Surgical Treatments

Surgical dental treatments are an option for some patients that may not have enough bone to support a dental implant. In this case, your doctor can perform a ‘bone grafting’ procedure to help your body build new bone for the implant placement.

When a tooth is broken near or below the gum line, it cannot support a crown or other prosthetic materials. Rather than pulling the tooth and having to replace it with a dental implant, we can frequently salvage it using a Restorative Crown Lengthening technique.

Crown lengthening is a surgical procedure that can create more tooth structure by removing soft tissue (gum) and hard tissue (bone) from the patient’s adjacent teeth (one tooth in front and one tooth behind the damaged tooth). This, therefore, becomes a three-tooth procedure, and its goal is providing adequate tooth structure to anchor the new crown.

This technique consists of trimming away infected gum tissue and recontouring the uneven bone and tissue while removing bacterial toxins from root surfaces. Small access incisions along the necks of the teeth are made under a local anesthetic with sutures, and a surgical dressing is typically required. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are more routinely used today.

This surgical procedure “regenerates” the previously lost gum and bone tissue. Other regenerative procedures involve the use of bioactive gels (Gem-21, Emdogain) to stimulate new bone formation as well as bone grafting materials and bioabsorbable membranes.

The gingiva is the gum area around the root of the tooth. When major recession of this gum area occurs, the body loses a natural defense against both bacteria and trauma. Gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance to the gum and tooth. Significant gum recession can expose the root surface, which is softer than tooth enamel, leading to root caries and root gouging.

A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth (palate), or gently moved over from adjacent areas, to provide a stable band of attached gingiva around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root.

In certain cases, we can avoid using the palate as a donor site by using a bioactive gel (Gem-21, Emdogain) in conjunction with a bone graft material and a bioabsorbable membrane to achieve the same goal of root coverage. The gingival graft procedure is highly predictable and results in a stable healthy band of attached tissue around the tooth.

Over a period of time, the jawbone associated with missing teeth sinks in and shrinks. This often leaves a condition where the poor quality and quantity of bone makes the patient ineligible for the placement of dental implants.

We now have the ability to grow bone where needed and prevent bone loss as well, using advanced biomedical materials such as Regenaform®, Dynablast® and Cerasorb®. This gives us the opportunity to place implants of proper length and width, and it also gives us a chance to more effectively restore esthetic appearance and functionality.

In the upper jaw when molars (back teeth) are lost, it is common that bone above the sinus will be shallow and have too little depth to hold dental implants. Sinus lift refers to a surgical bone graft technique whereby the floor of the maxillary sinus can actually be elevated to change the anatomy, increasing bone depth and volume.

The scientific term is called subantral augmentation, which means below the sinus addition of bone. The bone graft is placed under the sinus, not actually inside it, so sinus physiology and function are not disturbed. This is a safe and predictable procedure, which is often required when patients need dental implants in the posterior maxilla (upper position jaw).