Procedures


At The Academy for Reconstructive Periodontics and Implant Dentistry, we perform a wide variety of Reconstructive and Periodontal Implant services to help you attain better health and get the smile you deserve.

Open the links below to read about Non-Surgical and Surgical periodontic procedures. Dental Implants and Cosmetic Restorative Procedures are also performed by our office.


Dental Implants


Dental Implants

Dental Implants


A dental implant is a post made of metal that is designed to replace missing teeth. It is usually made out of titanium and is placed surgically into the jawbone where the tooth is missing. Unlike a bridge, an implant is a more permanent solution.

Single Implant Placement - Lateral Incisor


You have several options when replacing teeth. Your options are no longer limited to crowns and conventional bridges or dentures. Dental implants are aesthetically pleasing and feel very natural. Implants are surgically placed below the gums over a series of appointments. With time, they fuse to the jawbone and serve as a base for individual replacement teeth, bridges or dentures.

Through a process called osseointegration, implants offer stability because they fuse to your bone. Integration of the implants into your jaw also helps your replacement teeth feel more natural. Some patients have reported that the secure fit is more comfortable than alternatives. Dental implant candidates must have healthy gums and bone to support the implant.

Reasons for Dental Implants

•  Keep the look and feel of a real tooth where one is missing
•  Maintain healthy bone levels
•  Help support overdentures or bone anchored bridges (that are fixed and not removable)
•  Leaves neighboring teeth alone (either teeth that do not need to be ground down or teeth with stable restorations, ie. crowns)
•  Patients can clean teeth normally
•  In patients who are suceptable to decay, implants do not decay


Dental Implant Cases


Posterior Dental Implant Supported Crowns

Clinical photos of a dental reconstruction utilizing dental implants 7 years post-placement.


Single Tooth Replacement - Front Tooth

Pre-operative clinical and x-ray views of a root canal treated fracture lateral incisor.


Dental Implant Supported Dentures

Four implants placed in the lower jaw to support and and retain a bar overdenture.

Note the inside of the lower denture has retentive components which help the lock onto the bar.

In the upper jaw four implants were placed with two small bars to assist the natural teeth in retaining an upper denture. Both restorations feel and function like the patient’s natural teeth, yet are removable.



Patient Missing Incisors

Placed immediately before the crowns.
1 year post-op


3 year post-op

Non-Surgical Periodontics


Perioscopy (Periodontal Endoscopy)

Recent advances in dental technology have enabled us to utilize a very small camera at the end of a periodontal probe, much like the technology used in arthroscopic procedures. This probe can comfortably access the base of periodontal pockets to allow for complete visualization of the infected root surface at as much as a 40 times magnification. Periodontal debridement can then be performed allowing more complete root cleaning.

In addition, we can visualize many other problems, i.e. root fractures, root decay, root resorption, etc., which otherwise can only be visualized through surgical procedures. In addition to the previously mentioned uses, we utilize this technology in the treatment of sites with recurrent gum disease during maintenance/supportive periodontal care. Our hygienists have utilized this technology for over 10 years (or longer in Sacramento).


Scaling and Root Planing

Scaling meticulously removes contaminated biofilm, plaque, calculus, microorganisms and toxins from around the gum line down to the bottom of each periodontal pocket (with a measurement of greater than 3mm and with evidence of bleeding and tissue loss), in order to obtain a healing response.

Root planing involves smoothing the root surfaces of your teeth with thin instruments so gum tissue can more firmly reattach to roots that are clean and smooth, to prevent tooth loss and sensitivity problems. This procedure makes it more difficult for plaque, calculus and bacteria to accumulate along these root surfaces.

Why Root Planing May Be Necessary
•  To control the growth of harmful bacteria
•  Help the pocket wall reattach firmly to the clean root surface
•  Prevent further bleeding of the gums from disease
•  Reduce inflammation
•  Reduce discomfort
•  Prevent bone loss
•  Prevent gum disease related tooth loss
•  Reduce systemic disease

Supportive Periodontal Therapy

After Dr. Zablotsky has completed the active phase of periodontal treatment, your periodontal disease will be under control. He will provide you with a personalized maintenance program of care to keep your gums healthy.

Maintenance therapy is an ongoing program designed to prevent disease in the gum tissues and bone supporting your teeth. Adherence to a program of conscientious home oral care and regularly scheduled maintenance therapy visits with your dentist and Dr. Zablotsky will give you an excellent chance of keeping your teeth for your lifetime.

Microultrasonics

Ultrasonic Scalers use ultrasonic vibrations to help break down the plaque and calculus on the teeth that cause gingivitis and periodontal disease. The ultrasonic cleaners create microscopic bubbles that implode on the surface of the tooth, killing microbes and removing plaque and tartar in the process. Our instruments use a thin tip to better navigate in the periodontal pockets to help maintain optimal gingival health.

The procedure uses water and/or an antimicrobial liquid called chlorhexadine. It can remove tartar buildup in hard-to-reach areas, with no damage to the tooth enamel. Manual scaling often uses pressure for cleaning, while the vibration produced by the scaling tip of an ultrasonic scaler is barely perceptible. This makes ultrasonic cleaning suitable to those with sensitive teeth. The cleaning process is faster than manual scaling making your visit more comfortable.

After your teeth have been cleaned with the ultrasonic cleaner, your teeth will be hand scaled to check for any residual deposits and then polished.

Treatment of Biting Problems

In some cases, the bite may play a significant role in exacerbating the progression of periodontal disease. Parafunction happens when there are tooth contacts occurring outside normal function (i.e. chewing and swallowing). This is often a manifestation of stress, and clenching or grinding forces can be many times that of normal function (and can happen at night for hours at a time).

Severe Wear on the Inner Aspects of This Patient’s Upper Front Teeth and Notching Lesions (Abfractions) On the Outer Aspects of Teeth at the Gum-line

Treatments
•  Night guard/bite appliances which separate the teeth, reduce muscle forces, and splint the teeth to give them strength to resist overloading forces
•  Bite adjustment which reduces overloading forces by reducing heavy contacts through gentle recontouring of tooth structure
•  Restorative treatment. It may be necessary to build up the bite in some areas to facilitate a more normal occlusion/bite
•  Orthodontic treatment, if tooth positions are significantly out of alignment such that restorative treatment or bite adjustment cannot overcome the bite discrepancies
•  Biofeedback, if clenching occurs during the day, can be used to deprogram the musculature. This will allow the jaws to stay apart
•  Referral to Oral and Maxillofacial Pain Specialist is sometimes considered, if bite problems and pain cannot be conservatively dealt with


Surgical Periodontics


Dental Implants

Dental Implants


A dental implant is a post made of metal that is designed to replace missing teeth. It is usually made out of titanium and is placed surgically into the jawbone where the tooth is missing. Unlike a bridge, an implant is a more permanent solution.

Single Implant Placement - Lateral Incisor


You have several options when replacing teeth. Your options are no longer limited to crowns and conventional bridges or dentures. Dental implants are aesthetically pleasing and feel very natural. Implants are surgically placed below the gums over a series of appointments. With time, they fuse to the jawbone and serve as a base for individual replacement teeth, bridges or dentures.

Through a process called osseointegration, implants offer stability because they fuse to your bone. Integration of the implants into your jaw also helps your replacement teeth feel more natural. Some patients have reported that the secure fit is more comfortable than alternatives. Dental implant candidates must have healthy gums and bone to support the implant.

Reasons for Dental Implants

•  Keep the look and feel of a real tooth where one is missing
•  Maintain healthy bone levels
•  Help support overdentures or bone anchored bridges (that are fixed and not removable)
•  Leaves neighboring teeth alone (either teeth that do not need to be ground down or teeth with stable restorations, ie. crowns)
•  Patients can clean teeth normally
•  In patients who are suceptable to decay, implants do not decay


Dental Implant Cases


Posterior Dental Implant Supported Crowns

Clinical photos of a dental reconstruction utilizing dental implants 7 years post-placement.


Single Tooth Replacement - Front Tooth

Pre-operative clinical and x-ray views of a root canal treated fracture lateral incisor.


Dental Implant Supported Dentures

Four implants placed in the lower jaw to support and and retain a bar overdenture.

Note the inside of the lower denture has retentive components which help the lock onto the bar.

In the upper jaw four implants were placed with two small bars to assist the natural teeth in retaining an upper denture. Both restorations feel and function like the patient’s natural teeth, yet are removable.



Patient Missing Incisors

Placed immediately before the crowns.
1 year post-op


3 year post-op
Gum Grafting Procedures (Subepithelial Connective Tissue Grafts)

Gum recession often results in root sensitivity to hot and cold foods as well as a "long in the tooth" appearance to the smile. Also, gum recession, when significant, can predispose the area to root decay and gouging as the root surface is softer than enamel.

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 tissue 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 procedure is highly predictable and results in a stable healthy band of attached tissue around the tooth.

Factors that May Increase Risk for Recession of Thin Tissue:
•  Tooth brush abrasion
•  Biting overload. This can occur from grinding or clenching your teeth
•  Increased functional load, i.e. supporting teeth for bridges or partial dentures with thin tissues
•  Planned orthodontic therapy
•  Sensitive exposed roots
•  Roots exposure with high smile line (aesthetic concerns)
•  Ill fitting restorations under the gum-line or those which are too deep violating gum attachments

Grafting of Dramatic Recession Defect

Pre-operative view of isolated extensive recession of upper cuspid which is very sensitive to cold and touch.
Post-treatment View: Note the complete root coverage, resolution of symptoms and very nice cosmetic result.

Crown Lengthening

When decay occurs below the gum-line or if a tooth exhibits significant breakdown, it may be necessary to remove a small amount of bone and gum tissue. Your dentist may ask for this procedure before he or she makes a new crown for your tooth. This is crown lengthening to attain a healthy functional result. This will allow your general dentist adequate room to place a quality final restoration.

Aesthetic crown lengthening may be done to facilitate a crown or veneer. It is often indicated when the patient has a "gummy smile" with short looking teeth or when the gum-line is uneven. Other disciplines (i.e. orthodontics and cosmetic dentistry) are often utilized in addition to aesthetic crown lengthening surgery to attain a more ideal result.

Crown Lengthening of Multiple Teeth

Note the gummy smile (especially in the right lateral incisor area).
Post-op.

Osseous Surgery

Traditionally, gum disease is treated by eliminating the gum pockets by trimming away the infected gum tissue and by gently re-contouring or reshaping the uneven bone tissue. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are also utilized routinely today.

Guided Tissue Regeneration

This surgical procedure "regenerates" the previously lost gum and bone tissue. Most techniques utilize membranes, which are inserted over the bone defects. Some of these membranes are bio-absorbable and some require removal. Other regenerative procedures involve the use of bio-active gels.

Guided Tissue Regeneration Case Study 1

Pre-operative views of posterior molars with deep bone loss which have created crater-like defects just prior to guided tissue regeneration and bone grafting surgical therapy.
One year post-operative views. Note the complete regeneration of boney lesions.

LANAP

Another very conservative surgical option is LANAP (Laser Assisted New Attachment Procedure) may be a viable option to surgically treat periodontal disease with no incisions, sutures or swelling. This typically leaves the patient with less post-treatment gum recession and less tooth sensitivity post-operatively. In addition to a more stable and protected bite.

Pre-Prosthetic Surgical Treatments

Bone Grafting
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.

We now have the ability to grow bone where needed. This gives us the opportunity to place implants of proper length and width, and it also gives us a chance to more effectively restore aesthetic appearance and functionality.

Ridge Augmentation
The effects of tooth loss on the remaining gum and bone form can be devastating. Studies show that significant loss of the height and width of the ridge occurs as early as 6-12 months after extraction and may continue for years. You may have seen people who have a loss of gum contour with spaces under and between bridge replacement teeth. Not only is this unaesthetic, but patients often complain about speech difficulties and problems with food impaction. Many times reconstruction of lost form and function can occur via bone or soft tissue augmentation grafting techniques to regenerate lost structure.

Ridge Preservation
Careful management of extraction sockets after tooth extraction prevents disfiguring bone loss and leads to a better cosmetic outcome of tooth replacement. Whenever a tooth within the aesthetic zone (within the gummy area in the viewable smile line) is to be extracted or in sites which may later receive dental implants it is advisable to consider socket/ridge preservation bone grafting and sometimes soft tissue grafting. This will slow the process of gum and bone collapse. This atrophy occurs after the extraction of teeth and grafting allows for less shrinkage and a more aesthetic tooth replacement (either implant crown or fixed bridge around the replacement teeth).
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1 Scripps Drive Ste. 305
Sacramento, CA 95825

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Phone: (916) 641-1200
Fax: (916) 641-1400
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