Reconstructive Surgery for Bone and/or Gum Loss
When periodontal disease is more advanced, it can result in damaged gum tissue and/or bone loss, which then can lead to tooth loss. However, there are surgical solutions that can be used to restore the tissue and/or the bone before tooth loss occurs. These procedures have become more potent and predictable in the last decade and are sure to continue improving in the future with advances in biotechnology. Dr. Levine has been in the forefront with clinical research and publications in reconstructive surgical procedures.
Osseous Surgery (or Resective Surgery)
This technique consists of trimming away infected gum tissue and re-contouring the uneven bone and tissue while removing bacterial toxins from root surfaces. Small access incisions along the necks of the teeth are made under a local anesthetic with sutures and a surgical dressing typically required. Although this is still an effective way of treating gum disease, new and more sophisticated procedures are more routinely used today.
Guided Tissue/Bone Regeneration (Reconstructive Dental Surgery)
This surgical procedure “regenerates” the previously lost gum and bone tissue. Other regenerative procedures involve the use of bioactive gels, Gem-21®, Emdogain™, PRGF (Plasma Rich in Growth Factors), to stimulate new bone formation as well as bone grafting materials and bio-absorbable membranes.
Gum/Gingival Grafts (Periodontal Plastic Surgery)
The gingiva is the gum area around the root of the tooth. When major recession of this gum area occurs, the body loses a natural defense against both bacteria and trauma. Gum recession often results in root sensitivity to hot and cold foods as well as an unsightly appearance to the gum and tooth. Significant gum recession can expose the root surface, which is softer than tooth enamel, leading to root caries and root gouging.
A gingival graft is designed to solve these problems. A thin piece of tissue is taken from the roof of the mouth (palate) or materials such as acellular dermal matrix or Mucograft® to provide a stable band of attached gingiva around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root to significantly improve the esthetic outcome. Dr. Levine has been involved in clinical research and publications in root coverage surgical procedures.
In certain cases, we can avoid using the palate as a donor site by using a bioactive gel (Gem-21® Emdogain™) in conjunction with a bone graft material and a bio-absorbable membrane to achieve the same goal of root coverage.
The gingival graft procedure is highly predictable and results in a stable healthy band of attached tissue around the tooth.
Related articles from our Patient Education Center:
- Levine, R.A., Manji, A., Faucher, J., Present, S. “Use of Titanium Mesh in Implant Site Development for Restorative-Driven Implant Placement: Case Report. Part 1 – Restorative Protocol for Single-Tooth Esthetic Zone Sites,” Compendium of Continuing Education in Dentistry. April 2014.
- Levine, R.A. “Gum Recession and Tissue Regeneration Through the Use of Emdogain™,” Clinician Corner, Straumann®. 2012.
- Levine, R.A. “Esthetic Case Book: Growth in Recession. An Esthetic Case Selection for Straumann© Emdogain.™” Case 3, Case 2 (12-15). 2011.
- Dr. Levine Wins Straumann® Emdogain™ “Growth in Recession Esthetic Case Competition”. 2013.
- Another Winning Case from the Straumann® Emdogain™ “Growth in Recession Esthetic Case Competition”. 2013.
- Levine, Garber, Krauser. “Hard Tissue Grafting When Osseous Architecture Suggests a Compromise in Positioning,” Inside Dentistry. 2009.
- Garber, Krauser, Levine. “What Parameters Decide Whether to Perform a Hard Tissue Graft When Osseous Architecture Suggests a Compromise in Positioning?,” Inside Dentistry (Clinical Roundtable). 2009.
- Levine, R.A. “Soft Tissue Considerations for Optimizing Implant Esthetics,” Functional Esthetics & Restorative Dentistry. 2007.Levine, R.A., Horowitz, R. “Bone Reconstructive Surgery for Implant Site Preparation,” Functional Esthetics & Restorative Dentistry Series 1(2): 20-28. 2007.
- Levine, R.A., Makrauer, Z. “The Use of Periodontal Plastic Surgery Procedures in Aiding Esthetic Restorative Results,” Compendium of Continuing Education in Dentistry. 2003.