbed, the gums are folded back to visualize the extent of the damage and clean the root and bone defect. Once the area is adequately cleaned, bone grafting material is placed into the bone defect. In some instances, a guided tissue membrane may be placed over the bone to seal in the graft and prevent the gum tissue from growing into the defect. The gum tissues are then secured over the membrane with stitches. In most cases, after 5 to 6 months, the bone will have regrown and the pocket will have been reduced to a cleanable depth.
Teeth may need to be removed for a variety of reasons, usually because of gum disease and cavities. Other reasons may include fractures or resorption. We use local anesthesia to numb the area and extract, or remove, the tooth or teeth. We may also place a bone graft and membrane at the time of your extraction in preparation for implant placement. Extraction sites will heal for about three to four months prior to implant placement. In specific cases, we may decide to place an immediate implant at the same appointment as your extraction. We prefer that most cases heal first after bone grafting and recommend implants to be placed after that healing has completed.
When patients desire implants to replace their top teeth, they may have a lack of bone height due to the sinus. Once teeth have been missing, the floor of the sinus cavity pneumatizes, or droops down, further than it previously did leaving insufficient bone for implants. Therefore, we must perform a sinus augmentation also known as a sinus lift to add bone in preparation for implants. Sinus lifts provide a lattice structure for your natural bone to grow over time. Sinus lifts may be localized or lateral and can range in healing from four months to nine months.
A localized sinus lift is a small bone graft that can be placed at the time of implant placement. It may only add an extra month or two of healing.
A lateral sinus lift involves a much larger bone graft in preparation for implants. Usually, we allow this to heal for about six months prior to implant placement. In certain cases, we may be able to perform this sinus lift at the same time as implant placement. The lateral sinus lift will normally have a moderate amount of swelling and bruising; however, each patient heals differently.
Cone Beam Computed Tomography (CBCT)
A CBCT is a three-dimensional x-ray or scan that allows us to see the height, width and length of your bone structure in preparation for bone grafts and/or implants. Our appointments are about 30 minutes, and we will call you with the results of the scan if we are unable to view the scan at your appointment. We will also inform you of any other findings we may see.
A ridge augmentation is, often times, a large bone graft that serves as a lattice structure to allow your natural bone growth. The bone grafts are used to replace missing bone from previous tooth loss in preparation for implant placement. We use a membrane to contain the graft and stretch your gum tissue over the area to protect the graft. The healing may include some swelling and bruising, and the time for healing ranges from six to nine months.
A frenum is a ligament/muscle attachment from your lip to your gums. It can also be present underneath your tongue. This attachment may cause irritation and even gum recession. We use a laser to remove the muscle attachment. Removing the frenum will not change the way you eat, smile, or speak. The tissue may change color initially, but it will eventually change back to the initial pink color.
Scaling and root planing
When plaque and calculus sit below your gum line, you may or may not notice it; however, your dentist may notice it at your routine visits. Scaling and root planing is also known as a deep cleaning. A deep cleaning involves numbing the sites that need to be cleaned below your gum tissue in hopes that this tissue will reattach, as long as the area is kept clean. We reassess your disease status after about four to six weeks to determine if you need additional periodontal therapy, which may include periodontal surgery.