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PERDIODONTICS - SURGICAL

Bone Grafting

A bone graft is a surgical procedure that replaces missing bone with material from your own body (autogenous bone) or an artificial, synthetic, or natural substitute.
A bone graft not only replaces missing bone, but also helps your body to regrow its own lost bone. This new bone growth strengthens the grafted area by forming a bridge between your existing bone and the graft material.

Over time your own newly formed bone will replace much of the grafted material.

Bone grafts may be needed when part of your body is missing bone. This missing portion of bone is frequently called a “bony defect”. Examples of jawbone defects are: defects which occur following tooth extraction; generalized decrease in the quantity of jawbone from trauma or long-term tooth loss; defects surrounding "old style" dental implants; defects resulting from cysts or tumor surgery.

Why is a bone graft needed?

Bone grafting is performed to reverse the bone loss / destruction caused by periodontal disease, trauma, or ill fitting removable dentures. It is also used to augment bone to permit implant placement, such as augmenting bone in the sinus area for implant placement, or augmenting bone to enhance the fit and comfort of removable prostheses, or to enhance esthetics of a missing tooth site in the smile zone. When one loses a tooth, as in an extraction, the surrounding bone collapses. To preserve this bone for future implant placement or for esthetics, a bone graft is used.

What are the types of bone graft?

1. autogenous - bone taken from one area of the patient and transplanted to another area requiring such grafting
2. allograft - either synthetic bone or bone from a bone bank (cadaver bone)
3. xenograft - bovine /cow bone

Which graft is used and when and why?

Autogenous bone is the "gold standard" and oftentimes has the most predictable results. This is described as the best type of graft because such bone is live bone with live active cellular elements that enhance bone growth, whereas other types of grafts are devoid of any active cellular material.

Allografts and Xenografts both do not require a second surgical site as does the autogenous bone. Ample amounts can be easily obtained.

Barrier membranes

In conjunction with bone grafting, membranes are often used to help stabilize the bone graft as well as displace the gum tissue from invading the healing bone graft. Gum tissue grows at a much faster rate than bone, therefore, membranes are used to prevent gum tissue from growing in and displacing the bone graft before it matures.

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Guided Tissue Bone Regeneration.........

Missing bone and tissue can be restored to create a solid foundation for your beautiful smile.

Today we are able to restore or regenerate missing bone and attachment around teeth subjected to long-standing periodontal disease or trauma. If you have lost a tooth due to trauma or disease, we can restore or regenerate bone prior to the placement of bridges or dental implants.

These methods are referred to as Guided Bone Regeneration and Guided Tissue Regeneration. The procedures attempt to regenerate lost periodontal structures, lost bone, periodontal ligaments, and connective tissue attachment that supports your teeth. This is accomplished using biocompatible membranes, bone grafts and/or tissue stimulating proteins. These procedures are common prior to or in conjunction with the placement of dental implants.

Guided Bone Regeneration and Guided Tissue Regeneration procedures have allowed millions of people to restore health to diseased teeth which would have been condemned to extraction in the past.

If you have lost teeth, these remarkable therapies have given clients a second chance to enjoy the benefits of "permanent teeth" with the help of dental implant reconstruction. You will experience an enhanced quality of life as a direct result of improved health, function and appearance.

Bone heals more slowly than the gum tissues in your mouth. Guided Bone Regeneration allows the bone to maximize its full healing potential following surgical procedures.

The treatment is simple. A biocompatible membrane is placed between the gum and bone which acts as a barrier. This barrier prevents the growth of the gum tissue from limiting the growth of the underlying bone as it heals.

Membranes around teeth are typically designed to dissolve away, or reabsorb, after several weeks of healing have passed. Some membranes used to restore bony ridges in association with bone implant therapy are not absorbable and must be removed.

Bone Grafts

A bone graft is a surgical procedure that replaces missing bone with material from your own body (autogenous bone) or an artificial, synthetic, or natural substitute.
A bone graft not only replaces missing bone, but also helps your body to regrow its own lost bone. This new bone growth strengthens the grafted area by forming a bridge between your existing bone and the graft material.

Over time your own newly formed bone will replace much of the grafted material.

Bone grafts may be needed when part of your body is missing bone. This missing portion of bone is frequently called a “bony defect”. Examples of jawbone defects are: defects which occur following tooth extraction; generalized decrease in the quantity of jawbone from trauma or long-term tooth loss; defects surrounding "old style" dental implants; defects resulting from cysts or tumor surgery.

If you have lost teeth or have teeth at risk from periodontal disease, please request your complimentary DVD and information packet or contact Dr. Phil to arrange for a complimentary private consultation. Make your request today!

Regrowing Your Lost Bone:

Guided Tissue and Bone Regeneration

In the past, the treatment of periodontal (gum) disease was considered to be painful and disfiguring. For many years, the best way to achieve the ultimate goal of therapy (shallow, maintainable pockets) was to do resective surgical procedures that often resulted in the exposure of sensitive root surfaces and the appearance of "long" teeth.

Today, periodontists are often able to restore or regenerate missing bone and attachment around teeth subjected to long-standing periodontal disease. In addition, if you have lost a tooth due to trauma or disease, we can restore or regenerate bone prior to the placement of bridges or implants.

Guided tissue regeneration (GTR) refers to procedures that attempt to regenerate lost periodontal structures (bone, periodontal ligament, and connective tissue attachment) that support our teeth. This is accomplished using biocompatible membranes, often in combination with bone grafts and/or tissue stimulating proteins.

Guided Bone regeneration (GBR) refers to procedures that attempt to regenerate bone prior to the placement of bridges and implants. This is accomplished using bone grafts and biocompatible membranes that keep out tissue and allow the bone to grow.

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Frenectomy

A frenum is a fold of tissue or muscle connecting the lips, cheek or tongue to the jawbone. A frenectomy is the removal of one of these folds of tissue.

Sometimes a frenum can be attached too high on the gums causing either recession or spaces between teeth. The procedure to remove this is a called labial frenectomy and involves the removal of tissue attachment between the two front teeth as the gap between the teeth can again pushed apart by the frenum, even after it being initially corrected via a different procedure. The frenum can be attached in such a way that it prevents the baby teeth from coming through.

A lingual frenectomy removes the fold of tissue under the tongue. Some people have a large frenum that limits tongue movement and can interfere with speech.

The condition of limited tongue mobility is called ankyloglossia, or tongue tie.

Tongue-tie is generally diagnosed in childhood and symptoms include:

- Interference with feeding in infants. Problems with speech at 12 to 18 months.

- Some older children or teenagers may notice that the frenum under their tongue becomes stuck between their front teeth, or that they can't stick their tongue out as far as their friends can.

- Adults receiving dentures may need a frenectomy if the position of a frenum (usually one between the cheek and gum in the back of the mouth, or in the middle of the upper or lower lip) will interferewith the proper fit of the denture.

Before recommending a frenectomy in a child, a dentist will consider several factors, including the probability that the condition eventually will resolve itself without surgery.

If a child has tongue-tie, he or she will receive speech therapy first to see if that can correct the problem. The therapy will involve special exercises to increase the tongue's mobility.

To complete a frenectomy, a surgeon can use a scalpel or a laser. A laser minimizes bleeding, reduces the need for sutures and causes less postoperative pain. If a scalpel is used sutures will be needed after surgery.


People receiving a laser frenectomy must remain completely still during the operation, so younger children may require general anesthesia. In older children and adults, the procedure can be done with local anesthesia, with or without nitrous oxide. The surgery itself takes very little time, and can be completed in as little as 10 to 15 minutes.

A frenectomy can take several weeks to heal completely. Rinsing with salt water helps keep the area clean. Brush and floss carefully around the area. Depending on the type of stitches your dentist uses, you may need to return to the dentist to have your stitches removed or they may dissolve on their own.

If the operation does not solve the problem, it may need to be redone. Redoing a lingual frenectomy is somewhat common. Few labial frenectomies need repeating.

Any surgery carries a risk of bleeding. Because of the many blood vessels in the tongue, lingual frenectomies are more likely to result in bleeding, although this complication is quite rare.


In adults receiving a frenectomy in the lower jaw to correct the fit of dentures, there is a risk of bruising the nerve that provides sensation to the lower lip and chin. This will cause numbness in the area that can last at some level for several months. However, your lip will not droop, as the nerve does not affect movement, only sensation.

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