During your first visit to our office, Dr. Morales will evaluate the situation identified by your dentist and will perform a comprehensive periodontal examination. This includes a discussion with you regarding your chief complaint, medical and dental history review, analysis of radiographs and a clinical examination. A comprehensive periodontal examination may include:
- Extraoral (outside the mouth) and intraoral (within the mouth) examination.
- Periodontal examination to assess pocket depth, recession, and tissue attachment levels; to assess the health of your tissues by measuring bleeding on probing, discharge, lesions and clinical furcation status.
- Assessment of the amount and distribution of plaque, calculus and tissue inflammation.
- Dental examination including the status of dental restoration, decay, and other tooth problems.
- Assessment of the degree of mobility of teeth.
- Evaluation of the forces of your bite through assessment of the positioning of your jaw, teeth and TMJ.
- Analysis and interpretation of updated, diagnostic quality periapical radiographs and other diagnostic imaging needed.
- Evaluation of possible periodontal and systemic links.
After the periodontal examination, Dr. Morales will determine your periodontal diagnosis and prognosis, as well as the viability of dental implants. Working closely with your dentist, Dr. Morales will develop a logical plan of treatment customized to your individual periodontal and restorative needs.
Dr. Morales will invite you to a complimentary treatment conference, during which he will review your diagnosis, periodontal health status and present your individualized treatment plan, which will include:
- Referral for treatment or medical consultation when necessary.
- Periodontal procedures to be performed.
- Periodontal maintenance programs.
- Other considerations, provisions and diagnostic testing necessary for appropriate periodontal treatment.
Pocket Reduction Therapy
The main cause of periodontal disease is bacteria, which constantly forms on your teeth. When you have periodontal disease, the supporting tissue and bone around your teeth is destroyed, forming "pockets."
Over time, these pockets become deeper, providing a larger space for bacteria to live. These pockets are too deep to clean with daily at-home oral hygiene and professional hygiene care. As a result, these deep pockets gather even more bacteria, resulting in further bone and tissue loss. Without proper periodontal treatment, too much bone is lost and the teeth need to be extracted.
During periodontal surgery, Dr. Morales will fold back the gum tissue and remove the disease-causing bacteria,
smoothing any irregular bone surfaces to limit areas where bacteria can hide. Tissue is then sutured in place, reducing pocket depth and allowing greater access for at-home oral hygiene. Gum tissue will reattach to the clean, healthy bone. Patients are very comfortable during this procedure with the use of local anesthetic.
Once your periodontal disease is under control through periodontal surgery, the next step is maintenance care -- a personalized program of care to keep your gums healthy. Your commitment to health, in partnership with your dentist and Dr. Morales, will help you obtain the best results from your surgery and prevent deterioration of your periodontal health. Through proper home care and maintenance visits, you have an excellent chance of keeping your teeth for a lifetime.
Dental Tissue Grafting
Tissue grafting is a surgical procedure that helps protect the tooth roots and improve the appearance of the smile for patients who are self-conscious about receded gums caused by gingivitis. The gums help protect the mouth from bacteria and trauma while also covering the ends of the teeth for a happy, beautiful smile, making gum recession both a cosmetic and a medical concern.
Dr. Morales will evaluate the areas of recession and choose the proper tissue grafting procedure for your individual needs.
- Subepithelial Connective Tissue Graft - A small layer of tissue is obtained from underneath the healthy, gingival tissue on your palate
- Pedicle Soft Tissue Graft - A small layer of tissue is obtained from the area immediately adjacent to the area of recession. In order to do this, there must be an abundant amount of thick, healthy tissue next to the area of recession, which is frequently not the case.
- Free Soft Tissue Graft - A small layer of tissue is removed from the palate.
During the grafting procedure, autogenous (originating from the same individual) tissue is placed in the receded area of the gum and covers the exposed root. In some cases, the graft may be taken from a donor source (Alloderm) if the patient does not have sufficient available tissue. The tissue graft is then attached to the natural gum and carefully sutured into place. The graft helps correct the appearance of teeth that seem "too long" and affect the smile, and also reduces further gum recession and bone loss.
This procedure can be performed on one or more teeth to help even out your gum line and reduce sensitivity of exposed roots to hot or cold foods. Most patients are more than satisfied with the results of their procedure and enjoy a healthy and beautiful smile after treatment.
Crown Elongation - Crown Lengthening
Crown lengthening, also known as crown elongation, is a surgical procedure performed when there is not enough exposed tooth structure. This procedure removes gum tissue and/or bone to expose more of the tooth and allow a crown or filling to be placed. Crown lengthening is often performed when a tooth appears short, after a tooth breaks off at the gum or a crown or filling is removed and the tooth underneath is significantly decayed. A decent amount of healthy tooth structure is needed in order to properly perform a restoration.
The crown lengthening procedure is performed under local anesthesia to minimize any discomfort, and takes about an hour to perform, although the length may vary depending on the number of teeth being treated. During the procedure, Dr. Morales will make incisions in the gums to create a flap, which will allow access to the tooth root and surrounding bone. Gum tissue may then be removed to reveal enough of the tooth structure, although most cases will require bone removal as well. Bone removal is a more intricate process that involves several different surgical tools.
The teeth may appear longer than usual after bone and gum removal, since more of the actual tooth is now exposed.
After the crown lengthening procedure, the treated area will be sutured to promote proper healing. It is recommended for patients to apply ice to the area to reduce swelling and minimize any discomfort. You will be asked to follow a soft diet for the first few days after treatment.
Patients will need to return to our office one to two weeks after the procedure, at which point the sutures will be removed and the healing process will be evaluated. The crown or filling will not be placed on the treated tooth until one to three months after the lengthening procedure to ensure that the tooth is fully healed and prepared for restoration.
Guided Tissue Regeneration
Guided Tissue Regeneration is a regenerative treatment option for patients who have lost quality and quantity of supporting bone tissue as a result of periodontal disease or dental infections. Your bone and gum tissue should fit snugly around your teeth. As a result of periodontal disease the periodontium (the tissues that surround and support the teeth, which include the cementum, the periodontal ligament, the alveolar bone and the gingival) is destroyed and pockets develop. Regenerative procedures may reverse some of the damage by regenerating lost tissue and bone.
During the tissue regeneration procedure, the gums will be separated from the teeth so that Dr. Morales can gain access to the tooth roots and underlying bone.
The roots will be thoroughly cleaned of disease-causing bacteria and any bone defects adjacent to the root may be filled with bone or bone substitute, tissue-stimulating proteins and membrane to protect the bone and encourage your body's natural regenerative process. Once the graft is in place, the gums will be repositioned.
The graft used during this procedure may come from the patient's own body, a cadaver, cow bone or synthetic material. The most effective results are often achieved by using the patient's own bone.
After this outpatient surgical procedure, it is important for patients to keep their mouth as clean as possible while the bone graft heals. You will be asked to return to our office in about seven to fourteen days so that your mouth can be evaluated to ensure proper healing. Over time, new bone and soft tissue will develop in the treated area to help firmly reattach the tooth to the jaw, significantly reducing the patient's risk of tooth loss and reversing the effects of periodontal disease.
Periodontal maintenance therapy is an ongoing program designed to prevent disease in the gum tissues and bone supporting your teeth. The foundation of your periodontal health is based on your commitment to care of your mouth at home, and regular maintenance visits with your dentist and Dr. Morales.
Your periodontal maintenance visit may include:
- Reviewing changes in your health history
- Examining the oral tissues for changes
- Measuring pocket depths around the teeth
- Assessing your homecare techniques and oral hygiene habits and providing customized instruction
- Cleaning teeth to remove bacteria, plaque and calculus
- Taking necessary radiographs to evaluate tooth and supporting bone structure.
- Examining your teeth for decay or dental problems
- Applying or prescribing medication as necessary.
The frequency of your maintenance care visits is based upon your periodontal condition. Once your active periodontal therapy has been completed, Dr. Morales will reevaluate your status and recommend the necessary interval for your maintenance care. Periodontal maintenance visits do not take the place of regular dental checkups.
We work with your dentist work as a team to protect your periodontal health, provide you with the best possible care, and prevent future oral health problems.
Scaling and Root Planting
Scaling and root planing is a treatment procedure usually performed on patients during various stages of periodontal disease to help remove the plaque and tartar that have started to build up beneath the gum line. This procedure is basically considered a deep cleaning and may be performed to improve the quality of tissue before surgery or to prevent the disease from progressing to a more advanced stage.
During the scaling part of the procedure, an instrument called a scaler is used to scrape away any plaque or tartar that have built up beneath the gums. This plaque often develops in pockets that form between the teeth and gums. As the disease progresses, these pockets grow and may cause teeth to loosen and eventually fall out.
Once the scaler has removed the plaque and tartar, the treated area is rough and uneven. Root planing smoothes the root of the tooth so that the gums can heal and reattach to the tooth properly.
Dr. Morales may also prescribe antibiotics or anti-microbial rinses to help reduce bacteria development in the mouth. Local anesthesia is used during this procedure to allow the Periodontal Hygienist to properly access the root surface. There is little to no pain associated with this procedure, and patients can resume their regular activities immediately after.
After the scaling and root planing procedure, patients should practice proper oral hygiene in order to prevent pockets from forming again. Dr. Morales will evaluate you 3-4 weeks after the procedure to determine your periodontal health status.
To help you maintain proper oral health, Dr. Morales may recommend Periodontal Maintenance every 3-4 months. This is done in partnership with your dentist.
Periodontal Cosmetic Surgery Services
A beautiful smile is one of the most sought after physical attributes, which can be easily achieved through cosmetic gum surgery. Some of the cosmetic surgeries commonly performed to help patients achieve the smile they desire include crown lengthening, soft tissue graft and bone grafting.
Many people seek cosmetic gum surgery to cover unsightly gums or exposed root surfaces. Some people are also bothered by the appearance of short teeth. In many cases, these complaints can be resolved through cosmetic gum surgery that reshapes excess gum and bone tissue to expose the tooth. This procedure can be performed on just one, a few or all of your teeth.
Any necessary restorative care should be delayed for three to six months after your periodontal cosmetic surgery to allow proper healing and maturation.
Our Practice offers the following periodontal cosmetic surgery services:
- Subepithelial Connective Tissue Grafts
- Pedicle Soft Tissue Grafts
- Free Soft Tissue Grafts
- Crown Elongation (Crown Lengthening)