Periodontal Cosmetic Surgery

Periodontists are often considered the plastic or cosmetic surgeons of dentistry. If you are looking to improve your smile and periodontal health, Dr. Lear may be able to help.

Soft Tissue (Gum) Grafting

Do your teeth appear longer or do you notice exposed tooth roots? These are signs of jawbone loss resulting in gum recession. This recession may lead to root sensitivity or damage and can make you look older than you are. A gum tissue graft can be used to cover roots and thicken the gum to protect the tooth and underlying bone. It may also reduce tooth sensitivity, protect vulnerable roots from decay and improve esthetics of your smile. A gum graft may also be performed to thicken the gum over an implant to protect the implant and bone.

Soft tissue grafting is an effective periodontal therapy procedure for repairing and recreating lost gingival gum tissue. During gingival grafting, the exposed root(s) are thoroughly cleaned then the existing gingival tissue is gently loosened to make room for the tissue graft. The grafting material may be your own tissue or sterilized donor tissue from an accredited tissue bank. The tissue graft is placed under the existing gingival tissue at the graft site. A protective covering is placed over the graft for stabilization. Whether you have a gum graft to improve function or esthetics, patients often receive the benefits of both a beautiful smile and improved periodontal health.

Gum grafting may also be performed to correct indentations in the gums and the jawbone. Sometimes after an extraction, a sunken area or concave appearance will develop in your gum line because the jawbone recedes when it no longer is holding a tooth in place. This looks unnatural and can also jeopardize the appearance of a bridge that goes over the area. It causes the replacement tooth to look too long compared to the adjacent teeth. A soft tissue grafting material can be “inserted” under the gum to fill out this depression to recapture the natural contour of the gums and jaw.

Connective Tissue Graft

Chao Pinhole® Surgical Technique

Chao Pinhole® Surgical Technique (PST) is a breakthrough treatment for gum recession. Dr. Lear is trained and certified in this minimally invasive option to treat gum recession. PST differs from traditional gum grafting. There are no grafts, no sutures, and no incisions. It involves a small pinhole where the existing gum tissue is gently loosened and adjusted with special instruments. Collagen strips are then placed to help stabilize the gums.

Pinhole® Surgical Technique

Esthetic Crown Lengthening and Gingival Contouring

Do you feel your teeth look too short and your smile too “gummy” or that your gumline is uneven, covering too much of some teeth, while leaving others the right length? If so, dental crown lengthening may be the cosmetic periodontal treatment for you. Your teeth may actually be just the right length, you simply have too much gum tissue covering your teeth and hiding your smile.

During crown lengthening procedures, excess gum and bone tissue is gently 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. If restorations are indicated, Dr. Lear can work with your dentist to create the esthetic periodontal foundation for your new veneers or crowns to have the correct length and shape, giving you a beautiful new smile.

Esthetic Crown Lengthening

Frenectomy

A frenum, or frenulum, is the small fold of tissue that attaches to the lips or tongue to prevent it from moving too much. In some cases, the frenum is too short, tight or tough and basically does its job too well. The inhibited movement causes difficulty with regular tasks like eating and talking, or effects proper development in children, leading to esthetic problems.

In the mouth, there are three frenum positions that commonly require a frenectomy:

Labial Frenectomy (upper lip): A labial frenectomy most often involves the frenum attaching the upper lip to the upper jaw, usually in children as their teeth and gums develop. If the frenum is too short or tight, the ligament tissue can extend toward the two upper front teeth and cause a diastema, or gap in the teeth. A short, tight frenum can also create an “open mouth posture,” by limiting the movement of the lip and preventing the mouth from properly sealing. This leads to open mouth breathing, which in children impairs the development of nose breathing and by extension proper airway and jaw development. It can also cause gum recession.
Lingual Frenectomy: The lingual frenum is the tight cord underneath the tongue that tethers the tongue in its resting position. If it is too tight or short it restrains the tongue too low. In young children, it will hinder correct growth of the jaw and cause long-term orthodontic problems and sometimes sleep apnea. A lingual frenum that is too tight or short can also keep the tongue from pressing properly against the upper palate during swallowing, pressing it instead between the teeth and preventing the bite from closing all the way over time. Finally, being tongue-tied is a common culprit for lisping.
Labial Frenectomy (lower lip): In the lower lip, the labial frenum attaches the lower lip to the lower jaw. If this frenum is too short to too tight, the ligament tissue can extend toward the two lower front teeth and cause problems and gum recession. But it is also performed in older adults who are being fitted for dentures. When the lips move, the frenum can pull the dentures loose, leading to improper fit.

A frenectomy is the simple procedure by which the frenum is incised and typically removed to free up more movement. Depending on how much of the frenum is incised or removed, there may be sutures to reposition the tissue. Following a lingual frenectomy, there may be a need for speech therapy exercises to train the patient to properly use the tongue, once it’s been freed and has newfound mobility. The benefits of a frenectomy are usually fairly immediate and positive.

Fiberotomy

A fiberotomy helps prevent the relapse of teeth that were rotated or severely misplaced before orthodontic treatment. Around each tooth, at the level of the gum line, runs a thin band of fibers that attaches the tooth to the gum tissue. You might compare the arrangement to that of a bicycle wheel: the fibers are the spokes connecting the gum (wheel) to the tooth (hub). But unlike rigid spokes, the fibers are elastic and have a very long memory. When a tooth is moved or rotated into a new position, the fiber connection is stressed, and remains stressed for many years. This stress tends to return the tooth to its original position.

To eliminate the fiber connection stress, the fiber network can be incised and allowed to reheal in an unstressed relationship. The teeth undergoing the fiberotomy should not be loose and the procedure normally involves little discomfort. Patients typically return to school or work right away.