Dr. Zablotsky's practice provides a variety of surgical services. He prides himself on the fact that he is very conservative in his treatment recommendations and limits surgery to the areas where it is absolutely necessary. Periodontal procedures are available to regenerate the bone and gum tissue to their original function and cosmetic appearance. There may be multiple options which may successfully treat your periodontal problem(s). Dr. Zablotsky will carefully review the state of your disease, where it seems to be progressing, and the best options for your care.
Cosmetic Periodontal Surgery These procedures are a predictable way to cover sensitive or exposed root surfaces and to prevent future gum recession through grafting procedures. If you are unhappy with the appearance of short unsightly teeth or a gummy smile, these conditions can be greatly improved by a combination of periodontal procedures by Dr. Zablotsky and cosmetic dentistry by your dentist.
Gum Grafting Procedures (Subepithelial Connective Tissue Grafts) When the gums are thin and weak due to a lack of tough attached tissues, recession can occur. Many feel that when this occurs the area may be more susceptible to bacterial penetration and trauma. When gum recession is a problem, gum reconstruction using grafting techniques is an option.
Risk Factors for the Progression of Recession When Tissues Are Thin Include:
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
When there is only 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 (loose, moveable tissue), the first line of defense against bacterial penetration is lost.
In addition, 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.
On occasion, various forms of biological membranes can be used as a substitute for palatal donor tissue to accomplish the goal of root coverage and toughening the attached tissues.
Finally, previously restored root surfaces (either bonded or crowned surfaces) can often be grafted to eliminate the "long tooth" look and cover the exposed root surface. (These teeth may require more restorative treatment after the graft have healed.)
Root Coverage Graft
Multiple Recessions Grafting Case
Pre-operative Views: Note the extensive recessions on cuspids and incisors.
Post-treatment View: Note the almost complete root coverage with healthy attached tissue.
Root Coverage Grafting With Connective Tissue
Pre-operative View: Note the significant gum recession and root exposure on upper cuspids. This exposure was accompanied with significant temperature sensitivity and esthetic concerns due to a high smile line. This gave the patient a "long in the tooth" look.
Postoperative view: note the coverage of exposed cuspids with resolution of cold sensitivity and nice cosmetic blending of tissues.
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.
Grafting of Generalized Recession
Immediate Post-Op (with sutures)
1 Year Post-Op Smile
3 year Post-Up Closeup of the Tissues
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 Overview
Crown Lengthening Procedure
Crown Lengthening With Orthodontic and Restorative Treatment
20 year old with gummy smile and short teeth prior to the orthodontic treatment.
Preoperative views for esthetic crown lengthening.
Immediate post-op an esthetic crown lengthening.
Two weeks post-op on an esthetic crown lengthening.
Final esthetic crown lengthening case. Note porcelain veneers on peg lateral incisors enhances the final result. (Note the porcelain veneers on peg lateral incisors enhancing the final result.)
Crown Lengthening to Match Central Incisors
Asymmetric crown lengths and an old crown on central incisor.
Note the new crowns and gingival symmetry.
Crown Lengthening of Multiple Teeth
Note the gummy smile (especially in the right lateral incisor area).
Crown Lengthening of Central Incisors
Note that this patient is missing lateral incisors. The Cuspids have been moved into the lateral incisors positions.
Three weeks post-op.
Crown Lengthening of Multiple Teeth
Pre-op. Note the short anterior teeth with high smile line.
Three weeks post-op. Note the normal tooth lengths and pleasing smile.
Crown Lengthening to Improve Gum Asymmetry
Pre-op. Note the asymmetric smile due to skeletal overgrowth on the left side. Orthodontic and jaw surgical treatment options were given to this patient. However, she chose only esthetic crown lengthening to solve this problem.
Post-treatment. While skeletal asymmetry is still present, this patient's smile appears much more balanced.
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.
Pocket Reduction Procedure
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.
Guided Tissue Regeneration Case Study 2
Pre-operative views of anterior teeth with deep bone loss just prior to guided tissue regeneration with osseous graft surgical therapy.
Eighteen month post–operative view. Note regeneration of bone loss in all anterior teeth.
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.
Video: Courtesy of Millenium Dental Technologies & Dr. Dawn Bloore, Cerritos, CA
Perioscopic Debridement Perioscopic treatment may be a more conservative and non-surgical treatment option, but requires meticulous attention to detail. Our dental hygienists have been performing these procedures for over 15 years, please refer to the Non-Surgical Page to learn more about Perioscopic Debridement Therapy. Learn more about perioscopy.
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 Augmentation Under Bridge
A provisional bridge placed after the extraction of advanced periodontal diseased teeth. These photos are 12 weeks post-extraction and immediately pre-operatively to bone and soft tissue grafting to establish a more ideal soft tissue profile above the bridge.
Final bridge. Note improved soft tissue contours under the new bridge.
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).
Bone Grafting - Ridge Preservation
*Note: Dr. Zablotsky uses whenever possible.natural bone material.
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