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Common Procedures

Bone Grafting

Bone grafting is a surgical procedure that is necessary when a horizontal and/or vertical bone deficiency is present. The bone used for grafting can be either from the patient’s own body, from a human donor, of bovine origin or synthetic granules. This procedure is often required with implant therapy or during periodontal regenerative therapy.

Scaling and Root Planning

Scaling and Root Planing (SRP) is a careful cleaning of the root surfaces to remove plaque and calculus from deep pockets and to smooth the tooth root to remove bacterial toxins. This cleaning is more in-depth than a routine prophylaxis, or polish, with which you may be familiar. For comfort, local anesthesia could be used to numb the area prior to treatment. Research has consistently demonstrated that SRP reduces gingival inflammation and probing depths, and shifts the bacteria composition living in these pockets from one associated with disease toward one associated with health. Thus, SRP is usually the first mode of treatment recommended for most patients. Most periodontists agree that after SRP and oral hygiene instruction, many patients do not require any further treatment, including surgical therapy.

Sinus Augmentation

The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implant due to insufficient bone quality and quality and the close proximity to the sinus. If you’ve lost bone in that area due to reasons such as periodontal disease or tooth loss, you may be left without enough bone to place implants.

Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the placement of dental implants. Several techniques can be used to raise the sinus and allow for new bone to form. In one common technique, an incision is made to expose the bone. Then a small circle is cut into the bone. This bony piece is lifted into the sinus cavity, much like a trap door, and the space underneath is filled with bone graft material. Dr. Fisher can explain your options for graft material, which can regenerate lost bone and tissue.

Finally, the incision is closed and healing is allowed to take place. Depending on your individual needs, the bone usually will be allowed to develop for about four to nine months before implants can be placed. After the implants are placed, an additional two- to three-month healing period is required. In some cases, the implant can be placed at the same time the sinus is augmented.

Soft Tissue Grafting

Soft tissue grafting is a procedure used to either increase the thickness of an edentulous ridge or in most cases, to cover denuded roots. The soft tissue is usually taken from a donor site (palate) and then transferred to the recipient site (root surface). The main objectives are prevention of further root exposure, eliminate or decrease root sensitivity and to improve gingival aesthetics.

Periodontal Dentistry

what are periodontal diseases?

The word periodontium indicates the investing and supporting tissues of the tooth (gingiva, periodontal ligament, cementum, and supporting bone). Periodontal diseases are bacterial gum infections that destroy the periodontium that hold your teeth in your mouth. Periodontal diseases can be localized or generalized.

The main cause of periodontal diseases is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. If the plaque is not removed, it can turn into a hard substance called calculus (tartar) in less than two days. Tartar is so hard it can only be removed by an oral health professional, such as a dentist or dental hygienist. The bacteria in plaque infect the gums, and release poisons that cause redness and inflammation (irritation). The inflammation and the poisons themselves cause destruction of the tissues that support the teeth, including the bone. When this happens, the gums separate microscopically from the teeth, forming pockets that fill with even more plaque causing even more infection.

periodontal diseases are multifactorial

This means that there is not just one cause of periodontal diseases but rather multiple factors that can affect the health of your gums.

GENETICS and family history of periodontal diseases indicate a greater likelihood of developing these diseases.

TOBACCO use significantly increases the risk of developing periodontal diseases and can negatively affect treatment.

HORMONAL CHANGES during pregnancy, puberty and menopause can cause the gums to become red, tender and bleed easily.

STRESS can make it more difficult for the body to fight off infection, including periodontal diseases.

Some MEDICATIONS such as oral contraceptives, antidepressants and certain heart medicine, can affect oral health.

DESTRUCTIVE HABITS such as improper oral hygiene technique, oral piercing, drug or alcohol abuse can affect periodontal health.

POOR NUTRITION can make it harder for the body to fight off infection.

SYSTEMIC DISEASES that interfere with the body’s immune system may worsen the condition of the gums and supporting bone.

are all the forms of periodontal diseases the same?

There are many types of periodontal diseases. The following is an overview of the most common:

GINGIVITIS: As the mildest form of the periodontal diseases, gingivitis causes the gums to become red, swollen, and bleed easily. There is usually no discomfort at this stage.

PERIODONTITIS: Periodontitis (chronic or aggressive) is a condition resulting in inflammation within the soft tissues surrounding the teeth causing progressive or aggressive attachment and bone loss. It is diagnosed by bone loss on a dental X-ray, the formation of gum pockets and/or receding gums. It is most common in adults, but can occur at any age.

what are the signs of periodontal diseases?

Periodontal diseases are often silent, meaning that symptoms may not materialize until significant bone loss has occurred. Some people may have periodontitis and not experience any symptoms and be unaware that they have the disease. Common symptoms and signs of periodontal diseases include:

  • RED, SWOLLEN OR TENDER GUMS
  • BLEEDING WHILE BRUSHING OR FLOSSING
  • GUMS PULLING AWAY FROM THE TEETH MAKING TEETH APPEAR LONGER
  • LOOSE OR SEPARATING TEETH
  • PUS BETWEEN THE GUM AND TOOTH
  • PERSISTENT BAD BREATH
  • A CHANGE IN THE WAY YOUR TEETH FIT TOGETHER WHEN YOU BITE

periodontal examination

A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of tissues surrounding the teeth. In addition, periodontists are experts in the placement and maintenance of dental implants.

Periodontal diseases, as well as a patient’s individual risk factors for the diseases, are often diagnosed through a comprehensive periodontal examination. During a periodontal examination, Dr. Fisher will gently place a small measuring instrument called a periodontal probe in the pocket between the teeth and gums to measure pocket depths and help make a diagnosis. Pockets > 3 mm are considered problematic. The deeper the probing depth, the more severe the periodontal disease will be. In addition to probing depth and other clinical measurements, X-rays may be taken to evaluate the health of the bone supporting the teeth.

how are periodontal diseases treated?

Once your periodontal health has been evaluated, Dr. Fisher will work with you to determine the best treatment options to control your disease and bring you back to health. Treatment can vary depending on how far the disease has progressed. If diagnose and treated in the early stages, simple non-surgical periodontal therapy (SRP) may be sufficient. If periodontitis has advanced to the point where the periodontal pockets are deep and significant amounts of bone are lost, surgical therapy may be necessary.

Once periodontitis has been controlled, patients will require ongoing periodontal maintenance procedures to sustain health. This ongoing phase of treatment will allow Dr. Fisher to assess your periodontal health and make sure that your infection stays under control or remains eliminated. During these re-evaluation appointments, your mouth will be examined, new calculus and plaque will be removed and, if necessary, your teeth will be polished and your bite will be checked. Periodontal diseases are chronic diseases, just like diabetes. Without careful, ongoing treatment, periodontal diseases can and often do recur.

scaling and root planing

Scaling and Root Planing (SRP) is a careful cleaning of the root surfaces to remove plaque and calculus from deep pockets and to smooth the tooth root to remove bacterial toxins. This cleaning is more in-depth than a routine prophylaxis, or polish, with which you may be familiar. For comfort, your periodontist may wish to numb the area prior to treatment. Research has consistently demonstrated that SRP reduces gingival inflammation and probing depths, and shifts the bacteria composition living in these pockets from one associated with disease toward one associated with health. Thus, SRP is usually the first mode of treatment recommended for most patients. Most periodontists agree that after SRP and oral hygiene instruction, many patients do not require any further treatment, including surgical therapy.

oral hygiene instructions

The first step toward periodontal health begins with oral hygiene. If you’ve been diagnosed with periodontal diseases, you may be more susceptible to the diseases. For this reason, you may need to keep your teeth cleaner than most people. Be sure to review your at-home oral hygiene routine – including toothbrushing and flossing techniques and the use of special hygiene aids – with your dental team. Good oral hygiene and professional cleanings can go a long way toward preventing certain forms of periodontal diseases, and reversing early stages of the diseases like gingivitis.

Dental Implants

What Are Dental Implants?

Dental implants are predictable surgically fixed substitutes for roots of missing teeth. These fixtures are embedded in the jawbone and act as anchors to support restorations that resemble a tooth (crown) or a group of teeth (bridge or dentures).

What Are The Advantages Of Implant Therapy?

A dental implant provides several advantages over other tooth replacement options. In addition to looking and functioning like a natural tooth, a dental implant replaces a tooth without sacrificing the health of neighboring teeth that would be grounded down to support a cemented bridge.

Dental implants will also permit to preserve the surrounding alveolar bone and limit further resorption that normally occurs over time in an edentulous site.

How Will The Implant Be Placed?

First, the implant, which looks like a screw, is placed into your jaw. Over the next two to six months of healing, the surrounding bone will attach to the implant surface providing the needed strength to support the future restoration. During this time, a temporary tooth replacement option can be worn over the implant site.

A second surgical procedure can be required to uncover the implant so a small extension called a healing abutment can be inserted. The gums will be allowed to heal for a couple of weeks following this procedure. In most situations, the healing abutment is placed at time of implant insertion. Dr. Fisher will advise you on which procedure is best for you.

Finally, a replacement tooth called a crown will be created for you by your dentist and fixated to the implant. All final restorations are completed by a third party. After a short time, you will experience restored confidence in your smile and your ability to chew and speak.