When a tooth is lost, the bone quickly undergoes atrophic changes especially if the site is not grafted. Up to 50% volume of loss can occur within the first 3 months post-extraction. When upper posterior teeth are removed, the sinus begins to change as well. Over time, the sinus begins to migrate closer to the crest of the ridge which decreases the available bone depth required for the implant. A predictable and SAFE procedure can be completed to re-grow this lost space.
There are two types of procedures to accomplish this task. Depending on the amount of bone needed, one technique can be completed at the same time of implant placement while the other requires delayed implant placement. Remember, for an implant to be placed, there needs to be an adequate amount of bone to provide initial fixture stability.
There are many reasons for the extraction of teeth including Periodontal disease or advanced decay. Often times, patients present with severe pain and just want immediate relief. All treatment options to replace the extracted tooth must be discussed prior to tooth removal. A tooth abscess could result in a large amount of infection at the end of the root which would leave a significant bone defect if the site was not preserved.
When a tooth is removed, changes immediately occur to the fresh extraction site. When the blood clot forms on the bone, the site begins to heal. During the normal healing process, up to 50% atrophy or shrinkage can occur to the site within 3 months. The goal of ridge preservation is to reduce the amount of this shrinkage to the site. If there was infection at the root apex, complete removal of it is required prior to the placement of bone graft material. With grafting, the site will heal with less shrinkage and will provide greater support for a fixed bridge, partial, or dental implant.
There are many types of grafting materials including: Bovine, Cadaver and harvesting the patient's bone from a secondary surgical site. All products that are used in Dentistry are processed very meticulously and are very safe for our use. Your body uses these materials to build new bone but most importantly, their function is to hold and maintain space. When the extraction site is grafted, it is ready for implants or restorative options within 3-6 months depending on the amount of original infection and quality of bone that was present.
If you are experiencing severe discomfort in a tooth or teeth, we recommend you schedule an appointment with Dr. Engle as soon as possible. Treating your condition quickly may prevent additional costs or healing time prior to restoring your mouth to function.
I incorporate many techniques that can preserve a ridge. Depending on the amount of infection or bone loss present, a variety of different materials can be utilized to preserve or repair damage to the bone.
The simplest way to preserve the ridge of bone involves careful management of extraction sockets after tooth extractions. This helps prevent unsightly bone defects and will ensure better cosmetic outcome after tooth replacement with implants. The surgical management of the extraction site with simple extractions can be extremely important to the ultimate success of dental implants.
If a tooth is removed without bone grafting, there is a greater chance that more aggressive bone grafting techniques maybe recommended in the future. Depending on the overall size of the defect, multiple grafting procedures (both hard and soft-tissue) maybe required to achieve optimal esthetic results.
Periodontal disease is the leading cause of tooth loss in adults. The main cause of periodontal disease is bacterial plaque (sticky, colorless film that forms on your teeth). Secondary causes include smoking (tobacco use), genetics, pregnancy, puberty, stress, diabetes, poor nutrition, auto-immune conditions, poor restorations, bad occlusion, and certain medications.
When plaque forms on your teeth, the bacteria become irritations to the gums. The mildest form of disease is Gingivitis which is completely reversible with proper brushing and flossing habits and regular hygiene appointments. Symptoms of Gingivitis may include redness, swelling, and/ or bleeding gums. Left untreated, Gingivitis could progress to Periodontitis which is when the disease begins affecting the supportive bone around your teeth. The gums will begin to separate from the teeth causing increased periodontal pocketing (spaces). As periodontal disease progresses, the supporting gum tissue and bone further deteriorate. If left untreated, the end-point of disease is Tooth Loss.
The effects of Periodontal Disease can be prevented and reversed. Schedule a Consultation with Dr. Engle
When tooth decay or a tooth fracture occurs below the gumline, it may be necessary to remove a small amount of bone and gum tissue prior to completing restorative care. This is procedure becomes necessary so that the final crown can be placed in a healthy environment without impinging on either the gum or bone.
Crown lengthening is recommended because the decay or broken segment of the tooth extends below the gum line. Biological width is the distance between the crown margin and the bone. The distance between the crown margin and the marginal crest of the bone needs to be up to 3 mm. If the new crown margin violates this principle, then gingival inflammation or pain could occur over time.
The procedure can be completed without much discomfort and usually only takes a short while to complete. Within 6 weeks after crown lengthening, your Dentist can begin final impressions for your new crown.
A pocket is the detachment of the gum from the root surface. Pockets over 5mm deep are difficult to clean with a normal toothbrush or even with regular hygiene cleanings. These pockets will lead to bone loss, tooth mobility and eventually the loss of the tooth if left untreated.
Pocket Elimination surgery involves a small surgical procedure to help reattach the gum to the root surface. The infected gum is trimmed away and the uneven bone is re-contoured. This is considered definitive Periodontal treatment. After healing is complete, the gingival tissue might shrink depending on the overall amount of gingival pocketing. Following treatment, there could be initial Hot/ Cold sensitivity to some of the teeth which can easily be treated with fluoride rinses or toothpastes.
The end result is a tighter attachment of the gum to the tooth, no pocketing, and improved cleansiblity with a normal toothbrush. With Definitive Periodontal treatment, you will gain an increased long-term prognosis of the remaining teeth.
This surgical procedure "regenerates" the previously lost bone tissue and to a minor extent, the soft tissue. Depending on the topography of the defect, up to 50-80% regeneration of tissue can be accomplished. Vertical bone defects respond more favorably to definitive treatment. However, Horizontal defects can be "regenerated" but it is far more unpredictable.
Following a similar surgical protocol as Pocket elimination, the defect is completely debrided of all infected tissues, leaving good healthy bone. Utilizing Bovine, Cadaver and/ or Autogeneous (patient's bone from second surgical site), the site is completely filled (grafted). The graft is covered with either a Resorbable or Non-Resorbable barrier depending on the type of defect. Most of the time, I use a Resorbable barrier (Collage Type 1) since a Non-Resorbable barrier requires removal after 6 weeks of healing. It takes at least 3 months to demonstrate bone growth radiographically. However, it only takes a few weeks before all of the sutures are removed.
In the last couple of years, we have seen better results with growing a larger volume of bone. With the use of chemical Biologics, acting like a stem-cell stimulator, your body will heal quicker and "regenerate" a greater amount of attachment (and bone).
When recession of the gingival occurs, the body loses a natural defense against both bacterial penetration and trauma. The damage can be easily corrected/ reconstructed in most instances using soft-tissue grafting techniques.
When there is only minor recession, often times there is healthy gingiva present which can still protect the tooth. No treatment is recommended other than modifying home care practices or occlusal adjustments to prevent further damage from occurring. If the recession reaches deeper into the mucosa, then first line of defense against bacterial penetration is lost.
When gingival recession occurs, the teeth and gums could become sensitive to hot and cold foods/ drinks. Esthetically, teeth can become unsightly to appearance. When gingival recession becomes significant, the exposure of the root surface (softer than enamel) can lead to root caries and root gouging/ notching.
A Free or Connective Tissue graft is designed to solve these problems. A thin piece of tissue can be taken from the roof of the mouth, or gently removed from adjacent areas, to provide a stable band of attached gingival around the tooth. The gingival tissue is placed to either increase the amount of keratinized tissue and/ or to improve root coverage. For areas that require larger grafts, Commercially available grafts can be purchased. Follow strict harvesting protocols, these grafts are safe to use. Many patients prefer the use of these types of materials because it reduces the surgical time, the need to harvest a graft from a second surgical site, and the post-operative soreness following the procedure.
The gingival graft procedure is highly predictable and with certain clinical criteria can provide up to 100% root coverage.
Intravenous Sedation is one of the most beneficial services that I offer at my both of my locations (Naples/ Marco Island). Imagine having 3-4 hours of dental work completed with only feeling like 15-20 minutes have past. A majority of my patients enjoy the benefits of being "sedated" at my office. They experience less post-operative soreness and can recover faster compared to a non-sedated patient.
Fear of needles?
Fear of the Dentist?
Fear of having a tooth pulled or a root canal completed?
At my office, you can request to be IV sedated for both surgical and General Dentist services. Many of my patients travel from around the world to experience Comprehensive dental procedures completed with my Team (both have IV sedation credentials). IV Sedation Dentistry has allowed me to complete needed Dentistry to a population of patients that are nervous, have limited time, or simply want to be more relaxed during longer appointments.
Please contact my office to discuss how IV Sedation can benefit you.