We offer our patients a variety of esthetic periodontal plastic and reconstructive procedures to enhance the appearance of the teeth and smile. One of the most common esthetic procedures is anterior crown lengthening to improve a “gummy” smile. This procedure involves reshaping the gum and bone tissue to expose more of the natural tooth, or “lengthen” it. Soft tissue grafts are often used to cover exposed tooth roots, which enhances the appearance of the smile by creating a more natural-looking gum line and teeth that are the proper size and shape. Dr. Beagle has a special interest in these and other periodontal plastic surgery procedures.
A frenectomy is a surgical procedure performed to release small elastic fibers (the frenum) which put tension on the gum tissue and can limit tongue mobility, cause large spaces or diastemas between teeth, interfere with a prosthetic appliance, and/or cause gum recession.
Impacted Tooth Exposure
Patients frequently present with permanent teeth that fail to erupt and remain impacted or hidden below the gum tissue. These teeth often require the combined services of the Periodontist and Orthodontist to properly expose and then position the affected tooth in relation to the neighboring teeth. The periodontal surgical procedure exposes the tooth, allowing the orthodontist the opportunity to affix orthodontic appliances to complete the desired tooth movement.
Soft Tissue Grafting
Increasing the Thickness of Keratinized Tissue
Many people present with thin gum tissue both around teeth and dental implants. Thin gum tissue may have a greater tendency to become inflamed due to the presence of plaque. When this thin tissue becomes inflamed, many patients will become uncomfortable when performing brushing and flossing. Lack of treatment in this situation may result in the exposure of a root surface, or loss of bone around a dental implant. Treatment of this problem involves the surgical placement of a gum graft, also known as a Free Gingival Graft, at the affected site.
Deepening of the Vestibule
The anatomy that resides between the gum tissue and the lip or cheek is called the vestibule. In some patients the depth of the vestibule is very shallow, and may create challenges with plaque removal from teeth due to inability to brush properly. Shallow vestibules also may create problems for patients who wear dentures or removable partial dentures, preventing the appliances from seating properly, resulting in an unstable prosthesis. Treatment of this problem involves the surgical placement of a gum graft, also known as a Free Gingival Graft, at the affected site.
Coverage of Exposed Root Surfaces
Patients who present with thin tissue, prominent teeth, aggressive tooth brushing habits, or thin bone may be subject to the exposure of root surfaces. Exposed root surfaces are not merely un-esthetic, but may be prone to sensitivity to hot and cold temperatures, as well as tooth brushing. Exposed root surfaces can be treated with a gum grafting procedure, also known as a connective tissue graft, at the affected site.
Historically, soft tissue graft procedures (free gingival graft and connective tissue graft) have relied upon adding soft tissue usually taken from the roof of the mouth and transferred to the affected areas. Our office offers an alternative product, known as GINTUIT™ (Allogeneic Cultured Keratinocytes and Fibroblasts in Bovine Collagen) to reinforce thin gum tissue. Gintuit is an FDA-approved, cell-based product, than has been proven to predictably generate new tissue and thus eliminates the need to harvest tissue from other parts of the mouth. For more information about Gintuit, please go to the Patient Resource Center of our website and follow the link provided.
Ridge Augmentation for Prosthetics
Sites in which teeth have been extracted may present with a defect, or concavity, in the gum. This defect may be unsightly, and may affect the cosmetics of the replacement tooth when a fixed bridge is utilized. These defects can be corrected to allow for a more esthetic and hygienic outcome by using a soft tissue graft designed to surgically reconstruct the deficient ridge.
Dr. Beagle was the first periodontist in Indiana to integrate the surgical operating microscope into the practice of periodontic therapy, and remains one of the only a small number of periodontists in the midwest trained to perform periodontal microsurgery. Dr. Beagle utilizes the surgical microscope and microscopic surgical techniques extensively, as their benefits are well-documented within the clinical literature. Skilled use of the microscope allows for: • a much less invasive surgical technique • less trauma to the tissues during surgery • better visualization during the procedure • faster healing • improved esthetics • less post-operative discomfort
As periodontal disease progresses, the pockets that form between the teeth and gums become deeper and the bacteria that develops around the teeth accumulates and advances under the gum tissue. The result is damage to the supporting tissues and loss of bone. To prevent further damage to the bone and gum tissues caused by the progression of the disease and infection, it is necessary to reduce the pocket depth and eliminate the existing bacteria. The procedure to reduce the pockets involves folding back the gum tissue and removing the bacteria that causes the disease, then securing the gum tissue in place. It may also be necessary to smooth irregular surfaces of the damaged bone and reshape it. This makes it more difficult for bacteria to accumulate and grow and increases the chance of saving teeth that otherwise would have been lost.
Guided Tissue Regeneration
Regenerative procedures are recommended when the bone supporting the teeth has been destroyed. These procedures can actually reverse some of the damage by regenerating lost bone and tissue. Typically the procedures involve folding the gum tissues and removing the bacteria that cause the disease. Then special membranes, or bone grafts, can be used to encourage tissue and bone regeneration.
Laser Assisted New Attachment Procedure
Laser assisted new attachment procedure is a clinical procedure designed to treat periodontal disease utilizing a surgical laser in combination with root planing and scaling. As of this time, the merits of this procedure have not been established with appropriate studies in peer-reviewed scientific literature. Typically the procedure is considerably more expensive than other treatment modalities designed to achieve the same purpose, yet treatment outcomes have not been shown to be superior. Neither comparative nor long-term studies currently exist to sufficiently support this method of care and its significantly increased expense, as compared to other well-documented treatment protocols.
If teeth are decayed or broken below the gum line, crown lengthening is often necessary in order to restore the teeth. Since the procedure adjusts the gum and bone levels to expose more of the tooth surface, it is easier to restore these teeth with cosmetic fillings and crowns. Crown lengthening is often performed for cosmetic purposes, as well. One such indication is crown lengthening to improve a “gummy” smile. This involves reshaping excess gum and bone tissue to expose more of the natural tooth. The procedures can be performed for a single tooth to even the gum line or for multiple teeth to improve the appearance of the entire smile.