Crown Lengthening

The crown lengthening procedure is designed to increase the amount of viable tooth structure exposed. When decay extends below the gum line, it can often be difficult to attach a restoration. By removing some of the tissue around the tooth, we can often save teeth that, without crown lengthening, would be unrestorable.

A second reason for crown lengthening would be the existence of a "gummy smile." If you show a lot of gum when smiling, especially in the upper anterior area, crown lengthening may be recommended for cosmetic purposes.

Bone Grafts/Sinus Lifts

When there is not sufficient bone to place a dental implant, it is often necessary to add bone. This can be done in 2 ways. On upper posterior teeth, where the sinus can be an issue, a sinus lift may be recommended to increase the amount of sound bone to hold an implant. If significant bone loss has occurred in the past due to infection, traumatic extraction, a bone graft may be placed to increase the amount of viable bone to stabilize an implant.

Deep Cleaning

If it has been a few years between dental visits, or if you are not a regular flosser, tartar may start to deposit below your gums. When tarter builds up below the gum line, a regular cleaning may not be sufficient. When determining the need for such a procedure, we use a periodontal probe to measure pockets around the teeth. We expect healthy teeth to have pockets of 1-3mm. Any pocket 4mm or greater often requires special instruments and more time to remove tarter. It can also be uncomfortable without anesthesia, so we numb all patients before deep cleanings. Because of the increase in time and the fact that the patient will need to be numb, we do not do a full mouth deep cleaning all at once. Most likely we will plan to do a quarter or half of the mouth in one appointment.

It is very important that, after your deep cleaning procedure, you maintain a healthy state at home. Patients often believe that the deep cleaning is the end of treatment, when actually, all we have done is create an environment for healing. When all tartar is removed, it leaves the tooth surface smooth and ready for tissue to reattach. If the area is not cleaned thoroughly, more tartar will form and the pocket around the tooth will not heal. Through daily brushing and flossing, you can ensure you are doing all you can to promote healing of the gums.

Smokers often have a hard time healing due to the lack of oxygen to the tissue. We recommend quitting smoking before investing the time and resources into deep cleanings.

Surgical Cleaning

When tartar and bacteria build up below the gum line, our first attempt to clean below the gums is accomplished with a deep cleaning or scaling root planing. Often, if periodontal pockets around the tooth are 7mm or greater, or instruments can't get far enough down below the gum to effectively remove all tartar, we may need to surgically expose the area to remove it. This is known as a surgical cleaning, or open flap debridement.

Tissue Regeneration

Also known as a gingival graft, guided tissue regeneration is used to cover exposed roots of teeth. Each tooth has a certain amount of attached tissue surrounding it, preventing bacteria from getting between the tooth and gum. You can feel with your tongue that the entire roof of your mouth is attached tissue- meaning not moveable. On all other surfaces of your teeth, the attached tissue transitions into moveable tissue so you can move your lips and tongue. When the amount of attached tissue is insufficient for acting as a barrier to infection, we may recommend a tissue regeneration procedure, more commonly referred to as a graft.

Gingivectomy

A gingivectomy is a procedure to reshape the gum tissue. This can be done for a variety of reasons, and in a variety of areas. One of the more common areas for a gingivectomy is the anterior teeth. If teeth have the appearance of not being fully erupted, and a lot of gum shows when you smile, a gingivectomy can expose more tooth, giving the appearance that the teeth are longer. Sometimes this is necessary for health, and other times it is a cosmetic procedure. The procedure may be done with a laser, or traditional scalpel.

Another type of gingivectomy is a "distal wedge." This procedure involves re-sculpting the tissue behind a back tooth. The tissue behind the last tooth can grow up over the tooth and need to be removed. By removing a small section and then securing the gum back together, the prominence of this piece of tissue can be reduced significantly, helping with food impaction and ease of cleaning.

Before	After

Frenectomy

Your mouth has several frenum attachments. There are frenum attachments between the upper and lower front teeth, as well as near the premolar area. If this attachment is too low, or if it is pulling on the gum in such a way that it causes gum recession, a frenectomy, or frenum augmentation, is often necessary.

The procedure is performed after the area is numbed, and is usually a very short procedure. The frenum attachment can be altered using a laser or traditional methods, and heals completely in about 2 weeks.

Before	After