Osseous Surgery
Osseous surgery is a type of surgery that involves reshaping of the jawbone under the gum. Most of the damage associated with periodontal disease occurs in the underlying bone; osseous means bone. Bone is frequently destroyed by the infection associated with gum disease. This irregular bone will prevent the gum from laying down flat. Reshaping the bone with osseous surgery will allow the gum to lay down flat in the areas between the teeth.
Periodontal disease destroys the supporting tissue and bone, forming "pockets" around the teeth. Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.
During osseous surgery, the doctor folds back the gum tissue and removes the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease- causing bacteria can hide. This allows the gum tissue to better re-attach to healthy bone.
What are the benefits of this procedure?
Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease from coming back. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth and decrease the chance of serious health problems associated with periodontal disease.
Crown Lengthening
You may have asked your dentist about procedures to improve a "gummy" smile because your teeth appear short. Your teeth may actually be the proper lengths, but they're covered with too much gum tissue. To correct this, you can be referred to a periodontist who will perform a procedure known as crown lengthening.
The procedure to correct this problem is to reshape excess gum and bone tissue to expose more of the natural tooth. This may involve one tooth to even your gum line or several teeth to expose your natural smile. Crown lengthening may also be recommended to make a restorative or cosmetic dental procedure possible. If you have a decayed tooth that is broken below the gum line or the tooth has insufficient structure for a restoration, such as a crown, crown lengthening can be performed to adjust the gum and bone level to expose more of the tooth so it can be restored.
Whether you have crown lengthening to improve function or esthetics, patients often receive the benefits of both a beautiful new smile and improved periodontal health.
Before/After Photos
Gingivectomy
A gingivectomy is a periodontal surgical procedure which includes the removal of gingival (gum) tissue. Gum tissue removal may be required under the following two circumstances:
- Sometimes empty pockets develop between an individual’s gums and teeth. These spaces may become breeding ground for bacteria, and food particles may get stuck in them. The problem can be rectified by trimming of gums with gingivectomy.
- The problem can also be cosmetic with excess gum tissue marring the appearance. Extra gum tissue can also lead to non-cosmetic problems like speech impediments and chewing difficulties. The condition, which can sometimes be caused by medicines, will also make cleaning process a bit cumbersome.
A gingivectomy is done under local anesthesia. Though it is not always a lengthy procedure, it can extend up to an hour depending on the amount of tissue to be removed.
Gingivectomy is a comparatively risk free procedure. The possible risks are bleeding and some infection, but these happen very rarely, if at all. Normal post-surgical bleeding will be for one to two days.
Before/After
Sinus Augmentation
A key to implant success is the quantity and quality of the bone where the implant is to be placed. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity 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. The doctor will explain the techniques and your options for graft materials, which can regenerate lost bone and tissue.
Since every case is different, the bone will be allowed to develop for about four to 12 months before implants can be placed. After the implants are placed, an additional healing period is required. In some cases, the implant can be placed at the same time the sinus is augmented.
Sinus augmentation has been shown to greatly increase your chances for successful implants that can last for years to come. Many patients experience minimal discomfort during this procedure.
Gum (Tissue) Grafting
Gum or tissue grafting is needed when you have recession of the gum from the tooth. This sometimes occurs because of periodontal disease and sometimes you won’t have any signs of periodontal disease yet you will still have recession. Contrary to what some people have been told, most recession is not caused by neglect on your part. It often times is the result of the lack of thick, tough tissue which borders where the gums meet the teeth. This thick, tough tissue is called “Attached Gingiva”.
There are two types of grafts that can be used to correct this issue and they are Sub-Epithelial Connective Tissue Graft(CTG) or Free Soft-tissue Graft (FSG).
- A Sub-Epithelial Connective Tissue Graft is a procedure which takes tissue from under healthy gum tissue in the palate (roof of the mouth), which may be placed at the area of gum recession.
- A Free Soft-tissue (Gingival) Graft is a procedure where a thin piece of gum tissue is removed from the palate of the patient's mouth and transplanted to another site in order to create thick, tough tissue or "attached gingiva".
In some cases, this type of gum graft can only prevent further recession, which is all that is necessary to keep the tooth or teeth healthy. In other cases, this type of gum graft can partially or almost completely cover previously existing recession.
The donor site (the roof of the mouth) will heal without damaging the underlying gums, bone or teeth. In some cases, a freeze-dried human tissue product can be used in order to avoid taking the tissue from the roof of the mouth.
Before/After Photos