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. Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.
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.
Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is obtained from a tissue bank. Special membranes may be utilized that dissolve under the gum, protect the bone graft, and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.
If you are unhappy with the appearance of short unsightly teeth this can be greatly improved by a combination of periodontal procedures and cosmetic dentistry. Although your 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, crown lengthening.
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, your gum line, and to create a beautiful smile. Crown lengthening (or crown exposure) is required when your tooth needs to be restored and the edge of that restoration would be too far below the gum to be healthy for the gum or supporting bone. The procedure involves adjusting the levels of the gum tissue and bone around the tooth to create a new gum-to-tooth relationship. This allows us to place the edge of the restoration above where the gum attaches to the tooth. It should also provide enough tooth structure so the new restoration will not come loose in the future. This also helps to prevent decay and gum disease by allowing you to clean the edge of the restoration when you brush and floss. The procedure takes approximately one hour. Usually permanent restoration of the tooth is completed 45-60 days after the procedure so the position of the gum has time to heal and stabilize.
Gum (Gingival) Grafting
These procedures are a predictable way to cover unsightly, sensitive or exposed root surfaces and to prevent future gum recession. When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. With minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession reaches the mucosa, the first line of defense against bacterial penetration is lost. When gum recession is a problem, gum reconstruction using grafting techniques is an option.
In addition, gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance to the gum and tooth. 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. The gingival graft results in a stable healthy band of attached tissue around the tooth.
A gingivectomy is a relatively minor type of periodontal surgery that involves the removal of a small amount of gum tissue around a tooth or several teeth.A gingivectomy might be necessary to remove diseased tissue, allow a filling or crown to be placed below the gum line, or to improve esthetics.
If your gum disease cannot be cured with antibiotics, or root planing and scaling; a gingivectomy removes and reshapes loose, diseased gum tissue to get rid of pockets between the teeth and gums. A gingivectomy is necessary when the gums have pulled away from the teeth, creating deep pockets. The pockets make it hard to clean away plaque. A gingivectomy is usually done before gum disease has damaged the bone supporting your teeth.