Procedures

Treatment of Gum Recession Healthy gum tissue protects your teeth from disease and helps produce a great smile. However, when you experience gum tissue loss around your teeth, it can be the beginning of serious oral health problems. Exposed tooth roots are the result of gum recession. Recession is never normal, regardless of a person’s age. There are many causes of gum recession including periodontal disease, overly aggressive brushing, anatomic susceptibility, and tooth position. Orthodontic (braces) treatment, the shape of your teeth and roots, and improper tooth position, such as crowding. If recession progresses, without treatment, it can lead to cosmetic compromises, tooth sensitivity, tooth/root decay, and even tooth loss. It is important that a comprehensive examination be completed, to identify the potential risks for future progression.

Natural gum regeneration is the most common treatment for recession. The benefit of these procedures is that they permit Dr. Gonzalez to restore the tissue which has been lost or to prevent additional recession.

For more information about gum grafting, click on the link below to view a video from the American Dental Association.

There are several techniques to treat exposed roots but most common ones are: Connective Tissue Grafts, Gingival Grafts and Alloderm® grafts which is an acellular dermal matrix derived from donated human skin tissue supplied. For more information please see: http://www.biohorizons.com/alloderm.aspx

AlloDerm® Regenerative Tissue Matrix is processed from donated human tissue that must pass the same stringent screening criteria as any other implantable tissue or organ (heart, lungs & kidneys, etc.).

Besides its use in dental applications, AlloDerm® has been used extensively in Burn Reconstruction and Plastic Reconstructive Surgery.

In its history of over 10 years and 500,000 procedures, there has never been a reported case of viral disease transmission from AlloDerm® tissue.

AlloDerm® provides the collagen structure and proteins that help your body's own tissue grow and remodel. The collagen serves as a scaffold into which your cells can grow. The proteins act as recruiters, drawing your cells into the graft, and telling them how to remodel it. As the body's natural processes take over, your own cells move into the AlloDerm. Over time, your cells transform the AlloDerm into your own healthy gum tissue. You should experience significant healing within the first week. Complete healing may take 2 to 6 months depending on the type of surgery. Once recovery is complete, you won't be able to tell the AlloDerm was ever there!

You have the freedom of choice: to use tissue harvested from another part of your mouth, or to use AlloDerm®.

To make an appointment with us for gum recession evaluation in the Escazu area, please call 506-2289-4040 or in the Grecia area, please call 506-2494-2215.

Non-Surgical Treatments

Periodontal health should be achieved in the least invasive and most cost-effective manner.

Periodontal (Osseous) Surgery

If you're diagnosed with periodontal disease, Dr. Gonzalez may recommend periodontal surgery. Periodontal surgery is necessary when Dr. Gonzalez determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. The two types of surgical treatments most commonly prescribed are Pocket Reduction Procedures (pocket elimination) and Regenerative Procedures.

This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins) thereby permitting the tissues to repair themselves naturally. Sometimes, there is also a need for adjunctive therapy, such as local delivery antimicrobials and host modulation. This is determined on a case-by-case basis

Dr. Gonzalez and most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.

In advanced cases of periodontal disease, the first line of treatment, scaling and root planing, combined with excellent home care to keep new bacterial deposits from forming, is sometimes not enough to bring the disease under control. In some cases, periodontal surgery is necessary.

Osseous (Bone) Surgery After numbing the area very well, an incision is made in the gum to separate the gum from the tooth. This "flap" allows us to access to the plaque calculus deep in the pocket.

The rough sharp edges of the bone can be smoothed off

The gum is then repositioned around the neck of the tooth and held in place with sutures.

Your bone and gum tissue should fit snugly around your teeth like a turtleneck collar around your neck. When you have periodontal disease, the supporting gum tissue and bone is destroyed. Eventually, if too much bone is lost, the teeth may have to be extracted. Regenerative procedures are often recommended to regain some of the lost hard (bone) and soft (gum) tissues which have been lost. These procedures can reverse some or all of the damage naturally, by stimulating your body to reproduce the lost tissue. After painlessly removing the disease causing bacteria, bone grafts or tissue-stimulating proteins can be used to encourage your body's natural ability to regenerate bone and tissue.

Eliminating existing bacteria and regenerating gum and bone and tissue help to reduce pocket depth and repair the damage caused by the progression of periodontal disease. With a combination of daily oral hygiene and professional maintenance care, you increase the chances of keeping your natural teeth and are less likely to experience the serious health problems associated with periodontal disease.

Surgery is only rarely needed to control periodontal disease, a disease that affects almost everyone. Most people can keep their teeth and gums healthy by careful daily removal of the bacterial film which causes the disease, in combination with periodic visits to a dentist or dental hygienist for the removal of bacterial deposits below the gum line. However, when there is periodontal disease, and the gum has unzipped so far down the root of the tooth that dental instruments are no longer effective (about 5-6 millimeters), periodontal surgery may be necessary. If not done, the bacterial deposits will remain on the tooth and cause further bone destruction; ultimately causing the teeth to develop painful abscesses or simply to loosen and fall out.

Periodontal surgery sometimes known as pocket elimination, is a minor surgical procedure generally done in the dental office with a local anesthetic. It involves folding the gum back away from the tooth just enough so that a Periodontist, a dentist specializing in the treatment of gum diseases, can see the tooth root surfaces. Once they are seen, the deep bacterial deposits crusted on the tooth can be removed. In this way, the root surfaces can be made once again acceptable to the body, and the gum can reattach, at least to a degree. Surgical access also makes it possible to graft bone into defects to repair some of the damage. After root preparation, the gum is closed back with sutures and a dressing is often placed to keep the area undisturbed, especially for the first week.

Of course, some soreness is normal the first day or so after periodontal surgery. Many persons, however, have very little discomfort. A more common complaint afterward is sensitivity to hot or cold liquids. This is caused by exposure of more of the tooth root surface, and may last for a short period of time.

What are the benefits of this procedure?

Functional crown lengthening is an important part of an integrated effort to optimize your health, appearance, comfort, and function. A beautiful new smile and improved periodontal health are your keys to smiling, eating and speaking with comfort and confidence.

Functional Crown Lengthening

Periodontal procedures are available to lay the groundwork for periodontal and restorative dentistry and/or to improve the health and esthetics of your smile. Periodontal crown lengthening is a procedure that recontours the gum tissue surrounding one or more teeth so that an adequate amount of healthy tooth is exposed. Crown lengthening is often used as part of a treatment plan for a tooth that is to be fitted with a crown. This procedure provides the necessary space between the supporting bone and crown, preventing the new crown from damaging gum tissues and bone. Your dentist or Periodontist may recommend a crown lengthening procedure to make a restorative procedure possible. If a tooth is badly worn, decayed, or fractured, below the gum line, crown lengthening adjusts the gum and bone levels to gain access to more of the tooth so it can be restored.

When a tooth requires restoration with a filling material or a crown, the dentist must have adequate access to remaining tooth structure. It is a common occurrence that the dentist will not have adequate tooth structure to attach the restoration, and preserve favorable gum tissue health. As a rule, simply trimming back the gum is not sufficient, for the bone would be exposed. Crown lengthening is a surgical procedure in which the periodontist adjusts the gum and bone level to expose more of the tooth, so it can be restored.

Periodontal procedures are available to lay the groundwork for periodontal and restorative dentistry and/or to improve the health and esthetics of your smile. Periodontal crown lengthening is a procedure that recontours the gum tissue surrounding one or more teeth so that an adequate amount of healthy tooth is exposed. Crown lengthening is often used as part of a treatment plan for a tooth that is to be fitted with a crown. This procedure provides the necessary space between the supporting bone and crown, preventing the new crown from damaging gum tissues and bone. Your dentist or Periodontist may recommend a crown lengthening procedure to make a restorative procedure possible. If a tooth is badly worn, decayed, or fractured, below the gum line, crown lengthening adjusts the gum and bone levels to gain access to more of the tooth so it can be restored. When a tooth requires restoration with a filling material or a crown, the dentist must have adequate access to remaining tooth structure. It is a common occurrence that the dentist will not have adequate tooth structure to attach the restoration, and preserve favorable gum tissue health. As a rule, simply trimming back the gum is not sufficient, for the bone would be exposed. Crown lengthening is a surgical procedure in which the periodontist adjusts the gum and bone level to expose more of the tooth, so it can be restored. This procedure remodels the contour of the gum tissue and surrounding bone around one or more teeth providing the exposure of previously covered healthy tooth structure. Crown lengthening is often used as part of a treatment plan for a crown needing more tooth structure. This provides the necessary space between the crown margin on the tooth and the bone level, thus preventing damage to the gum tissue.

Crown lengthening is also recommended for making certain restorative procedures possible. If part of a tooth is broken down below the gum line, whether due to fracture or decay, a crown lengthening procedure adjusts the level of the gum and bone around the tooth or teeth involved, thus providing for more tooth structure and allowing for the final crown restoration to be constructed. The restorative dentist should wait about 8 weeks following crown lengthening before taking final impressions. This ensures that the gum, which shrinks slightly as it reattaches to the tooth during healing, is in its final healed position. The benefits of crown lengthening are important for the overall strength of the final crown, and provide for better health, comfort, and function. With periodontal gum health, one will be able to smile, eat, and speak with comfort and confidence.

What are the benefits of this procedure?

Whether you have crown lengthening to improve function or esthetics, patients often receive the benefits of both: a beautiful new smile and improved periodontal health – your keys to smiling, eating and speaking with comfort and confidence.

Periodontal procedures are available to lay the groundwork for restorative and cosmetic dentistry, and/or to improve the esthetics of your gum line. You may ask Dr. Gonzalez about procedures to improve a "gummy" smile because your teeth appear short. Your teeth may actually be the proper length, but they're covered with too much gum tissue. To correct this, "esthetic" crown lengthening is performed. During this procedure, excess gum and bone tissue are reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.

Soft Tissue Grafts are available to stop further gum recession, and/or to improve the esthetics of your gum line. Exposed tooth roots are the result of gum recession. Perhaps you wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or, you may not be bothered by the appearance of these areas, but you cringe because the exposed roots are sensitive to hot or cold foods and liquids. Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. Once these contributing factors are controlled, a soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss

Sometimes when you lose one or more teeth, you can get an indentation in your gums and jawbone where the tooth used to be. This happens because the jawbone recedes when it no longer is holding a tooth in place. Not only is this indentation unnatural looking, it also causes the replacement tooth to look too long compared to the adjacent teeth. Dr. Gonzalez can fill in this "defect" with a procedure called ridge augmentation, recapturing the natural contour of your gums and jaw. A new tooth can then be created that is natural looking, easy-to-clean, and attractive.

Re-establish lost tooth attachment with Emdogain® Emdogain® is a scientifically well-documented product that has been used in over 400,000 patients worldwide. Emdogain® allows your body to rebuild the natural attachment that is required to support your teeth. A natural tooth attachment consists of three basic elements: Root surface Tiny fiber bundles connecting the root surface and jawbone The jawbone itself Emdogain® is unique because it utilizes a matrix protein, to reestablish new tooth attachment previously lost due to moderate severe periodontitis. It promotes the reformation of tooth attachment (root surface, fiber bundles and bone) starting immediately and continuing for an extended period of time - in some cases more than a year. During this time, you can help to ensure a positive and long lasting result by visiting our office regularly and by carefully following Dr. Gonzalez' recommendations.

Conscious sedation dentistry allows Dr. Gonzalez to perform the work you need while you relax. He can accomplish in one visit what might have otherwise taken several appointments. Gum treatments, implants, smile restorations, and more can be accomplished while you relax comfortably.

Dental Sedation techniques include oral conscious sedation, and intravenous sedation. Many patients prefer oral conscious sedation during a planned procedure. With oral conscious sedation, the patient takes a small pill before an appointment, which produces a delightful feeling of relaxation and NO memory of the procedure. For patients with special needs or those requiring lengthy visits, we have a physician M.D. anesthesiologist on staff, providing intravenous sedation. Intravenous sedation is anesthesia administered through a vein during your visit to ensure your comfort and maximum relaxation.