Periodontics Case Study

Periodontitis Mountain View

Dental implant therapy provides you the long-term solution to reproduce the esthetics and function of your natural teeth. Different designs of implants are available to replace one or more teeth with crowns and fixed partial dentures and totally edentulous mouth with either fixed prostheses or moveable complete dentures.

Case Studys

Conservative Non-Surgical Therapy

  • Scaling and root planning (deep cleaning)
  • Microbial testing
  • Adjunct antimicrobial therapy (local and systemic)

Meticulous mechanical and manual cleaning will remove the tartar and contaminated root surface for proper gum healing. Microbial testing (cultural and DNA analysis) and adjunctive antimicrobial treatment will target the right bacteria that cause severe gum diseases in some patients and further reduce the presence of these specific bacteria.

A healthy young male adult presented with severe gum infection and boneloss. Deep cleaning in conjunction with systemic antimicrobial treatment resulted in significant improvement of the inflammation and the reduction of deep pockets.

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Crown Lengthening

This surgical procedure will expose more length of crown to help your dentist restore your tooth. Cosmetic crown lengthening can correct “gummy smile” by surgical removal of excessive gums.

Tooth fracture associated with dental decay made restoration of this tooth difficult because of inadequate tooth support for a new crown. By adjusting the gum and bone levels, more tooth structure was exposed for proper restoration.

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Soft Tissue Graft

Soft tissue from your palate or other sites in your mouth can be transplanted to the exposed roots and defect sites. This procedure helps you to reconstruct your loosed tissue, to cover the exposed teeth, to reduce root sensitivity and to improve your smile.

Gum recession may result in compromised periodontal health, root sensitivity and aging appearance. Soft tissue grafting improved this patient’s comfort, tissue health and gives him more natural appearance of his upper right canine.

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Ridge Preservation

Normal tissue healing after tooth extraction commonly results in bone reduction and collapse of your ridge. The depressed appearance on the ridge in the anterior areas may compromise your esthetics. Bone and soft tissue grafting after tooth extraction can preserve your ridge and maximize the esthetics.

A healthy middle-age female complained that her bridge was loosening. Clinical examination and x-rays showed severe bone loss and inadequate support of her upper left incisor. Ridge preservation procedure after tooth extraction resulted in healthy and natural soft tissue and optimized her final restorations.

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Ridge Augmentation

Inadequate ridge width and height due to bone resorption after tooth extraction may compromise your final restorations and implant placement. Ridge augmentation with soft tissue, bone graft, or combination of both can help you restore the ridge and maximize your esthetics.

Bone loss after tooth extraction caused compromised ridge support for replacement of this patient’s upper right central incisor with a dental implant. Ridge augmentation was performed to widen the ridge and eliminate the “dipping” appearance.

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Gingival Enlargement

Causes of gingival enlargement may include local acute and/or chronic inflammation, systemic factors, medications, hereditary gingival fibromatosis, and neoplasm.

A drug-induced gingival enlargement may present generalized severe enlargement of soft tissue. Treatment should involve meticulous plaque control, a physical consult regarding alternative drug therapy, and a surgical intervention to remove excessive tissue.

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Flap Osseous Surgery (Pocket Reduction)

When deep pockets are not manageable by deep cleaning and regular maintenance therapy, you may be recommended for periodontal surgical procedure to further reduce the periodontal pockets

6-7 mm deep pockets were present between this patient’s lower left premolars in spite of her previous deep cleaning and repeated regular maintenance dental visits.

A more definite periodontal surgery was performed to reduce the deep pockets by adjusting her gum and bone levels. 6-month follow-up showed shallow pockets and healthy tissue.

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Guided Tissue Regeneration

The goal of the regenerative procedure is to regain lost periodontal structure, to reduce pocket depth and to facilitate plaque control. This procedure commonly involves surgical open flap under local anesthesia, bone graft and barrier placement.

8 mm residual deep pocket was found on the facial surface of lower right first molar. Periodontal regenerative treatment resulted in healthy gums with pocket depth of 3 mm.

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Surgical Assistance for Orthodontic Treatment

Periodontal surgeries can correct certain oral anatomy and expose unerupted tooth to facilitate your orthodontic treatment.

A 10 year old female presented with an impacted upper left canine and a mal-positioned lateral incisor. Exposure of the unerupted canine by a periodontal surgery enabled her orthodontist to correct her bite (photograph of under orthodontic treatment)

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Laser therapy

Preoperative view of an unerupted upper left canine. Postoperative view of the canine immediately following laser exposure treatment. Postoperative view of the treated canine 5 days later. An orthodontic bracket was attached to guide eruption of the canine.

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Minimally Invasive Periodontal Surgery

Microsurgical instrument, magnifying surgical loupes/ surgical microscope and laser enhance periodontal esthetics, reduce post-operative discomfort, shorten healing time and improve clinical success.

We apply minimally invasive periodontal surgery principles on periodontal and implant therapies, such as guided-tissue regeneration, root coverage, jaw reconstruction, sinus/ ridge augmentation and cosmetic crown lengthening.

SOFT TISSUE GRAFT

Soft tissue from your palate or other sites in your mouth can be transplanted to the exposed roots and defect sites. This procedure helps you to reconstruct your loosed tissue, to cover the exposed teeth, to reduce root sensitivity and to improve your smile.

Gum recession may result in compromised periodontal health, root sensitivity and aging appearance. Soft tissue grafting improved this patient’s comfort, tissue health and gives him more natural appearance of his upper right canine.

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Treatment Of Gummy Smiles

“Gummy smile” is commonly associated with excessive soft tissue which covers part of crowns. Cosmetic crown lengthening exposes the length of natural crowns to improve your smile.

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Sinus Graft

After upper posterior teeth are removed, it is often to see there is minimal bony support for implant placements near the maxillary sinus. Fortunately, a sinus augmentation or sinus lift makes it possible for many patients to have implants placed in the sinus areas. 

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The sinus augmentation procedure involves lifting the sinus membrane and bone placement. It is usually done under local anesthesia. Conventionally bone graft is inserted into a space created by lifting a sinus membrane, through a lateral window.

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In the past few years, different less traumatic internal sinus augmentation techniques have been developed to minimize surgical trauma and to reduce post-operative discomfort. When severe bone loss around a tooth is involved (Fig1 below), the combined therapy of local ridge and sinus augmentations (Fig2,3) may be required for implant treatment (Fig4).

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Frenectomy

This dense band of soft tissue (frenum) between the front teeth may compromise your smile, cause separation of teeth, and carry risks of periodontal problems. By repositioning the frenum and releasing tension from it, the teeth and periodontal tissue are more stable.

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