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What is Periodontics?

Periodontics is the dental specialty that manages conditions affecting the supporting foundational structures that support teeth. These structures are the alveolar bone, gingiva and the periodontal ligament.

Who is a Periodontist?

Our God given teeth are always worth saving if it is appropriate. Periodontists are well positioned as surgical specialists who provide treatments to save and replace teeth. Our doctors will help you weigh these options during your comprehensive exam.

A Periodontist’s treatment focuses on three primary areas

Management of Periodontal Diseases

Saving Natural Teeth

Placement of Dental Implants

When natural teeth cannot be saved

Bone and Gingival Augmentation

Regenerating or growing bone and gum tissue to support teeth and dental implants

Treatment of Periodontal Diseases

Non-surgical Treatment

Mild to moderate periodontal disease can often be managed with a thorough cleaning over a pair of visits using local anesthesia for patient comfort. This deep cleaning seeks to create a pristine root surface free of accretions that have accumulated over time. These accretions contain bacterial, fungal and viral pathogens which cause bone loss. This treatment allows the gingival tissues and bone to heal and reattach to the tooth’s root surface

Surgical Treatment

Severe periodontal disease requires a surgical intervention whereby the diseased tooth roots are visualized and returned to a smooth and healthy state. This surgical cleaning allows removal of deposits of calculus (tartar) which harbor harmful bacteria and pathogen which destroy healthy bone. The treatment allows for application of medicaments which enhance the healing and reattachment of the bone and gum to the tooth root.

Periodontal Regeneration

Periodontal regenerative procedures use bone grafts, collagen membranes, and growth factors to regenerate lost tissue around periodontally diseased teeth. We can often change the prognosis of a hopeless tooth to a favorable tooth with these techniques.

Ridge Preservation

This is a routine procedure that complements the extraction of a hopeless tooth. A bone graft and often a collagen membrane is placed into the remaining tooth socket to preserve the height and width of the patient’s jawbone. This is an affordable bone graft which keeps the patient’s options open if they choose to replace the tooth with a dental implant in the future.

If this procedure is not performed in conjunction with the tooth extraction, the bone will atrophy. The atrophy will cause loss of height and width of bone bringing vital nerve and sinus tissue into close proximity to the mouth. This makes dental implant therapies more challenging. Even if the patient is not planning to replace the tooth, ridge preservation is a conservative way to preserve your bone.

Ridge Augmentation

When teeth have been missing for a long time a ridge augmentation is required whereby bone grafting materials with collagen membranes and growth factors are used to grow or augment the bony ridge to grown width and height. This is required to gain enough bone volume to place future dental implants or to enhance the function and stability of a fixed bridge. A common scenario is when a patient’s long-term fixed bridge fails in the back of the mouth and the replacement of the failed bridge will be with dental implants. The bone that was under the failed bridge is often atrophied and requires regeneration.

Sinus Augmentation

In the upper jaw, loss of teeth causes atrophy of the jawbone bringing the maxillary sinus cavity in close proximity to the oral cavity. A sinus graft can be either a crestal sinus lift or a lateral window sinus lift. These are completed in conjunction with placement of the dental implant or as a separate procedure before dental implant surgery.

Sinus Dental Implant Surgery

Dental implant surgery is simply the conservative preparation of a site to receive a Titanium or Zirconium fixture. This fixture serves as a replacement of a tooth root which will eventually support a dental prosthesis. Once a period of healing takes place, the dental implant “osseointegrates” into the bone for long term stability.

A dental implant can be used in a variety of ways. It can support a fixed single tooth or a fixed implant-to-implant bridge. It can enhance the fit and comfort of a removable partial or denture. Also, strategically placed dental implants can be used to replace a full set of teeth with fixed hybrid dentures or a series of fixed implant-to-implant bridges.

Gingival Augmentation

The term gingival augmentation encompasses a group of procedures commonly called gum grafts. The patients own tissue or donor tissue can be used to augment gum tissue where there currently is none. When gum tissue is absent, a thin friable tissue remains called mucosa. Mucosa hurts to clean, becomes inflamed very easily and will recede over time contributing to a poor prognosis of the teeth or dental implant.

Root Coverage Procedures

Root coverage procedures are those which aim to take existing gum tissue which has receded and reattach it to a denuded, recessed root surface. The goal is always to use the most minimally invasive technique possible. There are several we commonly use in our practice including: Tunneling techniques, VISTA techniques, Pin Hole Surgical Techniques, Coronally Advanced Flaps.

These minimally invasive techniques preserve the existing tissue and blood supply for optimal results. Growth factors may commonly be used including products from the patients own blood. The tissue used to augment and cover the roots may be from the patients own tissue or donor tissue.

Pin Hole Surgical Technique

This is a contemporary technique whereby no incisions are made in the tissue, only a small puncture or Pin Hole. Small pieces of collagen are used to bring the tissue down to cover exposed roots. This is often the treatment of choice when a patient has gum recession generalized throughout their mouth or on nearly every tooth.

Dr. Calahan is the only periodontist in Shreveport certified for this technique

Esthetic Gingival Recontouring

Some patients have the appearance of short teeth. This can also present as a smile that displays excess gum tissue. There are many etiologies or causes for this, but one of the most common is called altered passive eruption. Altered passive eruption is when the gum line stops short of displaying the full tooth length during growth and development.

A simple procedure called esthetic crown lengthening or gingival recontouring can be completed to expose the full extent of the God given tooth. All of us have long front teeth genetically, yours just may be hiding!

About 30% of cases leaving orthodontic therapy have some degree of altered passive eruption. It is common to finish braces and have your orthodontist recommend a periodontal referral. If your teeth are beautifully straight but still short after braces, we can fix it in about an hour.

Impacted Tooth Exposure

Delayed eruption of permanent teeth can cause them to become impacted. The most commonly impacted tooth is the upper canine tooth. The orthodontist will make a referral to the periodontist when an impacted tooth must be retrieved to facilitate bringing into the patients smile. A 3-D x-ray called a cone beam CT scan is taken to locate the tooth then a small procedure is done to put a button on the impacted tooth so the orthodontist can bring the tooth into the proper position.

Frenectomy and Fiberotomy

A gap between the front tooth teeth prior to orthodontic treatment is very common. This is often due to fibrotic tissue that exists between the front teeth due to a larger than average maxillary labial frenum.

Towards the end of orthodontic therapy, once the orthodontist has closed the gap between the front teeth, he or she will make a referral to the periodontist for management of this larger than average frenum. A quick procedure is complete the same day as the evaluation to recontour the frenum so that the closed gap can be stabilized long term.

Laser Gum Surgery

Lasers are used in periodontal surgery to treat a variety of conditions. They can be used to complement surgical and non-surgical procedures in the management of periodontal disease. They can be used to recontour gum grafts and gingival tissues around implants, teeth and crowns in a procedure call a laser gingivectomy.

Muscle pulls in the junction of the lip and gingiva are a common contributor to severe gum recession. These tissue pulls can be removed with a laser frenectomy in a very quick procedure. Often this is done after several months of tissue maturation following a minimally invasive gum grafting procedure.

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