OUR PERIODONTAL SERVICES
Pinhole Surgical Technique
What is Periodontal Disease?
The word "periodontal" literally means around the tooth. Periodontal disease, also known as "gum disease," is a chronic bacterial infection that damages the gums and bone supporting the teeth. Left untreated, it can lead to tooth loss. More importantly, research links periodontal infection to more serious problems, such as cardiovascular disease, diabetes, and preterm babies. As ongoing research continues to define how periodontal disease is linked to these and other health problems, effective oral habits are essential.
Signs for unhealthy gums may be any of the following: gums that are red and bleed easily, persistent bad breath, gums that are pulled away from the tooth, loose teeth, and changes in the position or bite of the teeth. Any of these signs may mean something is wrong. With the proper care, however, it may be possible to return them to a healthy state. This is where appropriate gum treatments come in. If you're having a problem, come in and see us and we may be able to take care of it right away. If the gum disease gets too severe it may need to be treated through surgery or extraction. This is why it is important to get it treated at the first sign of a problem.
Periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing. This is the processes of carefully cleaning the root surfaces to remove plaque and calculus from deep periodontal pockets and smooth the tooth root to remove bacterial toxins. For some cases, there is a need for additional therapy, such as local delivery of antimicrobial and host modulation.
Dr. Schoenenberger and most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. The majority of patients, however, will require ongoing maintenance therapy to sustain health. Non-surgical therapy does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and facilitate oral hygiene practices.
(Laser Assisted New Attachment Procedure)
Dr. Schoenenberger is proud to be one of the first periodontal offices in the area to offer this unique procedure. Conventional periodontal surgery has more loss of gum tissue, more root exposure, and more root sensitivity, compared to the PerioLase™ Laser. The laser has fewer adverse side effects than conventional periodontal surgery and is the only FDA approved laser to treat gum disease.
This highly advanced laser system is different than conventional lasers in dentistry today since it only destroys infected gum tissue, which are black in color, and leaves all healthy tissue alone. Before the laser treatment, Dr. Schoenenberger hand scales the plaque and calculus on the tooth surface and in the periodontal pockets. Once the patient's appointment is finished, they will notice a thin strip of white tissue along the roots of their teeth. The strip is the natural band-aid from the procedure and, underneath, bone begins to regrow naturally. Regrowing the bone will help strengthen the teeth as well as reduce the pockets. Reducing the pockets will help keep your mouth healthy on a daily basis but proper daily oral hygiene is still required.
With conventional periodontal surgery, bone grafting and membranes are usually used and increase the cost of conventional periodontal surgery. With LANAP™, these additional procedures are not typically necessary and the cost for LANAP™ is typically less than conventional periodontal surgery.
If needed, sedation can be used to keep you comfortable and relaxed.
Advantages of Laser Assisted New Attachment Procedure (LANAP™):
Only FDA Approved Laser to Treat Gum Disease
Only Laser Shown to Regrow Bone Around Teeth
Less Gum Recession
Less Root Sensitivity
Quicker Healing and Recovery
Usually Less Expensive than Conventional Periodontal Surgery
Laser Periodontal Therapy™
A procedure that brings your entire mouth back to health
Two to three weeks after LANAP, the patient will have a post-op visit to check the healing and review oral hygiene. Four weeks later there will be another post-op visit and review oral hygiene. The next three, six, and nine month visits after treatment consists of a periodontal cleaning for one hour, a periodontal oral evaluation, and an adjustment of the patients bite if necessary. The nine month evaluation will also include a post surgical set of x-rays at each surgical area, and we may start an alternating recall schedule with the general dentist.
Adjusting a bite removes harmful biting stresses on the bone supporting the teeth and helps to distribute the biting stress over all the teeth in the mouth. If clinching or grinding of the teeth is a habit, a night guard may also be helpful. A night guard would be fabricated after treatment by a dentist.
If there is a diagnoses of periodontal disease, Dr. Schoenenberger may recommend periodontal surgery. Periodontal surgery is necessary when Dr. Schoenenberger 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 offered are Pocket Reduction Procedures and Regenerative Procedures. 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.
Treatment of Gum Recession
(Connective Tissue Grafts and Gingival Grafts)
Exposed tooth roots are the result of gum recession. There are many causes of gum recession including periodontal disease, aggressive brushing, anatomic susceptibility, and tooth position. If recession progresses without treatment, it can lead to aesthetic compromises, tooth sensitivity, tooth decay on roots, or even tooth loss. Recession does not always need to be treated, therefore, it is important that an examination be completed to identify the potential risks for future progression. Soft tissue grafting is the most common treatment for recession. There are two different types of soft tissue grafting procedures: Connective Tissue Grafts and Gingival Grafts. During this procedure, Dr. Schoenenberger will move healthy gum tissue from the roof of the mouth, and restore the tissue in the area of recession.
AlloDerm® Gum Grafts
Healthy gum tissue protects teeth from disease and helps produce a great smile. When experiencing gum tissue loss around your teeth, it can be the beginning of serious oral health problems. Fortunately, Dr. Schoenenberger can perform a predictable procedure for reversing this tissue loss. In the past, this procedure has required a piece of tissue be harvested from the roof of the mouth to serve as the graft material. Unfortunately, not everyone has enough tissue available, or wants to have tissue taken from this sensitive area. Now patients have another choice.
AlloDerm is a dermal matrix that allows Dr. Schoenenberger to give patients the tissue graft they need, without the limitations associated with harvesting the graft material from somewhere else in the mouth. AlloDerm provides the missing components needed to restore health to damaged or receding tissue. It leads to fast healing with no second surgical site, and delivers great cosmetic results. Thousands of doctors and patients have made it their choice.
AlloDerm Regenerative Tissue Matrix is processed from donated human tissue that must pass the same strict screening criteria as any other implantable tissue or organ (heart, lungs & kidneys, etc.).
How safe is AlloDerm®?
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.
How does AlloDerm® work?
The AlloDerm provides the collagen structure and proteins that helps the body grown tissue. The collagen serves as a scaffold into which the cells can grow. The proteins act as recruiters, drawing cells into the graft, and telling them how to remodel it. As the body's natural processes take over, cells move into the AlloDerm. Over time, the patient's cells transform the AlloDerm into their own healthy gum tissue. Patients 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, patients won't be able to tell AlloDerm was ever there.
Crown Lengthening (Functional)
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. Simply trimming back the gum is not sufficient since 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. The following pictures may help visualize the process easier:
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. This provides for more tooth structure and allowing for the final crown restoration to be constructed.
Cosmetic Periodontal Procedures
In addition to procedures to treat periodontal disease, Dr. Schoenenberger also performs cosmetic procedures to enhance a smile! Cosmetic periodontal procedures include: Aesthetic Crown Lengthening, Soft Tissue Grafts, Gum Reshaping, and Ridge Augmentation.
Periodontal procedures are available to lay the groundwork for restorative and cosmetic dentistry, and improves the aesthetics of the gum line. Dr. Schoenenberger has procedures to improve a "gummy" smile, or having a smile with a large amount of gum tissue showing. The teeth are usually the proper length, but they're covered with too much gum tissue. To correct this, aesthetic 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 a gum line, or to several teeth to expose a natural, pure teeth smile.
Soft Tissue Grafts are available to stop further gum recession, and to improve the aesthetics of the gum line. Exposed tooth roots are the result of gum recession. Perhaps patients wish to enhance their smile by covering one or more of these roots that make teeth appear too long. Or, they may not be bothered by the appearance of these areas, but cringe because the exposed roots are sensitive to hot or cold foods and liquids. The 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.
When a patient loses one or more teeth, they may get an indentation in the 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. Schoenenberger can fill in this "defect" with a procedure called ridge augmentation, recapturing the natural contour of the rest of the gum line and jaw. A new tooth can then be created that is natural looking, easy-to-clean, and attractive.
If you've been diagnosed with periodontal disease, and a periodontist has recommended periodontal surgery, along with many other patients, there are many questions or concerns:
When is periodontal surgery necessary?
Surgery is only needed to control advanced periodontal disease. Most people can keep their teeth and gums healthy by daily oral care to remove the bacterial film, which causes the disease. Regular appointments at a dental facility is important for the removal of bacterial deposits that homecare products can't clean, located below the gum line. 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.
What exactly is periodontal surgery?
It 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 a Periodontist 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.
Is periodontal surgery a cure for periodontal disease?
No, it is not. The bacteria, which cause the disease, are normally in the mouth and continually form on the teeth as a thin film, requiring meticulous personal removal on a daily basis. Periodontal surgery can achieve a complete cleansing of deeply hidden bacterial deposits at a point in time. If the bacteria are kept off of the teeth long enough afterward for re-attachment and healing to occur, then a healthy and maintainable periodontal attachment can be achieved, and the teeth can be saved. If the bacterial film is allowed to build up during the healing period when the gum is actually less resistant to the destructive effects of bacteria, the result may be less than desired. Many people have undergone periodontal surgery to little avail when bacterial
How much will it hurt?
Of course, some soreness is normal the first day or so after periodontal surgery, however, many patients 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 else do I need to know about periodontal surgery?
Depending on exactly what types of defects or problems are present, many techniques may be used. These may include grafting of gum tissue and bone if needed, the correction of gum contours to improve their appearance and the ability to be cleaned more easily, the placement of dental implants, and the use of recent techniques for guided tissue regeneration. By the appropriate use of these of surgical procedures, as well as proper use of antibiotics, antiseptics, and anti-inflammatory agents, much can be done to control periodontal disease and save teeth from otherwise certain loss.
Waukesha, WI 53188