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Oral Hygiene
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Cosmetic Periodontal Surgery.......

These procedures are a predictable way to cover unsightly, sensitive or exposed root surfaces and to prevent future gum recession. If you are unhappy with the appearance of short unsightly teeth this can be greatly improved by a combination of periodontal procedures by our doctors and cosmetic dentistry by your dentist.

Although your teeth appear short, they may actually be the proper length. The teeth may be covered with too much gum tissue. We can correct this by performing the periodontal plastic surgery procedure, crown lengthening.

During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to more than one tooth, to even your gum line, and to create a beautiful smile.
Another cosmetic procedure is the soft tissue graft. It is used to cover unattractive tooth roots, reduce gum recession and protect the roots from decay and eventual loss.

Tooth loss causes the jawbone to recede and can lead to an unnatural looking indentation in your gums and jaw, an appearance of a general aging. The original look of your mouth may not be recaptured because of spaces remaining under and between replacement teeth. They may appear too long compared to nearby teeth.

Bone grafting following tooth loss can preserve the socket/ridge and minimize gum and bone collapse. There is less shrinkage and a more esthetic tooth replacement for either an implant crown or fixed bridge around the replacement teeth.

All of us strive to look and feel our very best. A critical part of our overall appearance is our smile - it mirrors our personality, it is our own unique calling card. Your dentist has the ability to offer a wide range of services to enhance your teeth and beautify your smile. As specialists in the treatment of the gums and supporting bone, we support your dentist's efforts in ensuring the health and stability of your teeth and smile.

Periodontal plastic surgery, or mucogingival surgery, involves the management of gingival deficits and deformities that may be preventing you from having the smile you always wanted. Among these are:

- A "gummy" smile

- Uneven gum line due to "short" teeth or receding gums ("long" teeth)

- Lost or "collapsed" gums due to missing teeth

- "Black holes" between your teeth, crowns, bridges, or implants

- The exposure of unerupted teeth

Why should you be concerned?

Because the presence of these conditions causes not only cosmetic concerns, such as "long" teeth and "black holes" between teeth and bridges, but also dental health concerns, like progressive gingival (gum) irritation and/or bone loss, root surface sensitivity, root caries, and in extreme cases, eventual tooth loss. Recent advances in techniques and materials have resulted in significant improvements in both comfort, predictability and esthetics.

Common Esthetic Problems

Below are just a few examples of some common esthetic problems and how they were corrected. Please visit our Smile Gallery to see even more satisfied patients!

Gummy Smile (Excessive Gingival Display)

A gummy smile can occur due to a number of reasons: a short upper lip, excessive wear of the teeth due to grinding, vertical maxillary excess (a long upper jawbone), and/or altered passive eruption.
Regardless of the cause, you do not have to live with a gummy smile. Let us work together with your dentist to determine the underlying cause and the proper treatment plan.
Gingival Recession

When the gums recede, the teeth appear much "longer" than normal. Besides the fact that this does not look good, recession exposes the sensitive root surface which can make it difficult to enjoy hot or cold foods and drinks. Also, the exposed root surface is much more susceptible to plaque accumulation and root caries. In advanced cases, teeth can become loose because as the gum recedes, so does the supporting bone.
In many cases, this situation can be corrected by transplanting a small piece of gum tissue to cover the exposed root and thereby correct the appearance of "long" teeth.

Papilla Regeneration

Probably the single most challenging problem in Periodontal Plastic Surgery is the reconstruction of the delicate tissue between the teeth, called the interdental papilla. No one ever thinks about this small section of the gums until it is lost, resulting in the presence of black holes or black triangles between the teeth.
Important advances have been made in the reconstruction of lost papillae but it is still the toughest task your dental team can face, often requiring the expertise of a dentist, periodontist, and/or orthodontist, among others.

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Osseous Surgery, gum

Osseous Surgery is a type of periodontal (gum) surgery that involves the removal and/or reshaping of the jawbone under the gum. The phrase 'gum disease' is not a technically accurate description because most of the damage occurs not in the gum but in the underlying bone; osseous means bone. Our Periodontist performs this procedure.

A simple analogy with carpeting may be used to describe the process of osseous surgery; the overlying gum is the carpet and the underlying soft matting is the bone. Bone is frequently irregularly destroyed by the infection associated with gum disease. This irregular bone will, like a bump in the soft matting under a carpet, prevent the gum, or carpet, from laying down flat. Reshaping the bone with osseous surgery by our Periodontist will allow the gum to lay down flat in the areas between the teeth.

Osseous Surgery is designed to modify and reshape deformitis in the alveolar bone surrounding the teeth. It is a common requirement in effective treatment of more involved periodontal diseases. In some instances, the bony support of the tooth assumes an unusual configuration as a result of uneven progression of the disease. When this occurs, modification of the altered bone support may be indicated.

Why do You Need Periodontal (Osseous) Surgery?

This surgical procedure is used by the Periodontist to smooth/correct defects and irregularities in the bone surrounding the diseased teeth with the ultimate goal of reducing or eliminating the periodontal pockets. Of course the areas to be treated are anesthetized with local anesthesia (Lidocaine or "Novocaine". Donít let the word "surgery" scare you. Except in the most complex cases, it feels like a thorough cleaning. If you must worry about something, you can worry about possible post-surgical discomfort; I must say though I give less pain medication now than I ever have- perhaps itís the experience!

The average surgical procedure takes about 1 hour, including the time to get numb. We use an average of 3 anesthetic cartridges per quadrant. We use a combination of two types of local anesthetic: 1. Carbocaine and 2.Xylocaine with epinephrine; the "epi" is used to control bleeding and to make the anesthetic last longer. If you have problems getting numb, please tell Dr. Mao at the beginning of the procedure, as Dr. Mao can usually give it in a different location to make it work better and perhaps faster. Also, some patients have problems staying numb; in these cases Dr. Mao must start the procedure immediately after the "shot" before it wears off. We aim to please!

What do we do exactly during surgery?

1. First, after getting the area "numb" we FLAP the gum back so that we can visualize the amount and type of bone loss. We can also visualize tartar that may be attached to the roots.

2. We then remove the tartar and clean out what we call granulation tissue from the bone defects or craters. This granulation tissue is basically infected/inflamed gum tissue that creeps into the craters and defects as the bone resorbs or disappears.

3. Next, we use hand instruments or a special diamond bur on a high speed handpiece to smooth and recontour the bone so that the craters are reduced or eliminated. Itís difficult to explain, but by doing this, the pockets will be reduced or eliminated.

4. At this time, in some cases where the craters or "holes" in the bone are too deep we will then use a bone graft to fill them in. As advances in periodontology have been made, additionally we now use a special membrane (Guided Tissue Regeneration procedure) to cover over the bone graft so that the gum does not grow down into the crater and "sabotage" the bone regeneration procedure.

There are 2 types of membranes currently being used:
A. Resorbable
B. Non-resorbable

5. After the bone is reshaped or augmented (bone graft), we then replace the original gum flap back over the bone and place sutures (stitches). The stitches are usually nylon and must be removed in about one week. Sometimes, however, if you canít get back here within a week we place a different type of suture that wonít irritate or attach to your gums; it must still be removed, but
you can wait as long as a month.

6. Lastly, we then place a putty-like packing over the area. Unlike many patients think, it is NOT important for healing. It is placed merely so that you donít have to worry about getting food stuck in between your teeth.

7. Post-Op instructions are then give to you to teach you how to take care of the area so that as little discomfort will take place as possible. Often a prescription is given for any discomfort.




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