Periodontal Treatment

Periodontal disease damages the surrounding soft tissues and bone that support the teeth. It is predominantly caused by the accumulation of bacteria, mucus and other particles in the form of plague or tartar that sit between the teeth and the gums. Periodontal disease can range in severity from a simple gum inflammation, known as gingivitis, to a more serious inflammation of the periodontal tissues. Left untreated periodontal disease can result in significant tissue damage and eventual tooth loss.

The problem with periodontal disease is that often the progression is painless. As a result, the affected individual may not be aware of an ongoing disease process. This is why, it is so important to recognize the signs of the earliest stage of periodontal disease, which is gingivitis. The symptoms of gingivitis typically include red, swollen and bleeding gums. Treatment instituted at this point is often sufficient to reverse the course of the disease and to avoid any permanent damage to the periodontal tissues.  A series of deep dental cleanings, an improved home care regimen, and a commitment to regular maintenance may be all that is required to prevent this stage of periodontal disease from progressing.

Left untreated, gingivitis can escalate into periodontitis. However, there are other factors that can contribute to the escalation of periodontal disease, including smoking, genetic tendencies, and unchecked diabetes. In either case, when periodontal disease has progressed to a more advanced stage there is usually clinical and radiographic evidence of damage to the bone and soft tissues supporting the teeth. Periodontal treatment in this phase is designed to halt the progression of the disease and to restore tooth support as possible. This may involve medications to control the bacteria and reduce the size of the pockets between the teeth and gums, gum surgery, as well as bone and tissue grafts.

Periodontitis

When left untreated, a case of gingivitis develops into a more advanced and damaging stage of gum disease, known as periodontitis. At this point, the connective tissue and bone that hold the teeth in place begin to break down. With the progression of periodontal disease and periodontitis, more and more tissue loss ensues. Damage often includes an increase in pocketing between the teeth and bone, gum recession, and bone loss. As unresolved periodontitis goes from mild to moderate to severe, it increasingly compromises the soft and hard tissue support for the teeth.  

While gum disease is almost entirely preventable, the numbers regarding its incidence are alarmingly high. Periodontal disease remains the leading cause of tooth loss in adults. According to statistics from the Centers for Disease Control and Prevention, one out of every two adults over the age of 30 in the United States has periodontitis, an advanced form of periodontal disease. 

It's essential to be aware of the signs and symptoms of gum disease: 

• Inflamed and red gums
• Bleeding when brushing or flossing
• Receding gums and exposed tooth root surfaces
• Sensitivity to hot or cold temperatures
• Bad breath or a bad taste in the mouth
• Teeth that feel loose
• Dental drifting and developing spaces between the teeth
• A change in the fit of existing partial dentures
• Discharge around the teeth and gums
• Sharp or dull pain when biting down or chewing food

While physicians and dentists in the past considered medical conditions and gum disease as separate and unrelated, increasing associations between poor periodontal health and systemic problems continue to emerge. Links between conditions such as cancer, cardiovascular disease, adverse pregnancy outcomes, stroke, diabetes, Alzheimer's, rheumatoid arthritis, and osteoporosis, as well as a host of other diseases and disorders, are becoming more apparent. 

The importance of timely care

Taking care of your smile does more than keep your teeth and gums in optimal condition; good oral health also supports systemic health. With all of today's advances in care, treatment for periodontitis not only helps to halt the progression of gum disease but also offers effective solutions to repair some of the tissue damage it has caused. 

At the office of Oscar Gonzalez, DDS, we provide personalized, state-of-the-art periodontal treatment to help you maintain healthy gums and a beautiful smile throughout your life. We specialize in preventing the onset and progress of gum disease, treating more advanced stages of gum disease as well as perform periodontal procedures to support the successful placement of dental implants. As skilled providers of care, we utilize leading-edge technology and treatment methods to provide precise and effective solutions to address a wide range of periodontal conditions and needs.

Periodontal Surgery

When gum disease has advanced beyond the initial stage, periodontal surgery is often recommended to effectively remove bacteria and tartar from around the teeth, reduce gingival pocket depth, restore lost tissue as possible, and halt disease progression. It’s essential to keep in mind that gum disease is a progressive condition. If appropriate measures are not taken, gum disease continues to compromise the support of the teeth and have consequences to one’s overall dental health and well-being.

As untreated gingivitis evolves into more advanced stages of gum disease, periodontal pockets deepen, the bacteria become more difficult to remove, and the gaps between the surface of the teeth and gums get larger. When pocket depth increases to the point of being beyond the reach of deep cleanings and other conservative methods of care (5mm or more), gum surgery to clean and treat the damage to gums and underlying bone is typically recommended.

The good news is that with proper surgical treatment followed by improved oral hygiene, the chances of tooth loss, further damage to the bone and soft tissues supporting the teeth, and complications from health problems that are linked to periodontal disease can be decreased.

The goals of pocket reduction surgery are to accomplish the following:

• Remove sub-gingival bacteria beneath the gums and from the surfaces of the roots of the teeth
• Halt damage to the underlying bone, and recontour the affected hard tissues as needed
• Reduce pocket depth to facilitate easier cleaning of the teeth and gums and the maintenance of optimal periodontal health

In many cases, a periodontal procedure, which is known as flap surgery, is frequently recommended. During this procedure, the gums in the affected area are reflected away from the teeth and supporting bone. Now, the pocket and roots of the teeth can be thoroughly cleaned and supporting tissues recontoured as needed. When this step gets completed, the tissue flag gets sutured back into place. While this approach represents a tried and true method of care, in some cases, dental lasers can also be employed to treat periodontal disease.

Gingival Graft

In addition to the development of pockets and bone loss, periodontal disease can cause the gums to recede, thereby exposing the roots of the teeth. When the root of a tooth loses its overlying soft tissue, it becomes more vulnerable to decay, sensitivity and additional bone loss. Gum recession also takes a toll on smile aesthetics.

By performing a gum graft procedure, which is also known as a “gingival graft or soft tissue graft,” the dentist replaces the soft tissue over the exposed area of the tooth to address the problems created by receding gums.  Gum tissue for grafting procedures can be harvested from a nearby site in the mouth or obtained from another donor source. A gum graft may be performed on a single tooth or multiple ones. And, based upon the needs of the case, the dentist will determine which type of gum graft to employ.

Guided Bone Regeneration

Guided bone regeneration is a dental procedure that is used for increasing bone mass in cases where vertical and/or horizontal defects in the jawbone exist. It is a reliable method for re-establishing hard tissue volume in areas of bone loss, which has taken place in the upper or lower jaw as the result of periodontal disease, trauma, cyst or tumor surgery, or subsequent to a dental extraction.

During a guided bone regeneration procedure a special membrane is positioned to cover a newly placed bone graft in the area of a bony defect. This membrane facilitates new growth of bone, while preventing any growth of unwanted soft tissue into the area. 

Guided bone regeneration can enable the placement of dental implants for cases in which implants would otherwise not be possible

Ridge Augmentation

The bone that surrounds the roots of the teeth is referred to as the alveolar ridge. A ridge augmentation is a surgical procedure performed to restore the normal height and width of the alveolar ridge that may have been diminished as result of having a tooth removed or for other reasons like denture wear or trauma. The main considerations when a reduced and narrowed alveolar ridge is present are how this lost tissue will affect the placement of a dental implant or other dental prosthesis.

A ridge augmentation procedure is performed by placing bone graft material into the tooth socket immediately after a tooth has been removed, or where there are deficient areas, as a means to rebuild the shape of the gums and jaw. While in certain situations dental implants can be placed at the time of a ridge augmentation procedure, they are more often placed after sufficient healing has occurred and the bone graft has successfully fused with the existing bone and new bone has formed. Bone graft materials can be collected from another area of the body, harvested from other natural sources, or can be made of synthetic materials. The choice depends upon the specific needs of the case.

Sinus Lift

For patients lacking a sufficient amount of bone for a dental implant to replace a maxillary back tooth (upper back tooth), a procedure known as a “sinus lift” may be performed. During this surgical procedure, the sinus membrane is lifted and bone graft material is added between the jaw and the floor of the sinus to provide the needed bone height to successfully support a dental implant.

All on 6

 A high-tech alternative to traditional dentures, the ALL-On-6 technique creates a comfortable and stable full set of upper and/or lower teeth using six strategically placed specialized dental implants. While conventional removable dentures can effectively replace a full complement of lost or missing teeth, ALL-On-6 dental implants provide a fixed and permanent method of reestablishing a complete set of teeth. This restores patients with a sense of having their own teeth and offers an improved quality of life as they can once again eat and speak with confidence.

With ALL-On-6 dental implants the need for messy denture adhesives or having to take one’s dentures out to clean and sanitize them is eliminated. The replacement teeth are cared for in very much the same way as a set of natural teeth.

 All-On-6 dental implants offer a less invasive and quicker way to restore a full upper or lower set of teeth than treatment with conventional dental implants. Requiring just six implants per jaw for a complete set of functional teeth, All-On-6 treatment  may reduce the need for preliminary bone grafting surgery. Utilizing the All-On-6 method, temporary teeth can often be placed right away with a permanent set to follow within just a few months after the implants become fully integrated with the surrounding bone.

All on 4

This remarkable technique requires only 4 implants in either the upper or lower jaw to support all the replacement teeth for that dental arch.  All-on-4®* typically involves only one surgery to place all the implants, avoids the need for additional bone grafting procedures, and provides the instant gratification of receiving a full set of temporary teeth immediately on the same day as the initial procedure. As a permanent fixed replacement for all the teeth, the All-on-4 dental implant technique achieves unprecedented results with a minimal number of dental implants and surgical procedures, thereby making it an appealing cost-effective solution for permanently replacing a full set of teeth. Once post-surgical healing is complete and the All-on-4 dental implants have fully integrated with your jawbone, the temporary bridge is permanently replaced by your customized final bridge.  These new permanent replacement teeth are completely secure and stable and function in a similar fashion as natural teeth.

*All-on-4 is a registered trademark of Nobel Biocare

Osseous Surgery

In cases of periodontal disease, an osseous grafting procedure may be necessary to address the bony defects around a tooth that have been caused by the progression of periodontal disease. An osseous grafting procedure, which involves guided tissue regeneration, rebuilds the bone and supporting tissues that have been lost. During this surgical procedure, the roots of the involved teeth are thoroughly cleaned and the bony defects prepared and filled with a suitable bone graft material. The bone graft is then covered by special membrane and the gums are then sutured back into place. With healing and time the osseous graft will fill in for the lost bone, thereby providing renewed support for the tooth.

Dental Implants

Losing a tooth due to injury, dental decay, or gum disease can happen. However, in order to avoid causing problems for the adjacent teeth and your overall dental health, it is important to replace the tooth that has been lost. This can be done any number of ways including fixed bridges, removable partial or full dentures as well as a more recent procedure known as dental implants.

 One of the most significant dental innovations in recent times, an implant is a small surgical fixture made of biocompatible metal or ceramic materials that is placed into the jawbone and functions in the same manner as the root of tooth. In the same way that natural root supports the natural crown of your tooth, an implant once it fully integrates with the surrounding bone, provides a stable and durable foundation for a replacement tooth. Implants often support a crown for an individual tooth, but can also be used as abutment teeth for a dental bridge, or strategically placed to help stabilize a denture.

Out of all the restorative choices available today, an implant comes the closest to replicating the look, feel and function of a natural tooth. Furthermore, it is the only method of tooth replacement that does not require the involvement or preparation of the adjacent teeth. A dental implant also stimulates bone remodeling to prevent shrinkage in areas where teeth are missing and helps to restore facial contours in areas where significant bone loss has occurred.

 Whether an individual tooth or multiple teeth are missing, our practice offers the most advanced implant-based solutions to help patients reestablish complete and beautiful smiles.