Surgical Periodontal Treatment

Laser Treatment (LANAP)

Stop periodontal disease with a gentle and highly effective approach. Dr. Scott Smith offers patients LANAP laser treatment. Dr. Smith is one of the first periodontists in the Philadelphia area to incorporate this technology. It can also be used to treat ailing implants.

The laser-assisted new attachment procedure (LANAP) is:

  • The only FDA-accepted laser protocol for gum disease treatment.
    Shown through research and histological studies to remove bacteria that causes gum disease.
  • Because there’s no scalpel involved, you don’t require incisions to remove tissue and bacteria, and you preserve more of your healthy gum tissue.

Read more about LANAP® Laser Treatment

Socket Preservation

A socket or alveolar ridge preservation procedure involves placing a bone graft into the socket, where the tooth once was. This graft can be made of synthetic materials, bone from other animals (such as cows) or human bone. After putting the graft in the socket, the dentist usually covers it up with a collagen membrane, then sutures the opening to keep it closed.

The goal of socket preservation is to improve the appearance of the remaining teeth and gums and to make the process of getting a dental implant less complicated.

Bone Grafts

Over a period of time, the jawbone associated with missing teeth atrophies or is reabsorbed. This often leaves a condition in which there is poor quality and quantity of bone suitable for placement of dental implants. In these situations, patients must undergo a bone graft in order to be a candidate for dental implants.

A bone graft gives us the ability to grow bone where needed. This not only gives us the opportunity to place implants of proper length and width, it also gives us a chance to restore functionality and aesthetic appearance to the jawline.

Bone grafting can repair implant sites with inadequate bone structure due to previous extractions, gum disease or injuries. The bone is obtained from a tissue bank.

Sinus bone grafts are also performed to replace bone in the posterior upper jaw. In addition, special membranes may be utilized that dissolve under the gum and protect the bone graft and encourage bone regeneration. This is called guided bone regeneration or guided tissue regeneration.

Connective Tissue Grafts

What is Connective Tissue Grafting ?
Gum grafting is a periodontal procedure to heal receding gums. Dr. Smith replaces receding gums by advancing your own gum tissue over top of donor tissue. Gum grafting is performed to protect receding gum lines from bacteria, which can lead to bacterial invasion, erosion, tooth decay, root decay and tooth loss.

Gum grafting, also known as soft tissue grafting or connective tissue grafting is also performed to improve the aesthetics of your smile. Factors that may cause your gums to recede include; clenching or grinding your teeth, ill-fitting dental fillings and crowns, trauma, and gum disease to name a few. Some individuals are more at risk if they have; “thin gums”, family history of gum disease or recession, and/or smoke or chew tobacco products. With gum grafting procedures Dr. Smith can repair receding gum lines. This prevents further gum recession, bone loss and provides you with a more aesthetically pleasing smile. The result is that your exposed root is once again re-covered, and the gum can function properly to protect the root and tooth. In addition to repairing receding gum lines, gum grafting can also eliminate gray pigmentation of the gums, cover up crown margins and thicken up gum tissue around implants and crowns.

To perform gum grafting successfully, Dr. Smith uses magnification loupes and micro-surgical instruments and clear stitches that will be virtually unnoticeable to others. Receding gums treated with microsurgery do not require any dressing.

Guided Tissue Regeneration

In the past, teeth were often removed without placing a bone graft into the site to preserve the shape of the jaw. Once a tooth is missing, the body no longer needs to maintain the width of the jaw which previously accommodated the tooth. Therefore, the jawbone shrinks in width and the gum tissue follows. This can lead to a deficient jawbone which is too narrow or short to accommodate an implant.

Now, it is possible to preserve the shape of the jawbone at the time of tooth removal and regenerate bone previously lost from prior extractions through bone regeneration.

After Guided Tissue Regeneration
Socket preservation is the procedure in which bone grafting is performed during tooth removal. This procedure can result in preservation and augmentation of the bone which surrounds the tooth. Tooth removal must be carried out conservatively to promote fast and pain-free healing. This is best performed using the surgical microscope and micro-surgical techniques. The tooth socket is then grafted with a combination of different bone graft materials, each with specific properties, to maximize the amount of bone regeneration. The bone graft is then covered with a type of collagen barrier to contain the graft and separate it from the gum tissue. The gum tissue is then conservatively advanced to reduce the exposure of the graft to the oral environment. Socket preservation usually takes about 1 hour to complete. It is generally associated with little discomfort and minimal swelling. The greatest inconvenience after the procedure is the patient needs to chew softer foods on the opposite side of the mouth for 2 weeks Three to four months after the procedure the patient is ready for implant placement.

If the patient has already lost bone structure from previously removed teeth and requires regeneration prior to implants, the procedure is very different. As an analogy, pretend the wood floor (bone) under a carpet (gum tissue) has a large hole. The carpet is now displaced into the wood floor. One would have to lift the carpet and place new flooring to restore the floor. The same applies with a

When bone is lost after tooth removal, this is analogous to the hole in the wood floor. To regenerate the bone, materials are used to maintain the desired shape of the bone under the gums, and a bone graft is placed within that shape. The shape can best be maintained using rigid materials/barriers that are non-resorbable. Non-resorbable materials mean that they are not absorbed by the body and will need to be removed during a secondary procedure. Resorbable materials are used when the amount of bone missing is minimal (a very small hole in the floor). Over time, resorbable materials become compressed from the pressure of the gum tissue, lips, etc, and the desired result is not obtained.

Most practitioners are not comfortable using rigid materials. This is a very technique-sensitive procedure which requires much training, skill and time to perform without complications. Practitioners are also concerned that using non-resorbable materials is more invasive for New York City patients because it is a two-step procedure.

Surgical Extractions

Good oral hygiene is a must. The loss of a single tooth can have major impact on overall oral health and appearance. Although we will use every measure to prevent tooth loss, there are still some occasions when a tooth needs to be extracted. A tooth may need to be extracted if the following occurs:

  • Severe decay
  • Advanced gum disease
  • Infection or abscess
  • Orthodontic correction
  • Malpositioned teeth
  • Fractured teeth or roots
  • Impacted teeth

We may suggest an extraction after careful examination and treatment. X-rays are used to understand the shape and position of the tooth and surrounding bone before extracting the tooth.

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