Our practice provides a variety of surgical and non-surgical services. We pride ourselves on the fact that we are very conservative in our treatment recommendations and limit surgery to the areas where it is absolutely necessary.
The conservative approach we take with regards to treating periodontal disease revolves around proven periodontal principles. After completing our initial evaluation and determining the need for treatment, unless otherwise indicated, we begin Initial Therapy. This typically will involve Scaling and Root Planing (deep cleaning). In certain circumstances, we will consider the use of adjuncts such as antibiotic therapy.
After completion of Initial Therapy, we will provide a follow-up evaluation to determine the level of improvement. If areas remain that need further treatment, it is then that surgical therapy is recommended.
Once periodontal health is achieved, patients typically begin Periodontal Maintenance which consists of follow-up hygiene appointments every 3 months.
Bacterial plaque (the film on your teeth) can always be found on the surface of your teeth. If left undisturbed, this plaque has been shown to cause inflammation and destruction of the gum and bone around your teeth ("Periodontal Disease").
Additional factors have also been shown to influence the development of periodontal diseases such as smoking, diabetes, and autoimmune diseases.
In order to preserve a healthy tooth foundation, a small distance must be maintained in the space between the gum tissue and bone. Normally, this small space does not permit the pooling of more aggressive bacteria, which may destroy the bone supporting the teeth. As we lose bone, a deep space develops below the gum line called "Pockets". Deep "pockets" allow the pooling of bacteria and the formation of tartar, which is almost impossible to remove and reach via dental cleanings. In this case, the undisturbed bacteria may change to a more aggressive form that can destroy the gum and bone foundation around the tooth.
Pocket Reduction Surgery is utilized to return the space between the gum and bone (around teeth) to a healthy distance. The overall goal of this type of therapy is to help stop the progression of the disease process and prolong the lifespan of your teeth.
Bone Grafting is traditionally used in conjunction with pocket-reduction surgery. Bone regeneration procedures involve the utilization of bone materials (powders) that come in a variety of forms including donor and synthetic. These powders can be used along with osseous surgery to minimize the distance between the gum and bone. The graft material is placed into the periodontal sites during Osseous Surgery to help stimulate your body to grow important supportive bone around your teeth. Grafts typically become incorporated into your newly formed bone or are completely replaced by it.
In many cases, a barrier or "Membrane" is used to help keep the graft in place during the healing period. This "membrane" is placed over the graft material and the gum tissue is then closed over the entire area.
Over the tooth's root surface is a layer of bone that is covered by a layer of gum tissue. Due to a number of factors such as gum inflammation, excessively thin gum tissue, tooth positioning that stretches the gum tissue, and very rough tooth brushing, gum loss can occur.
When gum recession occurs, the bone beneath the receding part deteriorates as well, leaving the root of the tooth exposed. This situation may start slowly and continue at a more rapid rate.
Concerns with gum recession are numerous. As we lose gum and bone, over time we begin losing teeth. In addition, the roots of teeth are not protected by enamel, like the chewing parts of our teeth, leaving them more prone to decay and the need for root canals. Patients also report an increase in sensitivity to hot and cold temperatures and are unhappy with the appearance of "longer" teeth.
In the past, periodontal procedures had the reputation for leaving a very unaesthetic appearance. Today, we are able to offer cutting-edge periodontal - plastic surgery procedures that can help reshape one's smile and improve the tissues' appearance around the teeth. There are many types of situations where the shape of the gum can affect the appearance of the teeth. Examples range from short looking teeth with a significant amount of the gums showing (Gummy Smile) to very long looking teeth.
Gingival Grafts - Mucogingival Procedures
Extraction Site Preservation
Ridge Augmentation (Soft and Hard Tissue)
Soft Tissue Grafts
These procedures are utilized in preparation for your dentist to complete your planned dental treatment. Pre-prosthetic surgery varies in nature from enhancing aesthetics to providing a healthy foundation to support your future dental restorations.
Extraction or tooth removal is performed for a number of reasons. Prior to tooth removal, it is important to determine if and how it will be replaced. In some situations, preservation of the remaining bone around the extracted teeth is indicated. Dr. Cohen will discuss your particular needs after a complete examination.
Teeth are extracted (removed) for a variety of reasons including cavities, fractures, infections, severe bone loss, improper location in the jawbone, among others. When teeth are removed, the space that is left may cause other teeth to shift or move from their existing location. Dr. Cohen will discuss appropriate options for tooth replacement, should the extraction site be in a location that may affect the shifting of other teeth.
After appropriate anesthesia is achieved in the treatment area, your tooth can be removed without pain. The anesthesia allows pressure sensation during tooth extraction. In many cases, teeth can be removed without opening the gum tissue at all. Every effort is taken to remove the tooth as conservatively as possible, so as to not disturb the supporting bone structure.
In almost all cases, Dr. Cohen will advise a patient to have a bone graft placed in the extraction site (Extraction Site Preservation) to help prevent the bone shrinkage that occurs after a tooth is removed.