We provide the full range of periodontal services with a particular emphasis on dental implants and implant related procedures. Below is a list of some of the services we can provide for you:
Dental implants are a fantastic means of replacing missing teeth. A dental implant is a titanium screw that is placed in the bone. The surrounding bone grows onto the titanium and it is incorporated into the bone. A crown, bridge or full-mouth prosthesis can be attached onto dental implants. We use Straumann and Nobel Biocare implant systems, two of the very highest quality implants that can be used. Both implant systems have a stellar long-term track record. The success rate of implants makes them one of the most predictable options for tooth replacement that can be offered. Whether you have a need to replace a single tooth, several teeth or all of your teeth, we provide a detailed treatment plan that is tailored to your needs. You will receive the highest quality treatment with the intent of a long-term solution. Expediting treatment will be performed whenever possible; however, in our office speed will never take precedence over quality of service.
For an implant to have longevity it needs to be placed in a site with adequate bone thickness, bone height and soft tissue thickness. It is also critical that it is placed in the proper location and at the proper angulation. Placing an implant in a site without these key components is a recipe for a short term solution with long-term complications.
A sinus lift procedure is sometimes required when an implant is being utilized to replace molars and occasionally premolars on the upper jaw. We all have sinuses (or air spaces) in our upper jaw. In some patients, this space is low enough that it gets in the way of implant placement. Fortunately, a sinus lift is a simple, predictable procedure to provide enough height for proper implant placement. A sinus lift is a procedure where the floor of the sinus is elevated with bone grafting in order to provide enough height for implant placement. There are different techniques that we use to perform this procedure depending on the amount of bone height you have. In the majority of patients a sinus lift is performed at the same time as implant placement. This procedure adds very little post-operative discomfort to the procedure.
Bone grafts for implants
Bone grafting is often utilized to prepare a site for implant placement. An implant cannot be a long-term solution unless it is placed in a site with bone completely surrounding it. Similarly, a wood screw placed on the edge of a board with the side of the screw perforating through the wood could not provide much strength or be expected to stay in place long. If there is not adequate width of the jaw bone in the site where the implant will be placed, a bone graft procedure can be performed to augment the thickness of bone for proper implant placement. Additionally, we often place bone grafts in extraction sockets when hopeless teeth are extracted and an implant is planned for the site. If thin bone is visualized on the side of the socket after the tooth is extracted, there is a high likelihood that the width of bone will collapse into the site where the tooth was, not leaving enough bone thickness for an implant. In these cases, a bone graft is placed in the socket to preserve with width of bone in preparation for an implant in the site.
We provide a large number of extractions and always maintain an emphasis on causing as little trauma to the surrounding bone and soft tissue as possible. This allows for better healing and better preserves the site for potential implant placement in the future. When an implant is planned in the site of extraction bone grafts are often utilized to preserve the width of bone. If the bone surrounding the socket where the tooth was is thin, the width of bone will often resorb and become too narrow to put an implant in the proper location.
Soft tissue grafts
Soft tissue grafting is the best way to fix recession of the gums. Recession can be a result of overzealous tooth brushing, the way in which your teeth make contact when they bite together or genetically thin gum tissue and bone triggered during orthodontic tooth movement. There are a variety of soft tissue types that can be used to cover the recession sites. This procedure can effectively cover the exposed tooth roots and thicken the tissue to prevent relapse. We commonly use this procedure to repair gum recession on single teeth or even large numbers of teeth.
A crown lengthening procedure is most commonly performed when there is inadequate tooth structure above the gum line for your dentist to place a crown. The margin of a crown needs to be placed further down than any fractures or existing fillings, otherwise the crown would only last as long as the filling. The crown your dentist will fabricate is intended to be a long-term restoration. In order to expose more of the tooth above the gum line, small amounts of gum tissue and bone are removed. If the bone is not removed the soft tissue will grow right back to where it was as it always grows to be a certain height above the bone. This provides adequate tooth structure above the gum line so that a high quality crown can be placed by your dentist.
Esthetic crown lengthening
This is a procedure that can dramatically improve the appearance of a “gummy smile”. When our teeth first erupt into the mouth as children, they continue to erupt until they make contact with the opposing teeth. At this point the downward movement of the teeth stops but the bone and gum tissue move upwards until the full length of the crown of the tooth is exposed. For some people, the bone and soft tissue never move up completely and they are left with a “gummy smile”. Too much gum tissue is observed and the full length of the tooth is hidden. This can be fixed by removing the redundant gum tissue and recontouring the bone to put it in the proper place. This procedure produces immediate and dramatic results.
Treatment of periodontitis
Periodontitis is an inflammatory disease of the gum tissue caused by bacterial plaque that results in a loss of the bone around teeth. The loss of bone can become so significant that it can result in a loss of the tooth. There are many different forms of periodontitis and the proper treatment depends on the diagnosis. Most commonly, treatment is commenced with a “deep cleaning” (scaling and root planing) and is often followed by procedures to either regenerate the lost bone or recontour the defects in the bone and gum tissue in order to create a cleansable environment.
Uncovering of impacted teeth
For some people, permanent teeth never erupt into the mouth, remaining impacted in the bone and gum tissue. These teeth can be surgically uncovered and moved into the proper location with orthodontics. The proper surgical repositioning of the soft tissue and bone around the uncovered tooth is key to maintaining proper soft tissue thickness after the tooth is moved in place.
All of our patients are given the option to have their procedure performed with local anesthesia alone or in conjunction with moderate I.V. sedation. Moderate I.V. sedation provides a way for patients to sleep during the entire procedure. Moderate sedation rarely gives patients the groggy and heavily sedated feeling after the procedure is completed. Most patients wake up after the procedure feeling like they had a nice nap.
The cone-beam CT is a great example of how a significant advance in technology can directly improve treatment for patients. A cone-beam CT gives 3D imaging of the jaws similar to a conventional CT but with less than 1/100th of the exposed radiation. A traditional CT has a resolution of 0.5 mm voxels (3D pixels) whereas our cone-beam has a resolution of 0.1 mm. This provides a much higher quality picture at a fraction of the radiation, all from a small machine that looks just like a traditional panoramic machine. A cone-beam CT is about 1/4th of the radiation of a full-mouth series of dental x-rays.
It is rapidly becoming the standard of care to have a cone-beam CT prior to implant treatment, especially in certain areas of the mouth. 3D imaging gives a precise measurement (to the tenth of a millimeter) of vital structures such a nerves, blood vessels and sinuses as well as displaying bone height and width for implant sites. Not every implant needs a cone-beam CT. It depends on the site and what anatomical structures are nearby. This takes the guess work out of implant treatment and greatly increases safety.