There are a number of procedures that Dr. Horowitz can use in order to correct or enhance your smile.
These procedures are a predictable way to cover unsightly, sensitive or exposed root surfaces and to prevent future gum recession. If you are unhappy with the appearance of short unsightly teeth this can be greatly improved by a combination of Periodontal procedures by Dr. Horowitz and cosmetic dentistry by your dentist.
Although your teeth appear short, they may actually be the proper length. The teeth may be covered with too much gum tissue. We can correct this by performing the periodontal plastic surgery procedure, crown lengthening.
During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to more than one tooth, to even your gum line, and to create a beautiful smile.
Another cosmetic procedure is the soft tissue graft. It is used to cover unattractive tooth roots, reduce gum recession and protect the roots from decay and eventual loss.
Tooth loss causes the jawbone to recede and can lead to an unnatural looking indentation in your gums and jaw, an appearance of a general aging. The original look of your mouth may not be recaptured because of spaces remaining under and between replacement teeth. They may appear too long compared to nearby teeth.
Bone grafting following tooth loss can preserve the socket/ridge and minimize gum and bone collapse. There is less shrinkage and a more esthetic tooth replacement for either an implant crown or fixed bridge around the replacement teeth.
Bone grafting
The use of Bone Grafting techniques has revolutionized Periodontal therapy.
We have the ability, in many instances, to rebuild bone lost either through infection
or trauma. There are a number of types of grafts used for a number of differing situations.
Tooth loss causes the jawbone to recede and can lead to an unnatural looking indentation in your gums and jaw, giving an appearance of aging. The original look of your mouth may not be recaptured by conventional dental therapy because of spaces remaining under and between replacement teeth caused by bone loss. Without grafting procedures teeth may appear too long compared to nearby teeth.
Bone grafting following tooth loss can preserve the socket/ridge and minimize gum and bone collapse. There is less shrinkage and therefore a more esthetic tooth replacement, either by an implant or crown/bridge, can be made for you.
Major and Minor Bone Grafting
Over a period of time, the bone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In many such cases bone grafting can correct the problem and allow for implant placement in areas where teeth have long been missing.
Sinus Lift Procedure
The maxillary sinuses are behind your cheeks and on top of the upper teeth. Sinuses are like empty rooms that have nothing in them. Some of the roots of the natural upper teeth extend up into the maxillary sinuses. When these upper teeth are removed, there is often just a thin wall of bone separating the maxillary sinus and the mouth. Dental implants need bone to hold them in place. When the sinus wall is very thin, it is impossible to place dental implants in this bone.
There is a solution and it’s called a sinus graft or sinus lift graft. The dental implant surgeon enters the sinus from where the upper teeth used to be. The sinus membrane is then lifted upward and donor bone is inserted into the floor of the sinus. Keep in mind that the floor of the sinus is the roof of the upper jaw. After several months of healing, the bone becomes part of the patient’s jaw and dental implants can be inserted and stabilized in this new sinus bone.
The sinus graft makes it possible for many patients to have dental implants when years ago there was no other option other than wearing loose dentures.
If enough bone between the upper jaw ridge and the bottom of the sinus is available to stabilize the implant well, sinus augmentations and implant placement can sometimes be performed as a single procedure. If not enough bone is available, the Sinus Augmentation will have to be performed first, then the graft will have to mature for several months, depending upon the type of graft material used. Once the graft has matured, the implants can be placed.
Today, we have the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and esthetic appearance.
Major Bone Grafting
Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. There are many bone graft materials available today and Dr. Horowitz will discuss the options most suitable for your situation.. Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.
Socket Preservation
Careful management of extraction sockets after tooth extraction prevents unsightly bone loss and provides a better cosmetic outcome for tooth replacement.
Socket preservation is a procedure used to prevent the bone and gum from “collapsing” after an extraction of one or more teeth. This can cause esthetic problems and even preclude the ability to restore the area with an implant. A number of studies have shown that bone is lost rapidly after an extraction causing a concavity in the area. The resulting jaw deformity,which occurs after an extraction, can be prevented by filling the extraction socket with bone or a bone substitute. This technique can greatly improve your smile while also ensuring the ability to place a properly fitting bridge or increase the success of implant procedures.
Ridge Augmentation
Ridge augmentation is used to correct anatomic deformities where teeth are missing.
This procedure fills in depressions that are unnatural looking and may make you look older than you are. If bone loss is not addressed after an extraction (via socket preservation) the area often caves in, affecting your ability to properly clean under a bridge. The problems of bone loss also affect your dentist’s ability to restore the area to a natural state. In addition, ridge augmentation is often used prior to, or in conjunction with, implant surgery to ensure the best orientation of the implant for both aesthetic and functional results.
Ridge Expansion
In severe cases, the ridge has been reabsorbed and a bone graft is placed to increase ridge height and/or width. This is a technique used to restore the lost bone dimension when the jaw ridge gets too thin to place conventional implants. In this procedure, the bony ridge of the jaw is literally expanded by mechanical means. Bone graft material is then placed and will mature over a period of time, allowing for implant placement, usually within 6 months of the first procedure.
Nerve - Repositioning
The inferior alveolar nerve, which gives feeling to the lower lip and chin, may need to be moved in order to make room for placement of dental implants to the lower jaw. This procedure is limited to the lower jaw and indicated when teeth are missing in the area of the two back molars and/or and 2nd premolar, with the above-mentioned secondary condition.
Since this procedure is considered a very aggressive approach (there is almost always some postoperative numbness of the lower lip and jaw area, which dissipates only very slowly, if ever) Usually other, less aggressive options are considered first (placement of blade implants, etc.)
Typically, we remove an outer section of the cheek side of the lower jawbone in order to expose the nerve and vessel canal. Then we isolate the nerve and vessel bundle in that area, and slightly pull it out to the side. At the same time we place the implants, we’ll be tracking the neuro-vascular bundle. Then the bundle is released and placed back over the implants. The surgical access is refilled with bone graft material of the surgeon’s choice and the area is closed.
These procedures may be performed separately or together, depending upon the individual's condition. As stated earlier, there are several areas of the body that are suitable for attaining bone grafts. In the maxillofacial region, bone grafts can be taken from inside the mouth, in the area of the chin or third molar region or in the upper jaw behind the last tooth. In more extensive situations, a greater quantity of bone can be attained from the hip or the outer aspect of the tibia at the knee. When we use the patient’s own bone for repairs or addition, we generally get the best results.
In many cases, we can use allograft material to implement bone grafting for dental implants. This bone is prepared from cadavers and used to get the patients own bone to grow into the repair site. It is quite effective and very safe. Synthetic materials can also be used to stimulate bone formation. We even use factors from your own blood to accelerate and promote bone formation in graft areas.
These surgeries are performed in the out-office surgical suite under IV sedation or general anesthesia. After discharge, bed rest is recommended for one day and limited physical activity for one week.