Dental Implants are a great way to replace single or multiple missing teeth. They also provide a fixed alternative to having removal partial or complete dentures. Implants can be utilized to provide excellent support and stability for those who wear removable appliances by adding a few implants.
Dental implants are artificial roots made out of titanium that are surgically placed into the upper or lower jaw bone by a Periodontist – a certified specialist of the gums and supporting bone. Crowns/teeth which are very natural looking are specifically fabricated and connected to these implants to restore a patient’s smile and function.
Dental implants are very strong, durable and if properly planned and placed by an experienced surgeon, should last many years, however dental implants still require follow up and care and occasionally need to be replaced.
Reasons for dental implants:
• Replace one or more missing teeth without affecting adjacent teeth
• Prevent teeth movement and shifting into missing tooth spaces
• Restore a patient’s confident smile
• Restore chewing, speech and improve digestion
• Restore or enhance facial profile and tissue
• Support a bridge or denture, making them more secure and increase comfort
What does getting dental implants involve?
Patient’s are first seen for a full examination and consultation with one of the Periodontists in our office. Depending on the complexity, impressions (molds) and radiographs (x-rays) are taken of the jaw to determine bone, gum tissue and spacing available for implant placement. On the day of the surgery, while the area is numb, the implant will be surgically placed into the bone and allowed to heal and integrate itself into the jaw bone. The healing time can range between weeks to months. Temporary restorations are fabricated in the meantime to fill the gap while the implant heals. Occasionally, a second surgery may be required in order to place the “post” that will hold the artificial tooth in place.
Once implants are healed, the artificial teeth are custom made and fitted to the implants, this process can be completed within a few weeks or months depending on the complexity of case. Once the artificial teeth are securely attached to the implants, they provide excellent stability and comfort to the patient.
You will receive step by step care instructions throughout your treatment process. Good oral hygiene, eating habits and regular dental visits will aid in improving the longevity of your new implant.
Chao Pinhole Surgical Technique
What is the Chao Pinhole® Surgical Technique (PST)?
How does the Chao Pinhole® Surgical Technique (PST) differ from traditional gum grafting?
How is Chao Pinhole® Surgical Technique (PST) performed?
What are the benefits of Chao Pinhole® Surgical Technique (PST)?
- Less discomfort for the patient after treatment
- Faster recovery for the patient than traditional grafting
- No need for uncomfortable sutures
- No need for scalpels or invasive surgical tools
- No need to take donor tissue from the patient’s palate
- Excellent, natural-looking, long-lasting results
A gum graft is also known as periodontal plastic surgery or a gingival graft. Surgical periodontal procedures that use grafted oral tissue to cover the exposed root of a tooth are collectively known as gum graft.
Periodontal disease can result in gingival recession. This exposes the roots of the teeth and is commonly caused by trauma or overly aggressive brushing.
Some of the most common types of gum grafting include:
- Free gingival graft – In order to thicken gum tissue, this procedure removes a layer of tissue from the palate and places it to the affected area of the gum recession. There will be no permanent damage as both sites heal.
- Subepithelial connective tissue graft – When roots are exposed, the procedure is commonly used because it is relatively painless. The site of gum recession is covered by a tissue that is removed from the outer layer of the palate.
- Acellular dermal matrix allograft – This procedure has minimal pain because the donor tissue is not taken from the patient but rather from medically processed, donated human tissue.
Reasons for gum grafting
While the name may conjure some trepidation, gum grafting is very common and yields excellent results.
Gum grafting has major benefits including:
- Reduced sensitivity – Drinking or eating hot or cold foods can cause increased sensitivity to the teeth when the tooth root becomes exposed. In order to restore health to your gums, gum grafting can be used to permanently cover the exposed root and reduce discomfort.
- Improved appearance – Inflammation and gum recession are common in periodontal disease. A “toothy” smile is caused when the teeth appear larger than normal because of a receding gum line. Gum grafting can provide symmetry by making the teeth appear shorter and generally more attractive to look at. Moreover, adjacent tissue can be augmented and enhanced in the same procedure to further enhance the look of the smile.
- Improved gum health – Gum tissue is destroyed rapidly as periodontal disease progresses and is left untreated. Gum grafting can stop tissue and bone loss while also providing protection for the exposed root. It can also prevent additional problems from occurring.
What does gum grafting treatment involve?
Before gum grafting takes place, the dentist must first determine if it is needed and then administer several treatments. First, calculus (tartar) and bacteria must be removed and the teeth thoroughly cleaned both supra and subgingivally. Education and awareness are important factors in effective treatment. The dentist will provide educational literature, care advice, and other tools to educate the patient on homecare and how to reduce and avoid future periodontal disease.
Usually, a local anesthetic is used when performing the gum grafting procedure. Depending on whether the tissue comes from the patient’s palate or a tissue bank helps to determine the exact use of anesthetic.
In order to accommodate the graft, a small pocket must be made by making a small incision at the recipient site. The connective tissue graft is placed in between two sections of tissue that are created using a split-thickness incision. There will be some excess graft material as it is usually a bit larger than the recession area.
To prevent shifting and to stabilize the graft, sutures are used. As the surgical area heals during the first week, it will be protected by surgical material. It will take approximately six weeks for the gums to heal and appear uniform.
Dentists diagnose and treat gum recession every day. It is a common and widespread problem but first requires a thorough examination of the affected areas to find the actual underlying problem. In order to stop the progress of gum recession and prevent future occurrences, both surgical and nonsurgical procedures may be performed. But first, the cause of gum recession must be identified.
Common Causes Of Gingival Recession Are:
- Overaggressive brushing – The tooth enamel at the gum line erodes as the tissue becomes irritated or inflamed. This can be caused by using a hard-bristled toothbrush or brushing too hard. Thus, over brushing can be just as harmful as brushing too little.
- Poor oral hygiene – Teeth are negatively affected with improper flossing and brushing because plaque builds up. The plaque can cause infection which leads to the erosion of the underlying jawbone because it contains various bacterial toxins.
- Chewing tobacco – The entire oral cavity can be destroyed by any kind of tobacco use. The devastating effects of chewing tobacco begin when the gingival lining of the mouth is aggravated. With continued use, gum recession occurs.
- Periodontal disease – Both systemic diseases, such as diabetes, and improper oral hygiene can bring about periodontal disease. Diabetics have excess sugars in the mouth and narrowed blood vessels that provide ideal conditions for oral bacteria. Infection results from bacterium progressing deeper into the gum and bone tissue. If left untreated, the tooth is lost.
Treatment Of Gum Recession
Individual cases of gum recession are varied and require slightly different treatments. Primarily, the underlying cause of the recession needs to be identified and addressed.
Using a softer toothbrush with a gentle brushing technique can help if the gums have been eroded by overly aggressive brushing. Poor oral hygiene may require prophylaxis (professional dental cleaning) to eliminate bacteria and debris from the gum pockets. Scaling and root planing may be needed to halt gingival inflammation and clean the teeth if severe calculus (tartar) has built up.
Cosmetic surgery or restorative surgery may be needed after the cause of the gingival recession has been dealt with. To restore natural symmetry to the gums, gum grafting and gum tissue regeneration are two very effective ways to create a beautiful smile.
Bone grafting is often closely associated with dental restorations such as bridge work and dental implants. In the majority of cases, the success of a restoration procedure can hinge on the height, depth, and width of the jawbone at the implant site. When the jawbone has receded or sustained significant damage, the implant(s) cannot be supported on this unstable foundation and bone grafting is usually recommended for the ensuing restoration.
There are several major factors that affect jaw bone volume:
- Periodontal Disease – Periodontal disease can affect and permanently damage the jaw bone that supports the teeth. Affected areas progressively worsen until the teeth become unstable.
- Tooth Extraction – Studies have shown that patients who have experienced a tooth extraction subsequently lose 40-60% of the bone surrounding the extraction site during the following three years. Loss of bone results in what is called a “bone defect”.
- Injuries and Infections – Dental injuries and other physical injuries resulting from a blow to the jaw can cause the bone to recede. Infections can also cause the jaw bone to recede in a similar way.
Reasons for bone grafts
Bone grafting is a highly successful procedure in most cases. It is also a preferable alternative to having missing teeth, diseased teeth, or tooth deformities. Bone grafting can increase the height or width of the jawbone and fill in voids and defects in the bone.
There are essentially two basic ways in which bone grafting can positively impact the health and stability of the teeth:
- Jaw Stabilization – Bone grafting stabilizes and helps restore the jaw foundation for restorative or implant surgery. Deformities can also be corrected and the restructuring of the bone can provide added support.
- Preservation – Bone grafting can be used to limit or prevent bone recession following a tooth extraction, periodontal disease, or other invasive processes.
Initially, the dentist will thoroughly examine the affected area in order to assess the general condition of the teeth and gums. If periodontal disease is present or the adjacent teeth are in poor condition, these factors will be fully addressed before the bone grafting procedure can begin. The dentist will also recommend panoramic x-rays in order to assess the precise depth and width of the existing bone. On occasion, a CAT scan may be recommended to determine the bone condition. Depending on these results, the dentist may also anesthetize the area and explore into the gum in order to determine what kind and how much bone is required.
What Does Bone Grafting Involve?
There are several types of bone grafts. Your dentist will determine the best type for your particular condition.
- Autogenous Bone Graft – Harvested from the patient’s own body (usually from the posterior part of the lower jaw or the chin). This method is usually preferred because it produces the most predictable results.
- Allograft Bone Graft – Cadaver or synthetic bone is used in this type of graft.
- Xenograft – Cow bone is used in this type of graft.
The bone grafting procedure can often take several months to complete. Bone is typically harvested from your own body (or on rare occasions obtained from a “bone bank”) and added to the affected site. This bone will fuse with the existing bone and the migration of cells will cause firm adhesion and cell growth. Supplementing the jaw with bone will result in greater bone mass to help support and anchor the implant(s).
During the surgery, the dentist will numb the grafting and extraction sites using local anesthetic. A small incision will be made to prepare the site for the new bone and it will be anchored into place. On occasion, a synthetic membrane may be used to cover the new bone. This membrane prevents soft tissue and bacterial invasions, and encourages new bone growth. The surgery does not require an overnight stay, and you will be provided with comprehensive instructions for your post-operative care. The dentist will prescribe medications to help manage infection, discomfort and swelling.
Dental implants and other restorative procedures depend on the jawbone being sufficiently strong and thick. When periodontal disease has taken hold, the jawbone may have become too thin to successfully support an implant. Natural bone regeneration (or bone grafting) is one of the best ways to promote growth and thicken the jawbone.
Initially, bone grafting material is obtained from elsewhere on the body or from a bone bank. The gums are gently pulled back, and an opening is made in the jawbone where the grafting material will be packed in tightly. A membrane is used to maintain the shape of the new bone, and tissue stimulating proteins and a platelet-rich growth factor may be applied to promote faster healing. The surgical site will be sutured and packed with protective material. The bone will naturally regenerate and become strong enough to eventually support an implant.
Periodontal Disease and Treatment
The word “periodontal” literally means “around the tooth”. Periodontal diseases are bacterial gum infections that destroy the gums and supporting bone that hold your teeth in your mouth. Periodontal disease can affect one tooth or many.
The main cause of periodontal disease is bacterial plaque, a sticky, colourless film that constantly forms on your teeth. If the plaque is not removed, it can turn into a hard substance called calculus or tartar. Calculus is so hard, that it can only be removed by an oral health professional, such as a dentist or dental hygienist. The bacteria in plaque infect the gums and release toxins that cause redness and inflammation. The inflammation and the toxins themselves cause destruction of the tissues that support the teeth, including the bone. When this happens, the gums separate microscopically from the teeth, forming pockets that fill with even more plaque causing even more infection.
Periodontal Diseases are multi-factorial
This means that there is not just one cause but rather multiple factors that can affect the health of your gums.
Examples are: Tobacco, Hormonal changes, Genetics, Stress, Oral contraceptives, Poor nutrition, Systemic diseases such as Diabetes.
Types of Periodontal Diseases
There are many types of Periodontal diseases. The following are the most common:
Gingivitis: Mildest form of periodontal disease. Gingivitis causes the gums to become red, swollen and bleed easily. There is usually no discomfort at this stage. It is reversible.
Chronic Periodontitis: Results in inflammation within the soft tissues surrounding the teeth, causing progressive attachment and bone loss. It is diagnosed by the formation of “pockets”, bone loss on a dental radiograph (x-ray) and/or receding gums. It is most common in adults, but can occur at any age.
Aggressive Periodontitis: This form occurs in patients who are otherwise in good health. Common features include rapid attachment loss and bone destruction.
Periodontitis as a manifestation of Systemic Diseases: Associated with one of several systemic diseases that are related to periodontitis, such as diabetes.
Necrotizing Periodontal Diseases: These types of periodontal diseases cause ulcers in the gums between the teeth and are most commonly observed in individuals with certain conditions including, but not limited to, HIV infection, malnutrition and immunosuppression. Stress and smoking can sometimes contribute to this problem..
Signs and Symptoms of Periodontal Diseases
Periodontal diseases are often silent, meaning that symptoms may not materialize until significant bone loss has occurred. Common symptoms and signs include:
- red, swollen or tender gums
- bleeding while brushing or flossing
- receding gums
- loose or separating teeth
- pus between gum and tooth
- persistent bad breath
- a change in the way your teeth fit together when you bite
- a change in the fit of partial dentures
The Periodontal Examination
The periodontist (a dentist who specializes in the prevention, diagnosis and treatment of tissues surrounding the teeth) will evaluate your periodontal health and will work with you to determine the best treatment options to control your disease and bring you back to health.
During a periodontal examination, the periodontist will gently place a small measuring instrument, called a periodontal probe, in the space between the teeth and gums to measure their depth. Probing measurements up to 4mm are considered generally healthy, and >5mm pockets may indicate periodontitis.
In addition, dental radiographs may be taken to evaluate the health of the bone supporting your teeth.
The Periodontal Treatment
Usually divided into 3 Phases:
Phase 1 (non-surgical periodontal therapy) – Oral Hygiene Instruction is the first step to learn how to control plaque-build-up. Scaling and Root Planing (SRP) is a meticulous cleaning of the root surfaces below the gum line to remove plaque, toxins and calculus from the root surfaces of the teeth. For comfort, dental anesthesia will be used. SRP may be the only mode of treatment needed or may be the first step towards more advanced periodontal treatments, such as periodontal surgery. Following adequate time to respond to your treatment, you will be asked to return to the office for a re-evaluation, to determine if further active therapy is needed.
Phase 2 – If periodontitis has advanced to the point where the pockets are very deep and significant amounts of bone are lost, surgical therapy may be necessary.
Phase 3 – Ongoing periodontal maintenance will allow your periodontist to assess your periodontal health and make sure your infection stays under control or remains eliminated. Regular cleanings (every 3-4 months) will be needed. Without ongoing treatment, periodontal diseases can often recur.
Your initial consultation will allow us the opportunity to assess your problem and diagnose whether there is an endodontic solution to fixing or repairing the natural tooth.
Occasionally endodontic surgery is required in order to remove the portion of damaged bone and root tip. This procedure is referred to as an apicoectomy or root-end resection.
Root Canal Diagnosis
Root canal diagnosis is the procedure of determining whether a root canal treatment, retreatment, or endodontic surgical procedure is the best solution to treat a particular dental problem.
Root Canal Treatment
This simple treatment can save your natural teeth and prevent the need for dental implants or bridges. Root canal therapy is one of the most common dental procedures performed.