"Periodontal Plastic Surgery"
Click a procedure category for more information:Tissue Conditioning
The initial stage or phase of treatment typically involves a thorough instrumentation of gum tissues that may include local anesthetic with scaling to remove tartar deposits beneath the gum line and reduce inflammation. The tooth roots may also be planed to smooth the root surface allowing gum tissue an improved environment to heal. These efforts do have their limitations and deep pockets may exist following this type of treatment requiring a periodontal surgery to restore periodontal anatomy damaged by periodontal disease.
In certain select cases, systemic antibiotics taken orally are prescribed to be used the day of tissue conditioning. These antibiotic medications are aimed at aiding in fighting additional bacteria and their infection.
Following Tissue Conditioning certain patients may require an additional visit with Dr. Mueller in what is called a “Re-Evaluation.” In a majority of patients this tissue conditioning and initial phase of treatment is a preparatory stage to an anticipated surgical phase of therapy, including but not limited to Pocket Reduction Therapy and Regenerative Therapy (i.e., “bone grafting”).
Periodontal disease is not a curable disease and requires consistent follow-up maintenance with our specially trained hygienist team to ensure that periodontal health is stable. This periodontal maintenance is recommended every 3 months. This process begins in our office and then may proceed to alternating visits with your General Dentist. We will communicate with your dentist after each visit to share pertinent information regarding the stability of your periodontal condition.
During your periodontal maintenance visit, your periodontal status is closely monitored for changes, a thorough cleaning is performed, and may be paired with an exam by Dr. Mueller. At times, additional periodontal procedures may be recommended to treat areas that exhibit bone loss and pocketing.
A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge. Dental implants are an ideal option for people in good general oral health who have lost a tooth or teeth due to periodontal disease, dental caries, an injury, or some other reason.
While high-tech in nature, dental implants are actually more tooth-saving than traditional bridgework, since implants do not rely on neighboring teeth for support.
Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth. You know that your confidence about your teeth affects how you feel about yourself, both personally and professionally. Perhaps you hide your smile because of spaces from missing teeth. Maybe your dentures don't feel secure. Perhaps you have difficulty chewing. If you are missing one or more teeth and would like to smile, speak and eat again with comfort and confidence, there is good news! Dental implants are teeth that can look and feel just like your own! Under proper conditions, such as placement by a periodontist and diligent patient maintenance, implants can last a lifetime. Long-term studies continue to show improving success rates for implants.
What Dental Implants Can Do?
Replace one or more teeth without affecting bordering teeth.
Support a bridge and eliminate the need for a removable partial denture.
Provide support for a denture, making it more secure and comfortable.
Advantages of Dental Implants Over Removable Dentures or a Fixed Bridge
Every way you look at it, dental implants are a better solution to the problem of missing teeth.
Esthetic Dental implants look and feel like your own teeth! Since dental implants integrate into the structure of your bone, they prevent the bone loss and gum recession that often accompany bridgework and dentures. No one will ever know that you have a replacement tooth.
Tooth-saving Dental implants don't sacrifice the quality of your adjacent teeth like a bridge does because neighboring teeth are not altered to support the implant. More of your own teeth are left untouched, a significant long-term benefit to your oral health!
Confidence Dental implants will allow you to once again speak and eat with comfort and confidence! They are secure and offer freedom from the irksome clicks and wobbles of dentures. They'll allow you to say goodbye to worries about misplaced dentures and messy pastes and glues.
Reliable The success rate of dental implants is highly predictable. They are considered an excellent option for tooth replacement.
Are You a Candidate for Dental Implants?
The ideal candidate for a dental implant is in good general and oral health. Adequate bone in your jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease.
Dental implants are intimately connected with the gum tissues and underlying bone in the mouth. Since periodontists are the dental experts who specialize in precisely these areas, they are ideal members of your dental implant team. Not only do periodontists have experience working with other dental professionals, they also have the special knowledge, training and facilities that you need to have teeth that look and feel just like your own.
If you are missing a single tooth, one implant and a crown can replace it. A dental implant replaces both the lost natural tooth and its root.
What are the advantages of a single-tooth implant over a bridge?
A dental implant provides several advantages over other tooth replacement options. In addition to looking and functioning like a natural tooth, a dental implant replaces a single tooth without sacrificing the health of neighboring teeth. The other common treatment for the loss of a single tooth, a tooth-supported fixed bridge, requires that adjacent teeth be ground down to support the cemented bridge.
Because a dental implant will replace your tooth root, the bone is better preserved. With a bridge, some of the bone that previously surrounded the tooth begins to resorb (deteriorate). Dental implants integrate with your jawbone, helping to keep the bone healthy and intact.
In the long term, a single implant can be more esthetic and easier to keep clean than a bridge. Gums can recede around a bridge, leaving a visible defect when the metal base or collar of the bridge becomes exposed. Resorbed bone beneath the bridge can lead to an unattractive smile. And, the cement holding the bridge in place can wash out, allowing bacteria to decay the teeth that anchor the bridge.
How will the implant be placed?
First, the implant, which looks like a screw, is placed into your jaw. Bone grafting is often performed at the same time as implant placement. Over the next two to six months, the implant and the bone are allowed to bond together to form an anchor for your artificial tooth. During this time, a temporary tooth replacement option can be worn over the implant site.
Occasionally, a second step of the procedure is necessary to uncover the implant and attach an extension. This small metal post, called an abutment, completes the foundation on which your new tooth will be placed. Your gums will be allowed to heal for a couple of weeks following this procedure.
There are some implant systems (one-stage) that do not require this second step. These systems use an implant which already has the extension piece attached. Your periodontist will advise you on which system is best for you.
Finally, a replacement tooth called a crown will be created for you by your dentist and attached to the abutment. After a short time, you will experience restored confidence in your smile and your ability to chew and speak.
If you are missing several teeth, implant-supported bridges can replace them. Dental implants will replace both your lost natural teeth and some of the roots.
What are the advantages of implant-supported bridges over fixed bridges or removable partial dentures?
Dental implants provide several advantages over other teeth replacement options. In addition to looking and functioning like natural teeth, implant-supported bridges replace teeth without support from adjacent natural teeth. Other common treatments for the loss of several teeth, such as fixed bridges or removable partial dentures, are dependent on support from adjacent teeth.
In addition, because implant-supported bridges will replace some of your tooth roots, your bone is better preserved. With a fixed bridge or removable partial denture, the bone that previously surrounded the tooth root may begin to resorb (deteriorate). Dental implants integrate with your jawbone, helping to keep the bone healthy and intact.
In the long term, implants are esthetic, functional and comfortable. Gums and bone can recede around a fixed bridge or removable partial denture, leaving a visible defect. Resorbed bone beneath bridges or removable partial dentures can lead to a collapsed, unattractive smile. The cement holding bridges in place can wash out, allowing bacteria to decay teeth that anchor the bridge. In addition, removable partial dentures can move around in the mouth and reduce your ability to eat certain foods.
How will the implants be placed?
First, implants, which looks like screws, are placed into your jaw. Bone grafting is often performed at the same time as implant placement. Over the next two to six months, the implants and the bone are allowed to bond together to form anchors. During this time, a temporary teeth replacement option can be worn over the implant sites.
Occasionally, a second step of the procedure is necessary to uncover the implants and attach extensions. These small metal posts, called abutments, complete the foundation on which your new teeth will be placed. Your gums will be allowed to heal for a couple of weeks following this procedure.
There are some implant systems (one-stage) that do not require this second step. These systems use an implant which already has the extension piece attached. Your periodontist will advise you on which system is best for you.
Finally, replacement teeth, or bridges, will be created for you by your dentist and attached to the abutments. After a short time, you will experience restored confidence in your smile and your ability to chew and speak.
Replacing All Teeth
If you are missing all of your teeth, an implant-supported full bridge or full denture can replace them. Dental implants will replace both your lost natural teeth and some of the roots.
What are the advantages of implant-supported full bridges and implant-supported dentures over conventional dentures?
Dental implants provide several advantages over other teeth replacement options. In addition to looking and functioning like natural teeth, implant-supported full bridges or dentures are designed to be long lasting. Implant-supported full bridges and dentures also are more comfortable and stable than conventional dentures, allowing you to retain a more natural biting and chewing capacity.
In addition, because implant-supported full bridges and dentures will replace some of your tooth roots, your bone is better preserved. With conventional dentures, the bone that previously surrounded the tooth roots begins to resorb (deteriorate). Dental implants integrate with your jawbone, helping to keep the bone healthy and intact.
In the long term, implants can be more esthetic and easier to maintain than conventional dentures. The loss of bone that accompanies conventional dentures leads to recession of the jawbone and a collapsed, unattractive smile. Conventional dentures make it difficult to eat certain foods.
How will the implants be placed?
First, implants, which looks like screws, are placed into your jaw. Then, over the next two to six months, the implants and the bone are allowed to bond together to form anchors for your artificial teeth. During this time, a temporary teeth replacement option can be worn over the implant sites.
Occasionally, a second step of the procedure is necessary to uncover the implants and attach extensions. These small metal posts, called abutments, along with various connecting devices that allow multiple crowns to attach to the implants, complete the foundation on which your new teeth will be placed. Your gums will be allowed to heal for a couple of weeks following this procedure.
There are some implant systems (one-stage) that do not require this second step. These systems use an implant which already has the extension piece attached. Your periodontist will advise you on which system is best for you. Depending upon the number of implants placed, the connecting device that will hold your new teeth can be tightened down on the implant, or it may be a clipped to a bar or a round ball anchor to which a denture snaps on and off.
Finally, full bridges or full dentures will be created for you and attached to your implants or the connecting device. After a short time, you will experience restored confidence in your smile and your ability to chew and speak.
What Can I Expect After Treatment?
As you know, your own teeth require conscientious at-home oral care and regular dental visits. Dental implants are like your own teeth and will require the same care. In order to keep your implant clean and plaque-free, brushing and flossing still apply! After treatment, Dr. Mueller will work closely with you and your dentist to develop the best care plan for you. Periodic follow-up visits will be scheduled to monitor your implant, teeth and gums to make sure they are healthy.
The maxillary sinuses exist behind your cheeks and on top of the upper teeth. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.
The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus (which is the roof of the upper jaw). After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.
If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the dental implant well, sinus augmentations and dental implant placement can sometimes be performed as a single procedure. If not enough bone is available, the sinus augmentation is performed first. Once the graft has matured, the implants can be placed.
While the concept of sinus augmentation may sound complicated, it is a procedure that is performed on a very routine basis in areas that require the procedure to allow for implant placement in theses areas.
The main cause of periodontal disease is bacteria in the form of a sticky, colorless plaque that constantly forms on your teeth. Many factors can cause periodontal disease or influence its progression.
Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, 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, too much bone is lost, and the teeth may need to be extracted.
A pocket reduction procedure may be recommended because you have pockets that are too deep to clean with daily at-home oral hygiene and a professional care routine. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth - and decreases your chances of serious health problems associated with periodontal disease.
During this procedure, we will fold back the gum tissue and remove 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 reattach to healthy bone.
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 recurrence. Deeper pockets are more difficult for you and your dental care professional to clean, so it's important for you to reduce them. 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.
Traditionally, eliminating the gum pockets by trimming away the infected gum tissue and re-contouring the uneven bone tissue treats gum disease. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are used routinely today.
Regenerative Procedures "regenerates" the previously lost gum and bone tissue.
Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed and pockets develop. Eventually, if too much bone is lost, the teeth will need to be extracted.
Regenerative procedures are recommended when the bone supporting your teeth has been destroyed. These procedures can reverse some of the damage by regenerating lost bone and tissue.
During this procedure, we will fold back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts and/or tissue- stimulating proteins can be used to encourage your body's natural ability to regenerate bone and tissue.
There are many options to enhance support for your teeth and to restore your bone to a healthy level. Dr. Mueller will discuss your best options with you.
Eliminating existing bacteria and regenerating bone and tissue helps to reduce pocket depth and repair damage caused by the progression of periodontal disease. With a combination of daily oral hygiene and professional maintenance care, you'll increase the chances of keeping your natural teeth – and decrease the chances of serious health problems associated with periodontal disease.
Crown lengthening (or crown exposure) is required when your tooth needs a new crown or other restoration. The edge of that restoration is deep below the gum tissue and not accessible. It is also usually too close to the bone or below the bone. This procedure create a new gum-to-tooth relationship. This allows your dentist to reach the edge of the restoration, ensuring a proper fit of your restoration to the tooth. It should also provide enough tooth structure so the new restoration will not come loose in the future. This allows you to clean the edge of the restoration when you brush and floss to prevent decay and gum disease.
ProcedureThe procedure involves adjusting the levels of the gum tissue and bone around the tooth in question, to create a new gum-to–tooth relationship. The procedure takes approximately one hour.
When the procedure is completed, sutures and a protective “bandage” may be placed to help secure the new gum-to-tooth relationship. You will need to be seen in one or two weeks to evaluate your healing.
Esthetic Crown Lengthening
This periodontal procedure is designed to expose more tooth structure prior to restorative and cosmetic dentistry and/or to improve the esthetics of your gum line. A frequently asked question is whether we can change the esthetics of a gummy smile because the teeth appear somewhat short. Your teeth can actually be of proper length and just covered with excessive gum tissue. In such circumstances, an esthetic crown lengthening procedure will correct this by exposing the shape of your natural teeth.
Esthetic crown lengthening can also be done to single teeth to even your gum line and create a pleasing smile. If your teeth are decayed, fractured at or below the gum line or have insufficient tooth structure for a new crown retention, a crown lengthening procedure may be recommended to enable your dentist to perform a restorative and/or cosmetic dental procedure.
During this procedure, excess gum and bone tissue is reshaped to expose more of your natural teeth, which can significantly enhance periodontal health.
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 – your keys to smiling, eating and speaking with comfort and confidence.
Teeth extractions may be needed for a number of reasons:
Advanced periodontal disease
Broken in a way that cannot be repaired
Poorly positioned in the mouth (such as impacted teeth)
Preparation for orthodontic treatment
The loss of a single tooth can lead to many problems, such as, the ability to chew, bone loss, problems with jaw joints and shifting of teeth, which can have a major impact on your dental health.
To avoid these complications, we will discuss treatment options, such as:
Extraction Site Preservation
At the time of extraction the doctor will numb your tooth, jawbone and gums that surround the area with a local anesthetic.
During the extraction process you will feel a lot of pressure. This is from the process of firmly rocking the tooth in order to widen the socket for removal. You feel the pressure without pain as the anesthetic has numbed the nerves stopping the transference of pain, yet the nerves that transmit pressure are not profoundly affected. If you do feel pain at any time during the extraction, we will give you more anesthesia to make you comfortable. Some teeth require sectioning. This is a very common procedure done when a tooth is so firmly anchored in its socket or the root is curved and the socket can't expand enough to remove it. The doctor simply cuts the tooth into sections then removes each section one at a time.
There is a special type of bone surrounding your teeth. This bone is called alveolar "ridge" bone (jawbone), and exists solely to support your teeth. As soon as the tooth is removed, this bone begins to degenerate and "melt away." The overlying gum tissue melts away with the alveolar bone and thins out as the ridge flattens. This occurs in two dimensions. The first is loss of horizontal width caused by the collapse of the bone surrounding the socket. This makes the remaining ridge narrower than when the tooth was present. The second is a loss of vertical height. This makes the remaining bone less "tall." This process is faster in areas where you wear a partial or complete denture.
You have many options to prevent this, and it is important that you consider them before any teeth are extracted. Some of these procedures are best performed at the time the tooth is removed. When you need to have a tooth or teeth extracted, whether it be due to tooth decay, fracture, abscess, gum disease or traumatic injury, a socket site preservation is recommended to preserve as much of your underlying jawbone as possible for your future restorations.
You will have several choices for replacing the newly missing teeth. All of the options rely on bone support and bone contour for the best function and esthetics. Here is a list of the possible options:
Dental implants: These are root-shaped supports that hold your replacement teeth. The more bone support you have, the stronger the implant replacements will be. In some cases, the bone can degenerate to a point where implants can no longer be placed without having more complex bone grafting procedures to create the necessary support. Obviously, preventing bone loss is much easier than recreating the bone later.
“Fixed bridge”: This is a restoration that is supported by the teeth adjacent to the missing tooth space. The replacement tooth (or pontic) spans across the space. If the bone is deficient, there will be an unsightly space under the pontic that will trap food and affect your speech.
Other replacement alternatives include removable partial or full dentures. These often perform better with more supporting bone as there is added support against dislodgement.
There are two important phases in retaining your alveolar ridge during and after the tooth extraction. Non-traumatic extraction techniques are designed to preserve as much bone as possible and reduce bleeding and discomfort. In addition to non-traumatic extractions, and key to preventing the collapse of the socket, is the addition of bone replacement material to the extraction socket.
There are several types of bone grafting materials and techniques. Dr. Mueller will discuss the most appropriate one with you. After the tooth is extracted, the socket will be packed with bone or bone substitute and covered with an absorbable membrane then suture. Early on, the grafting material will support the tissue surrounding the socket, and in time will be replaced by new alveolar bone. This bone will be an excellent support should you choose later to have dental implant-supported replacement teeth.
Although the bone created by socket grafting supports and preserves the socket, it will not do so indefinitely. Placing dental implants three to twelve months after the extraction and socket grafting will provide the best long-lasting support for preserving your jawbone and allow you to function as before. Otherwise the graft may “melt away” or resorb over time.
In some selected cases it is possible to actually extract the tooth and place the dental implant at the same time. Dr. Mueller will discuss this option with you if it is a viable alternative.
The eye teeth (or canines) erupt into the mouth between the ages of 11 and 13. Sometimes they come in the wrong position, and in conjunction with your orthodontist, we need to help them erupt into the mouth. If the tooth is left alone, it will not erupt normally and could damage the roots of the adjacent teeth or even push them out of position.
Other teeth in the mouth, but less commonly, could have the same problem.
To expose impacted teeth, anesthetic is placed in the tissues around them. The gum is pushed back to the surface of the tooth at the same time keep all the gum around it. Occasionally some of the bone surrounding the crown of the tooth is removed. Once the tooth is exposed, your orthodontist will move it into position with a bracket and a chain that will be placed the day of the procedure, either by us or by your orthodontist.
As in any surgical procedure you may experience some soreness afterwards. Follow the postoperative instructions to minimize pain and swelling. A post-op visit will allow us to check the area treated. Further appointments will be necessary with your orthodontist for on-going orthodontic care.
A frenum is a piece of tissue in the mouth that extends from the lips and the cheek to the gums. (You can probably detect one of your frenums by placing your tongue in the space between your upper lip and your upper front teeth.) There are several different frenums in the mouth and they can attach to the inside of the lip, inside of the cheek or to the bottom of the tongue.
In certain cases a frenum can prevent teeth from staying in place after they have been orthodontically moved together. For example, after a patient's central incisors have been brought together in order to close the space between them, an excessive frenum can possibly cause the teeth to separate again.
In your lower front teeth the frenum can actually pull the gum away from the teeth and cause recession. When a denture patient's lips move, the frenum pulls and loosens the denture, which can be quite upsetting. This surgery is often done to help dentures fit better.
Lingual frenectomy is the removal of the lingual frenum. The lingual frenum attaches the tongue to the floor of the mouth and if it is to short it will cause a tongue-tied patient.
Labial frenectomy is the removal of the frenum between the maxillae or mandibular central teeth.
The area is anesthetized, then the frenum is released with an incision. Dissolvable sutures are placed that will dissolve within one week. The frenectomy site will be sore for 24-48 hours, and medications will help alleviate any discomfort. The site will usually be observed a week later to ensure proper healing.
Fibers around the teeth hold it in position. These fibers are like rubber bands that are stretched during orthodontic therapy to achieve the alignment of the teeth. If the braces are removed, these fibers will tend to pull the tooth back to its original position. This is called relapse.
A fiberotomy is performed to detach the fibers that attach the tooth to the bone. It is typically done near the completion of the orthodontics and is shown to be effective preventing the relapse of teeth.
This procedure may be a routine component of a comprehensive retention regimen. Consultation with your orthodontist is required when making this decision.
ProcedureWe will first anesthetize the area to be treated then we will detach the fibers that attach the tooth to the bone via the gum. No sutures are required.
Very little to no discomfort is expected after this procedure. Mild pain medication is used if necessary.
Periodontal procedures are available to stop further dental problems and gum recession, and/or to improve the esthetics of your gum line.
Exposed tooth roots are the result of gum recession. Perhaps you wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or, maybe you're not bothered by the appearance of these areas, but you cringe because the exposed roots are sensitive to hot or cold foods and liquids.
Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. You may not be in control of what caused the recession, but prior to treatment we can help you identify the factors contributing to the problem. Once these contributing factors are controlled, a soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss. Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession.
During this procedure, gum tissue is taken from the palate or another donor source to cover the exposed root. A recipient site is prepared in the affected areas. The graft is then gently adapted and sutured into the recipient site to either cover exposed root surfaces and/or to create a wide band of protective gum tissue. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.
A soft tissue graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. This may reduce tooth sensitivity and improve esthetics of your smile.