Scaling and Root Planing

Scaling and Root Planing can be performed with or without local anaesthetic. The goal of the procedure is to remove as much of the infected root surface as possible. Also, in the process, the damaged tissue is removed. The gum tissues usually respond by becoming less red and puffy and they tend to bleed much less.

Pocket Reduction Surgery

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 pre-term low-birth weight babies. As ongoing research continues to define how periodontal disease is linked to these and other healthy problems, good oral health is essential. 

Many factors, such as oral hygiene habits, tobacco use, genetics, stress, general health conditions and medications may have contributed to your disease and can influence treatment effectiveness and disease recurrence.

A pocket reduction procedure is recommended when pockets are too deep to clean with daily homecare and a professional care routine. During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria before securing the tissue back into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.

Unforeseen conditions may call for a modification or change from the surgical treatment plan. These include but are not limited: to a) extraction of hopeless teeth to enhance healing of adjacent teeth, b) removal of a hopeless root of a multi-rooted tooth so as to preserve the tooth, c) placement of a bone graft or other material to enhance tissue regeneration, d) termination of the procedure prior to completion of the surgery originally outlined.

Soft Tissue Grafting

Soft tissue grafts are recommended to stop further dental problems and gum recession, and/or improve the esthetics of your gum line. Your gums can recede for a number of reasons such as aggressive tooth brushing and periodontal disease. Exposed tooth roots are the result of gum recession, which makes your teeth appear too long. The exposed roots can be sensitive to cold or hot foods and liquids. 

A soft tissue graft will repair the defect and help prevent additional recession and bone loss. Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. It may be impossible however, to guarantee 100% root coverage (see figures 3a and 3b). The ability to cover the roots of teeth completely depends on many factors, some of which are beyond the control of the surgeon.

During this procedure, the periodontist takes tissue from your palate to cover the exposed root. There will be two packings placed in your mouth, one on the donor site and one where the graft was placed. The packaging on the donor site will usually fall off within a day or two. The packing where the graft was completed should stay in place for a week. 

There are several different types of soft tissue grafts. Some of the more common ones are connective tissue grafts and free gingival grafts. Connective tissue grafts are better in providing more root coverage to the tooth than are free gingival grafts. Also, the final result of either graft will provide a different appearance. The free gingival grafts tend to appear more pink and bulky than the connective tissue grafts.

Hard Tissue Grafting

In instances when you have lost a tooth or teeth, the gum and bone begins to disappear leaving you with an indentation. This indentation may be limiting if you are considering implant treatment.  In order to properly have an implant placed that is both functional and aesthetic your doctor may need to rebuild the bone and gum in this area. A variety of different bone graft materials can be used to build up the bone. Your clinician will review these with you.

Functional and Aesthetic Crown Lengthening

Functional crown lengthening is a surgical procedure that recontours the gum tissue and often the underlying bone around a tooth. This is to provide your dentist with an adequate amount of healthy tooth that is exposed. Once there is enough tooth exposed, your dentist can properly place a filling or a cap/crown over the tooth. Without this procedure, it may not be possible to fix the tooth or do so in a healthy manner.

Aesthetic crown lengthening is a surgical procedure that recontours the gum tissue and often the underlying bone to reduce your “gummy smile” and allow your dentist to fabricate veneers/crowns which will allow for a more aesthetic smile. 

Pre-orthodontic Procedures

Often certain procedures are necessary either before, during or after orthodontic treatment. Some of these are crown exposures, fibrotomy and frenectomy. In some cases, a thorough periodontal examination may be necessary prior to orthodontic treatment.  This is to either rule out periodontal disease or examine whether any type of soft tissue grafting is necessary.  Periodontal disease must be treated prior to any orthodontic treatment.  Soft tissue grafting may be treated before, during or sometimes after orthodontic treatment.  A thorough periodontal examination will determine what periodontal needs are necessary prior to beginning the orthodontic treatment.

Sometimes, teeth are not able to make their way into the oral cavity and get stuck in the jaw bone. The only way to pull these teeth down is by performing a crown exposure. Your doctor will expose the hidden tooth and place a little button (like a bracket in braces) that the orthodontist can use to pull the tooth into the dental arch.

A frenectomy is a procedure where your doctor will gently trim at the muscle tissue that attaches your lip to your gum either in the lower front or upper front area of your mouth. This muscle attachment sometimes is positioned too low and it interferes with closing the gap between your two front teeth. This procedure is quick and requires little to no recovery time.

A fibrotomy is usually done at the conclusion of orthodontic treatment. If your teeth were really malpositioned prior to the braces, there is concern that there will be relapse – meaning the teeth will want to move back to where they were before the braces. A fibrotomy is a very simple procedure to help prevent this problem. The goal of this procedure is to gently loosen the fibers that attach your tooth to the jaw bone. This will help new fibers to form that don’t exert as much pressure to try and bring your teeth back to how they were positioned before.


A dental implant is an artificial tooth root that a periodontist places into your jaw to hold a replacement tooth, bridge or denture. Unlike bridgework or partial dentures, dental implants do not rely on neighbouring teeth for support. They are natural-looking and feeling. Dental implants are recommended for patients in good general oral health that have lost a tooth or teeth due to periodontal disease, an injury or some other reason.

Dental implants can be used to replace one or more teeth without affecting bordering teeth. Implants can support a bridge and eliminate the need for a removable partial denture or provide support for a denture to make it more secure and comfortable. Dental implants integrate into the structure of your bone and prevent the bone loss and gum recession that often accompanies tooth loss.

Adequate bone in the jaw is needed to support the implant, and the best candidates have healthy gum tissues that are free of periodontal disease.

In most cases, prior to placing the implant, a special radiograph is required to enable the periodontist to determine the bone density and the location of the sinus and nerves. This helps to determine the type, size and placement of the implant. The radiograph required will be determined by the periodontist for each individual case.

An implant is an artificial titanium fixture that is surgically placed into the jaw as a substitute for the missing tooth’s root. This fixture bonds to the living bone tissue, and is concealed by gum tissue and a new tooth, which is created by a prosthodontist or your dentist.

Once the implant is secured in place in the jaw bone, the overlying gum tissue is then stitched closed and the area is allowed to heal for 3-6 months. After this healing stage, a second small surgical procedure may be necessary to expose and test the stability of the implant. Following this, the implant is ready to receive the crown and this stage will be done by your dentist.

Sinus Augmentation

A key to implant success is the quantity and quality of the bone where the implant is to be placed. The upper back jaw has traditionally been one of the most difficult areas to successfully place dental implants due to insufficient bone quantity and quality and the close proximity to the sinus. Sinus augmentation can help correct this problem by raising the sinus floor and developing bone for the ideal placement of dental implants.

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