Periodontics

Periodontics Our expertise also involves correcting “gummy smiles,” uneven gum lines, “long teeth” from exposed roots, indentations in the gums and jaw bone – all the areas necessary to give you a brilliant smile, no matter what canvas we begin with.

Periodontics is the specialty of dentistry that studies supporting structures of teeth (bone and gum), diseases, and conditions that affect them. Dr. Romanos will review with you in details all the procedures needed to treat your periodontal condition and improve your overall gingival and bone health.

Periodontal therapy will vary depending on each patient’s case. Whether you are in need of gum recession treatment, dental implants, or another aesthetic dental treatment, you can rest assured that we will provide you with the best oral care possible.

Esthetic Crown Lengthening

Definition: Aesthetic considerations have influenced the management of dental maladies in varying degrees for many years. A crown lenghthening is a surgical procedure that apically repositions the gingiva and possibly the alveolar bone in order to expose more tooth structure; it may be done to facilitate restorative procedures or enhance aesthetics. The procedure can be done inside the clinic without any pain.

Advantages of a crown lengthening:

One of the major advantages of aesthetic crown lengthening is that it is usually completed in one visit. Essentially, the excessive gum tissue that is hiding your teeth, is removed to expose the normal length of the tooth.

With aesthetic crown lengthening, you’ll benefit from:

- An enhanced appearance of your teeth so that they no longer look short or like "baby teeth"
- A much more attractive and harmonious smile
- An improved self-image and more self-confidence
- Having healthier teeth and gums
- A relatively short healing period with little to no discomfort and immediate visible results!

In addition to the aesthetic benefits arising from crown lengthening, correcting a “gummy” smile can also improve your overall periodontal health. When the gum tissue does not recede normally as adult teeth emerge, pockets can form in the gums, which can result in advanced periodontal disease. By contouring the gums through crown lengthening, you are not only improving the look and confidence of your smile but also preventing future problems.

Gingival Grafting

Definition: A gingival graft (also called gum graft or periodontal plastic surgery) is a generic name for any of a number of surgical periodontal procedures whose combined aim is to cover an area of exposed tooth root surface with grafted oral tissue. What are the benefits of gum graft surgery?

- A gum graft can reduce further recession and bone loss.
- It covers exposed roots to protect them from decay.
- It reduces tooth sensitivity and improves the aesthetics of your smile.

Bone Grafting

Most dental bone grafting procedures are done to restore your bone to its previous form following tooth loss, gum disease or trauma. Bone grafting may also be used to maintain bone structure after tooth extraction.

Restoring and maintaining facial bone structure is important for several reasons. Many dental procedures, such as dental implant placement, require that the bone be as close to its original dimension and position as possible for optimal results. Also, the jaw and other facial bones support the skin and muscle that are responsible for our outward cosmetic appearance. Without the support of the underlying bone, our faces can look prematurely aged.

Bone grafting material comes from several sources. Autograft bone is material that is taken from another point in the patient's body and transplanted to the desired place. It is a good graft material since it contains the patient's own cells, and carries no risk of disease transmission. The chief drawbacks are that it requires a second surgical site and enough quantities of harvestable bone that may not be readily available.

Allograft bone is a material that was taken from an organ donor and processed to ensure its safety and improve the handling characteristics. The advantages of allograft bone biomaterial are that it is readily available and does not require a second surgical site. Allograft bonehas been well documented in clinical trials and has an excellent safety record.

Gummy Smile

A smile will usually be perceived as "gummy smile" when four millimeters or more than an eighth of an inch of gum tissue shows.

There are several possible causes of gummy smile, including:

- An excessive display of gum tissue in your upper jaw can result from the abnormal eruption of the teeth. Teeth covered by excessive gum tissue appear short, even though they may actually be the proper length.
- The muscle that controls the movement of your upper lip could be hyperactive, causing your upper lip to rise higher than normal. When this occurs, more of your gum tissue is exposed when you smile.
- The manner in which your upper jaw bone grew and developed could cause the appearance of a gummy smile. For instance, if there was an excessive bulging protrusion of the upper jaw within the gum tissue, you would experience an obvious gummy appearance when you smile.

A Gummy Smile; is it an Aesthetic Problem or More?

The teeth that show when you are smiling are determined by several factors, including:

• The shape and size of your lips.
• Your facial muscles.
• The shape and size of your teeth.
• Your gum tissue.

Depending on the factors causing a gummy smile, more serious underlying dental conditions could be present. For example, if you have a gummy smile caused as a result of how the teeth erupted and how the jaw developed, you may also have an uncomfortable or improper bite that could ultimately affect your long-term oral health.

Guided Tissue Regeneration

Guided bone regeneration or GBR, and guided tissue regeneration or GTR are dental surgical procedures that utilize barrier membranes to direct the growth of new bone and gingival tissue at sites having insufficient volumes or dimensions of bone or gingiva for proper function, esthetics or prosthetic restoration.

GBR is similar to guided tissue regeneration (GTR) but is focused on development of hard tissues in addition to the soft tissues of the periodontal attachment. At present, guided bone regeneration is predominantly applied in the oral cavity to support new hard tissue growth on an alveolar ridge to allow stable placement of dental implants. Bone grafting used in conjunction with sound surgical technique makes GBR a reliable and validated procedure.

There are several uses of bone regeneration:

- Building up bone around implants placed in tooth sockets after tooth extraction
- Socket preservation for future implantation and prosthetic tooth
- Filling of bone defects after removing the root of a tooth/removal of impacted teeth
- Repairing bone defects after the reopening of a wound

Connective tissue graft

Definition: A Connective-tissue graft is the most common method used to treat root exposure. During the procedure, a flap of skin is harvested from the roof of your mouth (palate) and tissue from under the flap, called subepithelial connective tissue, is removed and then stitched to the gum tissue surrounding the exposed root. An example of a connective tissue graft case; a 48 year old women, non smoker is complaining of her ugly and long teeth. Upon careful assessment of her case, the doctors found that the best solution is to apply the connective tissue grafting method.

• Free gingival grafts: Similar to a connective-tissue graft, free gingival grafts involve the use of tissue from the roof of the mouth. But instead of making a flap and removing tissue under the top layer of flesh, a small amount of tissue is removed directly from the roof of the mouth and then attached to the gum area being treated. This method is used most often in people who have thin gums to begin with and need additional tissue to enlarge the gums.

• Pedicle grafts. In this procedure, instead of taking tissue from the palate, it is grafted from gum around or near the tooth needing repair. The flap, called a pedicle, is only partially cut away so that one edge remains attached.

The gum is then pulled over or down to cover the exposed root and sewn into place. This procedure can only be done in people who have plenty of gum tissue adjacent to the tooth.

Some dentists and patients prefer to use graft material from a tissue bank instead of from the roof of the mouth. Sometimes, tissue-stimulating proteins are used to encourage your body's natural ability to grow bone and tissue. Our dentists can tell you which method will work best for you.

Melanin Pigmentation

Melanin is produced by the oxidation of the amino acid tyrosine, followed by polymerization. The pigment is produced in a specialized group of cells known as melanocytes.
It is a procedure used in cosmetic dentistry to remove black spots or patches on the gums caused by excessive melanin.

The normal color of the gum tissue (gingiva) is pink, but excess deposits of melanin (melanin gingival hyperpigmentation) can create what seem to be black spots or patches on the gums, creating an aesthetic or cosmetic problem. Discoloration may also be caused by long term use of certain medications.

A clinical assessment is carried out to customize the treatment to the patient’s needs and the procedure itself can involve surgical, chemical, or laser ablation techniques