Oral Surgery at O'Neal Periodontics of Marietta

Periodontal Surgery for the Treatment of Periodontal Disease

Periodontal disease is an oral infection that begins when harmful bacteria organize below the gum line and progressively destroy soft tissue and bone. As a periodontal specialist, Dr. Cheria O'Neal has a practice focus on treatment of periodontal disease and placement of bone grafts and soft tissue grafts to restore dental health.

Upon determining a diagnosis of periodontal disease, Dr. O'Neal will develop a treatment plan to stop the progress of the infection and rebuild the soft tissue and bone to proper health. She may recommend a combination of non-surgical and surgical treatment.

Non-surgical periodontal therapy includes root planing, a procedure to remove toxins and hardened dental plaque deposits (tartar or calculus) from the root surfaces of the affected teeth. Dr. O'Neal will also remove diseased soft tissue around the teeth during periodontal therapy; this helps to promote growth of healthy gum tissue.

Surgical treatment of periodontal disease is sometimes necessary to create access for Dr. O'Neal to provide deeper cleaning of the root surfaces, or, to treat damaged areas in need of bone or soft tissue grafting procedures. Periodontal surgery is minor dental surgery that Dr. O'Neal performs at our Marietta periodontal practice.

After making the affected area numb with local anesthetic, Dr. O'Neal will fold the gum away from the teeth to remove the deep bacterial deposits from the root surfaces and eliminate any diseased soft tissue. This type of oral surgery is also known as a dental ‘flap’ procedure.

Periodontal flap procedures also create the opportunity for Dr. O'Neal to place bone or soft tissue grafts to fill structural defects and stimulate new tissue or bone growth.

Laser-assisted Periodontal Surgery

Dr. O'Neal utilizes dental laser technology during non-surgical and surgical periodontal procedures. This technology gives her the ability to direct laser energy for bacteria control and removal of hard deposits. The dental laser is also less invasive than traditional cutting instruments, helping to speed healing and improve post-treatment comfort. Learn more about LANAP® (Laser-assisted new attachment procedure) protocol and WaterLase® Dentistry for periodontics.

To complete the periodontal surgery procedure, Dr. O'Neal will close the tissue with sutures and cover it with a dressing material to allow it to heal undisturbed. The dressing is removed by Dr. O'Neal at a follow up appointment in about a week.

Post-Surgical Periodontal Care & Maintenance

Periodontal surgery is not a cure for periodontal disease. The bacteria that cause periodontal infection exists naturally in the mouth; it forms continuously on the teeth as a thin film (this film is called dental plaque).

While periodontal surgery is a thorough removal of harmful bacteria and hard deposits, it is just the first step in the treatment process. If bacteria is allowed to accumulate during the post-surgical healing period (when the gums are especially vulnerable), the results may be less than desired. It is important to keep the mouth as clean as possible with consistent home care to protect the surgery site and support new tissue growth.

In addition to consistent home care, long-term periodontal health also depends on regular visits with your dental hygienist for cleaning and tissue maintenance. It may be necessary to see the hygienist more frequently to prevent recurrence of periodontal disease.

Sinus Lift Surgery

The roots of the upper teeth are anchored in place by the upper jaw bone, or maxillary bone. Some of the upper teeth roots may extend into the sinus cavity, or maxillary sinus. If these teeth are removed, the jaw bone level in the area is often too thin to support a dental implant.

In many cases, Dr. O'Neal can provide a bone grafting procedure, known as a ‘sinus lift’ to add bone to these areas and create a stable foundation for a dental implant. The dental implant can be used to support a prosthetic tooth replacement, such as a dental implant or bridge.

Maxillary dental implants are sometimes used to attach to removable partial or complete dentures and hold them firmly in place.

The sinus lift graft is a minor surgery that Dr. O'Neal performs in our Marietta periodontal practice. While the surgical site is comfortably numb under local anesthetic, Dr. O'Neal gently lifts the roof of the upper jaw (which is also the floor of the sinus cavity). The bone graft is inserted into the opening to ‘lift’ the sinus floor and increase the bone level.

The goal of sinus lift surgery is to expand the level of the patient's upper jaw bone. After several months of healing, the graft becomes part of the patient's existing jaw bone structure and will also help to stimulate new bone growth in the area.

After the jaw bone has reached a sufficient height, Dr. O'Neal will place one or more dental implants in the area. Dental implants are restored by the general dentist to replace the function and appearance of natural teeth.

Soft Tissue Grafts

A gum graft, also known as a soft tissue graft or gingival graft, is a minor surgical procedure that Dr. O'Neal may recommend to correct gum recession around one or more teeth.

What is Gum Recession?

Healthy gum tissue, or gingiva covers the tooth root and forms a border around the top of the tooth, or ‘crown’, the part of the tooth that we see when we smile.

Gingival tissue is both ‘free’ and ‘attached’; the free gingiva is closest to the tooth crown and is somewhat flexible (making it possible to floss); attached gingiva is immovable and firmly attached to the root and bone structures.

Gum recession is a condition in which the gum tissue pulls away from the tooth crown and deteriorates, exposing the underlying tooth and root surface. Gum recession has the effect of making the tooth look ‘longer’ than the other teeth.

The progression of gum recession begins with the free gingiva and may progress to the attached gingiva and bone. In cases of advanced gum recession, teeth become loose, or mobile. This is an indication that the underlying bone support is also damaged.

Tooth sensitivity typically occurs with gum recession. The tooth root and structures that are normally beneath the gum line contain tiny pain receptors or tubules that lead to the tooth nerve. Without the protection of the gum tissue, hot, cold and pressure travel through the tubules directly to the tooth nerve, triggering pain and sensitivity. The exposed tooth root surface is also at risk of developing tooth decay.

What causes Gum Recession?

Periodontal disease, an infection of the gums, is the most common cause of gum recession. If periodontal disease is not treated, the infection will spread, causing damage to the bone support for the teeth. As the bone diminishes, the affected teeth will become loose and require extraction.

Teeth clenching and grinding place abnormal pressure and stress on the teeth, bone and gums. This can lead to breakdown of gum tissue around the teeth, as well as tooth fracture.

Other causes of gum recession include: misaligned tooth position, frenum ‘tongue-tied’ tissue attachment, old or poorly fitting dental work, aggressive brushing with a hard toothbrush, poor oral hygiene, hormonal changes, or genetics.

Repairing Gum Recession

During your periodontal consultation, Dr. O'Neal will evaluate the condition of your teeth, gums and bone support and talk with you about your goals for your dental health.

Gum recession does not always require treatment. Small areas of gum recession can often be maintained with daily brushing and flossing. Slight tooth sensitivity related to minor gum recession may be managed with desensitizing treatments or fluoride toothpaste specially formulated for sensitive teeth.

If you have active periodontal disease that is causing gum recession, Dr. O'Neal will recommend treatment of the infection as a priority. Learn more about periodontal disease and laser periodontal therapy.

If gum recession is placing the tooth or bone support at risk or making you feel uncomfortable with your smile appearance, Dr. O'Neal may recommend a gingival graft procedure to replace the lost gum tissue.

To perform a grafting procedure, Dr. O'Neal will use your own gum tissue or a suitable tissue replacement (such as donor tissue, or allograft) to repair the area of recession and help prevent further loss of gum tissue or bone.

Soft tissue grafts are performed with local anesthetic in our Marietta periodontal practice by Dr. O'Neal in collaboration with your restorative dentist. After the soft tissue graft is placed, new gum tissue will grow around the graft; this is the body’s natural regenerative response (similar to when you have a small cut).

Like any mouth surgery, it is important to keep the surgical site and donor site (if your own gum tissue is used) clean while the tissue heals. We also recommend that you eat soft foods and don't over-exert yourself physically. Dr. O'Neal will see you for post-surgical care and again after a few weeks to evaluate your results.

Your gums serve an artistic purpose to frame your smile - we want you to feel completely confident with your smile appearance. Dr. O'Neal will work closely with your dentist to help you achieve adequate periodontal support for restorative procedures such as crowns, veneers or bridges.

Extractions

Removal of a tooth, or tooth extraction, becomes necessary when the tooth structure is damaged beyond repair due to extensive decay or fracture. Tooth extraction may also be required in cases of advanced periodontal disease that have resulted in loss of adequate bone support for the tooth.

Third molars, or wisdom teeth, develop during the teen years. Most patients do not have room in the mouth to keep wisdom teeth clean, so generally these are recommended for extraction to prevent decay and infection.

Consultation for Tooth Extraction

Marietta Periodontist Dr. Cheria O'Neal will evaluate your teeth, gums and jaw bone support during your periodontal assessment and consultation. As a Periodontist, Dr. O'Neal has specialty training and experience in routine, impacted and surgical tooth extractions. She may recommend extraction of one or more teeth to help restore health to your smile.

In some cases, Dr. O'Neal may refer extraction cases to an oral surgeon; this is common with removal of third molars (wisdom teeth).

Dr. O'Neal and our O'Neal Periodontics team want you to feel completely comfortable in our care. Prior to any treatment, we will discuss options with you and address any questions you may have to help you make an informed decision.

With the exception of wisdom teeth, it is important to consider replacement options when a tooth is removed. Dr. O'Neal will work closely with your restorative dentist to provide you with recommendations to replace an extracted tooth with a dental implant or bridge. Or, if multiple teeth are involved, full mouth implants, removable partial dentures, or complete dentures may be considered.

Bone Socket Grafting

For an extraction procedure, Dr. O'Neal will first administer local anesthetic to numb the area around the tooth. The tooth is removed by separating it from the bony tooth socket with dental instruments. After the tooth is extracted, the jaw bone is left with an open void where the tooth roots were previously positioned. This opening also weakens the bone wall around the tooth socket.

Dr. O'Neal may recommend placement of a bone graft in the open tooth socket using compatible bone from a donor source. The bone graft will also stimulate growth of new bone as the area heals. Bone socket grafting is common with permanent tooth extractions to support future tooth replacement with a dental implant or bridge.

Bone Grafts

Dr. O'Neal specializes in the placement of bone grafts to correct jaw bone defects or to augment the level of bone support for a dental implant restoration. As part of your periodontal consultation, Dr. O'Neal will evaluate the condition of the gums, teeth and jaw bone by visual examination and any necessary dental x-rays.

Types of Dental Bone Grafts

The removal of a tooth leaves openings in the bone, or the tooth ‘socket’, where the tooth roots were previously anchored. The bone level around the socket will naturally decline after a tooth is removed.

Socket Preservation Graft

Dr. O'Neal may recommend that a bone graft be placed at the time of the tooth extraction if a dental implant or other dental restoration is planned to replace the missing tooth. Immediately after the tooth is extracted, the bone graft material is inserted into the socket openings left by the tooth roots and held in place with a membrane material that protects the graft and encourages bone growth (vs. soft tissue growth). The area is allowed to heal for several months; during this time the body will regenerate new bone growth around the graft to reinforce and expand the existing bone level.

Guided Bone Regeneration and Ridge Augmentation

Bone grafts, also known as Guided Bone Generation (GBR), may be used to raise the height or width of the jaw bone in a specific area, procedures known as ridge augmentation or ridge preservation. Bone grafts are also used to restore defects in the bone that are genetic in nature or a result of a prior tooth loss.

Periodontal disease can destroy the supporting bone surrounding teeth. In some cases, bone grafts may be used around the affected teeth to regain some of the lost bone.

During the grafting procedure, Dr. O'Neal will make an incision in the gums to access the bone around the tooth roots using surgical instruments or the dental laser. After the area is exposed, Dr. O'Neal will place the bone graft material and membrane in the bone defects, then close the area with sutures.

After the bone has healed and grown to the necessary level (generally 3-6 months), Dr. O'Neal will place the dental implant to support the prosthetic tooth replacement (crown, bridge or denture) in coordination with the restorative dentist.

Bone Graft Materials

Bone graft materials may be sourced from a variety of resources, including cadaver bone, synthetic bone, cow bone or your own bone (also known as autogenous or autograft). Dr. O'Neal will talk with you about these options and help you choose the best bone graft materials for your needs.

Crown Lengthening

A dental crown is a restoration used to rebuild tooth structure after it has been substantially damaged by tooth decay or trauma. The crown is designed by your dentist and dental laboratory to look and feel like a natural tooth.

To help keep the remaining tooth structure and surrounding gums healthy, the restorative dentist will usually plan for the edge at the base of the crown (margin) to rest just above the gum line. This allows for a snug crown fit and easy access for brushing and flossing.

If the natural tooth is broken at the gum line, or if the tooth is just not long enough to create a proper margin, it may be necessary to remove a portion of the overlying gum tissue and bone to expose more tooth surface. This procedure is known as ‘crown lengthening’.

Dr. O'Neal performs crown lengthening procedures to support dental crowns, veneers, bridges and other dental restorations in her Marietta periodontal practice.

Crown Lengthening with the Dental Laser

Crown lengthening is an oral surgery procedure; Dr. O'Neal utilizes the dental laser to remove and shape the tissue and bone to expose natural tooth structure and essentially ‘lengthen’ the amount of tooth structure above the gum line (the tooth ‘crown’).

Crown lengthening gives the restorative dentist more available tooth structure to support retention of the dental crown. Dr. O'Neal also uses the laser to contour the soft tissue and compliment the restoration with a smooth, even gum line.

The dental laser works quickly and efficiently, and is less invasive than traditional dental surgery tools. This helps speed healing times and reduces post-surgical discomfort.