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Cosmetic Enhancement
These procedures are a predictable way to cover unsightly, sensitive or exposed root surfaces and to prevent future gum recession. If you are unhappy with the appearance of short unsightly teeth this can be greatly improved by a combination of periodontal procedures by Dr. Canal or Dr. Calem and cosmetic dentistry by your dentist.
Gum Grafting Procedures
(Subepithelial connective tissue grafts)
When recession of the gums occurs, the roots of the teeth show and the body loses a natural defense against both bacterial penetration and trauma. The primary problem is that the patient is not only losing gum tissue, but also bone. The underlying reason for the recession is genetically thin gum and bone. When gum recession is a problem gum reconstruction using grafting techniques is an option.
When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary. However, when recession reaches the cheek tissues, the first line of defense against bacterial penetration is lost.
Gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance to the gum and tooth. Also, gum recession, when significant, can predispose to worsening recession and expose the root surface, which is softer than enamel, leading to root cavities and root gouging.
A gingival graft is designed to correct these problems. A thin piece of tissue is taken from the roof of the mouth, or gently moved over from adjacent areas, to provide a stable band of attached gum around the tooth. The gingival graft may or may not be placed in such a way as to cover the exposed portion of the root.
The gingival graft procedure is highly predictable at thickening the gum and protecting the bone.
Crown Lengthening
When deep decay occurs below the gumline, it may be necessary to remove a small amount of bone and gum tissue. Your dentist may ask for this procedure before he or she makes a new crown for your tooth. Reshaping the gum and supporting tissues allows your general dentist adequate room to place a quality good fitting final restoration.
Another cosmetic indication for crown lengthening is when the front teeth are too short or of uneven length. This procedure corrects a "gummy smile".
What is Crown Lengthening?
When a tooth is fractured or decay extends below the gum line, this area must be uncovered before it can be restored, for a number of reasons.
In order for the gum to heal against the tooth in a healthy manner, there must be 3 millimeters of healthy tooth between the margin of a filling or cap and the crest of the bone which supports the tooth. This allows space for proper attachment of the gum to the tooth.
A tooth which is broken or decayed below the gum is also difficult, if not impossible, for your dentist to restore correctly, as access and visualization of the area is compromised.
In addition, even the best filling or cap will trap bacteria where the restoration meets the tooth.
If this area is below the gum where you can not properly clean it, the bacterial accumulation results in both periodontal problems and the formation of a new cavity at the base of the filling.
A crown lengthening procedure, which reshapes the gum and supporting tissues, will solve these problems.
After treatment, the fractured or decayed area is uncovered and accessible to the dentist for restoration, and the needed space has been established between the supporting tissues and the final position of the restoration.
This will allow a final restoration to be placed in a healthy environment.
Commonly Asked Questions About Crown Lengthening
Q: How long does a crown lengthening procedure take?
A: The visit to perform crown lengthening is about 60 minutes long. The stitches are removed approximately one week later in a 5-10 minute visit. One or two 10 minute check-ups may be scheduled to ensure that the area is ready for restoration by the dentist.
Q: Will the crown lengthening procedure hurt?
A: Only "novocaine" is necessary to perform crown lengthening. During the visit you will feel nothing once the area has been numbed. When the "novocaine" wears off, there will be some mild discomfort. Medication will be prescribed to control any discomfort you might experience. This procedure will not cause you to miss work, etc.
Q: What is the cost of crown lengthening?
A: The cost of the crown lengthening will vary with the situation. However, your periodontist will ensure that this is discussed with you thoroughly before proceeding with treatment. Please remember that there will be a cost for the restoration of the tooth with your dentist.
Q: How well will the crown lengthening work?
A: Crown lengthening is highly predictable. If the procedure is carried out correctly, the end result is a tooth which may be restored in a healthy manner and which should prove very stable over time.
What is Esthetic Gingival Recontouring?
Improving Your Periodontal Health and Maximizing Your Esthetic Potential
Permanent teeth erupt until they contact opposing teeth. Once this contact is made and tooth position is established, the gum continues to move down, exposing more of the tooth until reaching the junction of the crown and tooth. This movement is why permanent teeth seem to get longer as children pass through adolescence.
In some instances, the tissue does not move down the permanent tooth as it should. While we do not know the cause of this phenomenon, the result is the presence of excess gum over the crowns of the teeth, and is called incomplete passive eruption. This excess gum does not attach to the enamel of the tooth crown, and results in a potential gum pocket which may trap bacteria and lead to periodontal problems.
In addition to potential periodontal health problems, incomplete passive eruption results in an unnatural, short tooth appearance, and a gummy smile.
Fortunately, incomplete passive eruption is easily treated by gently reshaping the gum and the bone surrounding the teeth to position the gum at a more natural and esthetic level. Following such treatment the gum pockets are eliminated, the gum is placed where the crown and the root of the tooth meet, and esthetics is dramatically improved.
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Figure 1: Bonding was placed on the front teeth without first eliminating the incomplete passive eruption. Note the short unnatural appearance of the bonded teeth.
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Figure 2: Following elimination of the incomplete passive eruption and placement of new bonded restorations, both the health and esthetics of the patient are significantly improved.
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Commonly Asked Questions About Esthetic Gingival Recontouring
Q: How long does esthetic gingival recontouring take?
A: The visit to perform esthetic gingival recontouring is about 50 minutes long. The stitches are removed approximately one week later in a 5-10 minute visit. One or two 10 minute check-ups may be scheduled to ensure that the area is ready for restoration by the dentist.
Q: Will esthetic gingival recontouring hurt?
A: Only "novocaine" is necessary to perform esthetic gingival recontouring. During the visit, you will feel nothing once the area has been numbed. When the "novocaine" wears off, there will be some mild discomfort. Medication will be prescribed to control any discomfort you might experience. This procedure will not cause you to miss work, etc.
Q: What is the cost of esthetic gingival recontouring?
A: The cost of esthetic gingival recontouring will vary with the situation. However, your periodontist will ensure that this is discussed with you thoroughly before proceeding with treatment.
Q: How well will esthetic gingival recontouring work?
A: Esthetic gingival recontouring is highly predictable. If the procedure is carried out correctly, the end result is a healthy, more esthetic appearance.
What is a Gingival Graft?
In health, a tooth is surrounded by two types of tissue. The first is gingiva (gum), which is pink in color and thick and dense under a microscope. Gingiva forms a tight seal around the tooth which serves as a barrier against the penetration of bacteria to the underlying supporting bone. The gingiva also helps to withstand trauma from brushing, eating, etc.
The other type of tissue, mucosa, found directly below gingiva, is red, very thin and appears loose under a microscope. It does not seal tightly around the tooth, nor does it withstand trauma well ( as shown by how easily you can scrape the floor of the mouth).
When recession of the gingiva occurs, the body loses a natural defense against both bacterial penetration and trauma. When there is only minor recession, some healthy gingiva often remains and protects the tooth, so that no treatment other than modifying home care practices is necessary.
However, when recession reaches the mucosa, the first line of defense against bacterial penetration is lost.
No matter how meticulously the patient tries to control the bacteria, there is a greater chance of it penetrating and affecting the underlying supporting bone around the tooth.
In addition, gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance to the gum and tooth.
A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth, 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.
The gingival graft procedure is highly predictable, and results in a stable healthy band of attached tissue around the tooth.
Commonly Asked Questions About Gingival Grafts
Q: How long does a gingival graft procedure take?
A: The visit to perform a gingival graft is about 45-60 minutes long. The stitches are removed approximately one week later in a 5-10 minute visit. One or two 10 minute check-ups may be scheduled to ensure the area has healed correctly.
Q: Will the gingival graft procedure hurt?
A: Only "novocaine" is necessary to perform a gingival graft. During the visit you will feel nothing once the area has been numbed. When the "novocaine" wears off, there will be some mild discomfort. Medication will be prescribed to control any discomfort you might experience. This procedure will not cause you to miss work, etc.
Q: What is the cost of a gingival graft?
A: The cost of a gingival graft will vary with the situation. However, your periodontist will ensure this is discussed with you thoroughly before proceeding with any treatment.
Q: How well will the gingival graft procedure work?
A: A gingival graft procedure is highly predictable. If the procedure is carried out correctly, the end result is a healthy stable band of attached gum tissue which reseals and protects the tooth and underlying bone.
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