Dental Implants

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, an injury, or some other reason. Dental implants look and feel like natural teeth, and with proper care, they can be a long-term solution to tooth replacement.

The procedure involves a titanium screw/post, which is surgically placed into your jaw. Over the next few months, the implant and bone are then allowed to bond together to form an anchor for your artificial teeth. During this time, a temporary tooth replacement option can be worn. Sometimes a second procedure is needed to place an extension on the implant. This small metal post, called an abutment, completes the foundation on which your new tooth will be placed. The replacement tooth (or bridge or denture) will then be created by your general dental professional and attached to the implant.

Dental implants look and function like natural teeth, and they require the same care. We recommend brushing twice a day, flossing at least once a day, and receiving regular check-ups including an annual comprehensive periodontal evaluation.

Additional procedures may be required before an implant can be placed:

• “Bone Grafting” or “Ridge Modification”  may be needed if you don’t have enough bone to support an implant. During this procedure, bone or bone substitute is added where needed to ensure a proper foundation for implants.

• “Sinus augmentation” may be needed to place implants in the upper back jaw, where your bone is very close to your sinus. In this procedure, the sinus floor is raised so there is more room for new bone to grow to provide a proper foundation for implants.

• “Gum Grafting” may be necessary to improve the quantity or quality of tissues for a future dental implant.

• All of these procedures have been shown to greatly increase your chances for successful implants that can last for years to come.

Grafting

Gum Grafting

Gum grafting, also called ‘soft tissue grafting’, ‘connective tissue grafting’, or ‘periodontal plastic surgery’ include procedures done to strengthen the gum tissue around teeth and implant sites.

The quality or quantity of gum tissue may be deficient due to a number of causes, including genetics, aggressive brushing, and tooth position. As a result, recession, tooth sensitivity, and increased inflammation can occur in these areas.

A gum graft can be done to strengthen this tissue. It may also be possible to cover these exposed roots to improve esthetics, protect from decay, and improve the long-term health and stability of the teeth. Gum tissue from the palate is often used to augment the soft tissues, and can provide safe and predictable results. 

Bone Grafting

Bone grafting, also called ‘allografting’, ‘autografting’, ‘ridge modification’, ‘socket preservation’ or ‘sinus augmentation’ involves the addition of bone mineral to your jaw in order to improve the success of dental implant procedures. After a healing period, the bone will be ready for implant placement.

• “Ridge modification/Alllografting” may be needed if you don’t have enough bone to support an implant. This bone loss could be caused by periodontal disease, wearing dentures, injury, or trauma. During this procedure, bone or bone substitute is added where needed to ensure a proper foundation for implants.

• “Sinus augmentation” may be needed to place implants in the upper back jaw, where your bone is very close to your sinus. In this procedure, the sinus floor is raised so there is more room for new bone to grow to provide a proper foundation for implants. 

• “Socket Preservation” is sometimes needed to preserve bone and minimize bone loss when a tooth has been removed. One common technique is to fill the socket with bone or bone substitute and allow the bone to heal before implant placement. 

In general, these grafting procedures are recommended to improve the health, stability, and long-term function of both teeth and implants.

Periodontal Disease

Periodontal Disease, also called ‘gum disease’, is a breakdown of the supporting foundation of the teeth. Around 50% of adults experience some form of this chronic inflammatory breakdown, and it is often painless and worsens over time if it is untreated. Similar to a fence-post in the ground, a tooth is anchored by its root, and any lost support may lead to further problems. Early detection is important, and maintaining the foundation below the surface not only keeps your teeth and mouth healthy, but is an important part of total body health. 

The process starts when plaque bacteria below the gum line irritate the gums and trigger an inflammatory response characterized by reddened tissue, swelling, and bleeding. In severe cases of periodontal disease, bacteria erode gum and supporting bone tissue, causing gum recession, spaces between the teeth and gums, loosening and shifting teeth, and eventually tooth loss. 

Risk Factors 

• Poor Oral Health Habits: Without twice-daily brushing and regular flossing, there is an increased likelihood of plaque buildup. 

• Age: Adults age 65 and over have higher incidences of periodontal disease, according to data from the Centers for Disease Control and Prevention. 

• Medications: Certain drugs can reduce the flow of saliva. Without adequate saliva production, the mouth can become a breeding ground for bacteria. 

• Tobacco Use: Users of cigarettes and chewing tobacco are at an increased risk of periodontal disease. Tobacco use is said to be one of the most significant risk factors in the development and progression of periodontal disease. 

• Genetic Predisposition: Research has found some individuals may be genetically susceptible to periodontal disease.

• Smoking: In addition to serious illnesses such as cancer, lung disease, and cardiovascular disease, research finds smoking to be a significant risk factor in the development and progression of periodontal disease. 

If periodontal disease is suspected, the next best step is to seek the counsel of a periodontist, a dental specialist uniquely trained in the treatment of periodontal disease. Depending on the severity of disease, a periodontist may recommend a number of treatments ranging from deep cleaning, medication, or surgery. There are also a number of procedures to restore aesthetics and function in the event of tooth loss. Treatment may also include a care routine and the avoidance of certain habits like smoking. 

Periodontal Plastic Surgery Treatments

Just as cosmetic surgery has been helping people improve their appearance, several periodontal plastic surgery procedures are available to help enhance the aesthetics of your teeth and gums. Here are some examples of these procedures: 

Crown Lengthening

Crown lengthening is a procedure to remove excess gum tissue, exposing more of the “crown” of the tooth. This procedure is for patients who feel their teeth are too short or their gum line is uneven. The gum line is then sculpted to create the right proportion between gum tissue and tooth surface. This can be done to just one tooth, or to enhance your entire smile. 

Pocket Depth Reduction

Deep pockets caused by periodontal disease can be corrected through pocket depth reduction. This procedure is used to clean the pockets and secure the gum tissue in its original place. Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help maintain your healthy smile. 

Grafting Procedures

Gum Grafting and Bone Grafting procedures are recommended to improve the health, stability, and long-term function of both teeth and implants. Further information can be found here.

Combination Procedures

Sometimes you may need a few of these procedures to build the framework for your perfect smile. Often, periodontal plastic surgery is used to lay the foundation for further cosmetic enhancements, such as orthodontics and veneers. A combination of periodontal procedures can result in a beautiful new smile and improved periodontal health- your keys to smiling, eating, and speaking with comfort and confidence.  

Procedure Expectations and Post-Operative Care

A detailed explanation of all aspects of your treatment, including the risks/benefits, expectations during the procedure, and post-operative care, will be discussed at your consultation appointment. 

Some general post-operative instructions for oral surgical procedures can be found below: 

Activity

After leaving the office, relax for the remainder of the day. Avoid strenuous activity for several days.

Swelling

Swelling may be present after the surgery and may peak at 48-72 hours after surgery. Using an ice pack outside of the face for the remainder of the day at 20-minute intervals can help minimize this. 

Bleeding

You may notice slight bleeding from the surgical site. This type of minor bleeding for one or two days is not unusual and is not a major concern. If at any time you notice the formation of large blood clots or any obvious flow of blood which is more than a light ooze, you can apply pressure with wet gauze for 30-60 minutes.

Eating

It is necessary to maintain a relatively normal diet throughout the course of healing. For the first few days, soft foods can be eaten. Chewing should be done predominately on the side opposite the surgical site. It may be necessary to stick to liquids for the first day, if chewing is uncomfortable.

Discomfort and Medications

Periodontal surgery, like other surgical procedures, may be associated with varying degrees of discomfort. This depends on the procedure involved and individual differences. If analgesics have been prescribed, it is usual to take the first dose while the surgical site is still anesthetized (“numb”). All medication should be taken strictly as prescribed. The interval between taking the medications and the total length of time that you are to remain on your medications has been carefully determined to give you the maximum benefit with the minimum use of drugs. Variation from the prescribed regime can affect healing and the success of your procedure.

Oral Hygiene and Care of the Surgical Site

Continue to brush and floss the teeth that were not involved in the surgery. The surgical area should not be disturbed for the first 7-10 days post-operatively. However, you may rinse gently with a mouthwash prescribed to you. After your sutures have been removed, we will provide a soft post-surgical brush to clean the area.