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Cosmetic Recontouring:
Creating a great looking smile is in large part dependent on the shape of the gum tissues. In some cases, excess gum tissues need to be reshaped to create a more cosmetically pleasing shape or contour. A similar cosmetic problem can be encountered if one or more teeth are too short. The procedure to correct these cosmetic problems usually is minor and often stitches are not necessary. The procedure can be thought of as a manicure for the gums. There are other situations where there is a need for more gum tissue, that can be addressed with “Gum Grafting” or “Ridge Augmentation” procedures (see below). This procedure is carried out in the office with local anesthetic.
 
 
 
Left: The Patient complained of a long looking cuspid tooth and of cold sensitivity at the exposed root
Right: After the ‘connective tissue graft’ the patient was happy with the improved cosmetics and the complete disappearance of the root sensitivity.
 
 
Crown Lengthening
Crown lengthening procedures remove some tissue to expose more of the ‘crown’ of your tooth. There are several situations where crown lengthening is necessary. The most common is when there is decay or a fracture that is too far below the gum. The crown lengthening will expose the decay or crack to allow the new crown to properly extend over the area where the decay of fracture occurred. If new crowns or veneers are planned by your dentist, then this procedure sets the stage to allow for a more natural and beautiful smile (see “Cosmetic Contouring” above). This procedure is carried out in the office with local anesthetic.
 
Flap Surgery:
Periodontal Disease that is more advanced often results in significant amounts of residual sub-gingival (under the gum) plaque and calculus (tartar) deposits. Periodontal Disease will also cause bone resorption and deeper pockets. When non surgical treatment cannot control the disease process, Flap Surgery may be indicated. The procedure is carried out in the office and often with local anesthetic. The gums in the affected area are slightly folded open (like the flap of an envelope). This allows the visibility necessary to remove the visible residual plaque and calculus. As well, the uneven bone contours may be reshaped. Finally the gums are sutured and may be tightened to help reduce the pockets.
 
Gum (Soft Tissue) Grafting:
Many patients have one or more areas of significant gum recession. The cause of these recessions may be due to “thin” gums and over-zealous tooth brushing. These areas are often associated with very thin remaining gum tissue that may be more at risk for further recession. The affected areas may have exposed roots that are very sensitive and may be a cosmetic concern. The Gum Grafting procedure is carried out in the office and often with less local anesthetic than required for a filling. A small amount of tissue is taken from the palate and sutured to the receded area. The palate regenerates completely and sutures are not usually needed
 
 
 
Left: Gum recession at 3 front teeth
Right: After “Connective Tissue Grafts”, not coverage of the previously exposed roots and the thickening of the gums
 
 
Regeneration
Guided Tissue Regeneration: These procedures attempt to grow back the previously lost gum and or bone tissue around the natural teeth. Some techniques utilize membranes, which are used to cover the bone defects and under the gums. Some membranes are resorbable and others require removal. Regenerative techniques often include the use of bone grafts or specifically engineered gels. Research is ongoing in an effort to increase the predictability of these techniques and new products are being introduced. These procedures are carried out in the office with local anesthetic.
Guided Bone Regeneration: These procedures attempt to grow back the previously lost bone tissue after one or more natural teeth have been lost. Over a period of time, the jawbone associated with missing teeth atrophies is resorbed. This bone would be unsuitable for the support of dental implants. Today, it is often possible to re-grow or regenerate bone where we need it for the support of dental implants. This, in turn, gives us the opportunity to effectively restore esthetics and function to their natural state. Some of these procedures are carried out in the office with local anesthetic.
Ridge Preservation: This technique involves the careful management of sockets after tooth extraction with the goals of preventing bone loss and a better outcome for implant placement. This procedure is carried out in the office with local anesthetic.
 
Ridge Augmentation:
When a tooth is lost, the underlying bone undergoes a shrinkage process, similar to a muscle shrinking from lack of exercise. This defect may show when smiling, and cause an esthetic concern. Fortunately there are several Ridge Augmentation procedures that can “fill” some defects. This procedure can recreate the natural contours of your gums and create a more pleasing looking smile. These procedures are carried out in the office with local anesthetic.
 
 
 
Left: Upper right central incisor on the denture is too long due to the collapsed ridge
Right: After the collapsed ridge was “augmented”, the upper right central incisor can now be the proper size