What is gum disease?

There are various types of gum diseases, but most people think of two gum disease—Gingivitis and Periodontitis.  The gum disease gingivitis is when bacteria invade the gum tissues and create red, swollen, or tender gums.  Fortunately this is a reversible disease, and can be treated with professional cleanings and management.  The supporting structures are not damaged beyond repair.

Unfortunately, if Gingivitis is not treated it can lead to the gum disease Periodontitis.  This disease does affect the supporting structures of the teeth (specifically the jaw bone, connective tissue, and periodontal ligament).  The infection can progress to where harmful bacteria invade the bloodstream and affect your health.  While this disease can be treated, it cannot be cured.  It is an inflammatory disease influenced by other health issues and genetics.  Many people with Periodontitis have parents that have also had this disease.  Treating and managing Periodontitis requires a life-long commitment.  Remember the phrase “only floss the teeth you want to keep!”

Periodontal Management – non-surgical and surgical techniques

Periodontal management involves cleanings that are deeper than a “normal” cleaning by one of our hygienists. Patients with a history of periodontal disease need deeper cleanings because periodontal “pockets” have formed. (Also known as “deep pockets” or “gum pockets”)  Pockets are spaces between the teeth and gums where plaque and tartar form.

What’s the deal with “deep pockets?”
Gum disease begins when bacteria invade the gums.  The bacteria multiply and invite their bad bacterial friends and cause infection below the gum line.  Your body tries to kill these bacteria but they leave a sludge behind them on the roots of the teeth.  Your body gets confused and sends messages to attack your diseased roots.  The amount of damage can be measured with an instrument called a periodontal probe.  Your dentist or hygienist will frequently say “you have deep pockets” when the probe measures beyond a certain level.  The higher the “pocket depth” the greater the risk for tooth loss!  So the only “deep pockets” you want are those in your pants!

Periodontal Treatments

• Pinhole Technique
• LANAP and LAPIP
• Osseous or Regenerative Periodontal Surgery
• Soft tissue grafting
• Guided Surgery
• Crown Lengthening
• Dental Implant Therapy
• Sinus Lift Augmentation
• Exposure of Impacted Canines
• Lip Repositioning
• Ridge Augmentation
• Combination Procedures
• Oral Pathology/Oral Medicine
• Deep Cleaning or Scaling and Root Planing
• Sedation Dentistry

Pinhole Technique

We are the first and only office in the greater San Antonio and New Braunfels area to offer a minimally invasive technique to treat gum recession.  This procedure, known as the Pinhole Surgical Technique, is a suture and scalpel free way to lift the gums over the roots.  We also do not use your own tissue to help cover the roots, so there is minimal discomfort after the procedure.  This procedure covers most of the exposed roots and dramatically reduces or eliminates sensitive teeth.

We can achieve complete root coverage in 80% of Miller type I and II defects with gains in attached tissue. This is an excellent alternative to the gold standard of autogenous soft tissue grafts

LANAP and LAPIP

Laser Assisted new Attachment Procedure and Laser Assisted Treatment of peri-implantitis

Laser Assisted New Attachment Procedure and Laser Assisted Treatment of Peri-implantitis. This is a scalpel and suture free form of osseous gum surgery.  A specific laser (Periolase) selectively removes the infected tissue and the bacteria that cause gum disease.  This is an FDA approved procedure that will regenerate tissue lost from gum (periodontal) disease.  This procedure can also be used to treat infected tissue around dental implants.

This procedure uses the Periolase (an Nd:YAG laser) that specifically targets darkly pigmented or inflamed and diseased tissue, endotoxic (especially helpful with peri-implantitis), and stimulates the surrounding cells into regeneration This is an FDA approved procedure and will achieve cementum-mediated new periodontal ligament attachment to the root surface in the absence of a long junctional epithelium. It frequently regenerates lost bone.

Osseous or Regenerative Periodontal Surgery

Sometimes the gums have become very unhealthy and non-surgical treatment cannot control the disease process.  The gums need to be gently moved back from the teeth to access the areas of severe damage.  The infection is removed, deformed areas corrected, and tissues area carefully repositioned.  This is known as Osseous Periodontal Surgery.  This treatment is most beneficial when used with bone grafts or proteins designed to regenerate or grow back the lost bone and tissues lost to severe damage.

Soft tissue grafting

Soft tissue grafting procedures improve stability, cover exposed roots, reduce caries risk and improve the zone of attached gingiva.

Some teeth have exposed roots.  People with these conditions may be unaware of this or may have sensitive teeth—especially to cold drinks or when tooth brushing.  A gum or soft tissue graft, known as a connective tissue graft, can cover the exposed root.  This typically involves transplanting tissue from another area of the mouth, but the donor source may be ‘freeze-dried’ tissue.  The gum graft is secured between the exposed root and the existing tissue.  After healing, the gum graft blends in beautifully with the surrounding gums.  Also, the sensitivity greatly reduces or goes away, and the stability and comfort of the tooth (or teeth) improves for years to come.

Guided Surgery

ICAT/CBCT and Advanced Imaging
The i-CAT FLX offers the most flexible imaging control of any cone beam 3D unit**, allowing you to target the desired field-of-view on each patient  while minimizing the radiation dose.

Crown Lengthening

Crown lengthening—fractured or severely decayed tooth/teeth

Sometimes teeth have severe decay or fracture and needed to be ‘lengthened’ in order for your dentist to place a crown on them.  In this procedure, some of the gums and bone around the teeth are removed to actually make the teeth ‘longer’ while still maintaining their health and support.  You will then return to your dentist about 8 weeks later to have an impression taken for the final crown or restoration.

Bone and soft tissue are sculpted to achieve ideal symmetry and biological width (health) for aesthetic or pre-prosthetic needs.

Esthetic crown lengthening—gummy smile

Many people have a gummy smile or their teeth appear too short.  Others have an uneven smile.  This procedure is performed by selectively removing some soft and hard tissue from the front of the teeth.  This simply procedure can give you a symmetric and harmonious appearance allowing you to smile with confidence.

Dental Implant Therapy

Full mouth reconstructions, immediate placement and temporization

Sinus Lift Augmentation

Lateral and internal lifts can be performed predictably

Exposure of Impacted Canines

Open and Close Exposure

Lip Repositioning

This is a simple solution to limiting the amount of gingiva display that is especially hard to treat in people with large teeth. This is an alternative to larger osteotomies.

Ridge Augmentation

When someone has lost a severe amount of bone, we can reconstruct the area.  This is done using either your own bone taken from another area of the mouth, freeze dried bone, regenerative proteins, or a combination of materials.  The process depends on the individual situation.  Frequently, dental implants are placed in the healed areas and a smile is reconstructed.

Combination Procedures

Various procedures are frequently combined to create a beautiful smile. This procedure combines crown lengthening, implants, hard and soft tissue augmentation with aesthetic restorations.

Oral Pathology/Oral Medicine

We handle a variety of soft and hard tissue concerns. Here is a CBCT scan of a nasopalatine duct cyst showing progression through diagnosis, removal, and
post-augmentation.

Deep Cleaning or Scaling and Root Planing

The gum disease periodontitis affects the supporting structures of the tooth. When you cannot effectively brush or floss, plaque gets and stays below the gum line. This plaque then hardens into tarter. To make matters worse the tarter and plaque are areas where harmful bacteria breed.  The gums can bleed and even form puss pockets. To treat this disease we offer a non-surgical procedure to clean gently below the gum line.This is frequently referred to as a “deep cleaning” or scaling and root planing. This procedure effectively removes the plaque and tarter accumulation so that the gums can heal.  We will also give instruction in oral hygiene to help keep your teeth their cleanest.

Sedation Dentistry

Ever wish you could sail through dental visits without anxiety or fear? Would you rather endure an agonizing toothache than go to the dentist? Answering “yes” to these questions could mean that you’re a perfect candidate for sedation dentistry. With sedation dentistry, you can forget about fear and focus on pure relaxation.

There are different levels of sedation to accommodate every patient. Minimal sedation involves inhaling nitrous oxide (“laughing gas”). Nitrous oxide helps you relax and wears off quickly. Electronic anesthesia is an alternative form of mild sedation that uses electronic impulses to help you relax. Conscious sedation is a moderate level of sedation that causes drowsiness and is taken in pill form. IV deep sedation is typically administered intravenously and works very quickly. With IV deep sedation, most patients fall asleep but can be easily awakened. Total sedation could be the only solution for people with an intense fear or phobia of dentistry. With total sedation, or general anesthesia, you are completely unconscious and cannot be easily awakened.