Specific Services

Here are a few descriptions of many of the procedures we do:

Soft Tissue Grafting

When gum tissue (gingiva) has been destroyed by periodontal disease or aggressive tooth brushing, among other factors, regrowth can be actively encouraged by way of soft tissue grafting (also called gum/gingival grafting, periodontal plastic surgery).
This procedure helps cover exposed root surfaces, decrease tooth sensitivity, improve esthetic appearances and health of gums and teetht, helps keep teeth longer, and protect against progressive gum recession.
There are different type of grafting and different sources from which tissue can be taken. Sometimes gum tissue is taken from your own palate (roof of your mouth), and sometimes from donor tissue. In both cases, the graft encourages growth of more resilient and plentiful gums at the recipient site.
When donor tissue is taken from your palate, a portions of either the overlying (free gingiva graft) or underlying portion (connective tissue graft) is used, depending on the indications in your particular circumstance. This type of grafting has been performed for decades by periodontists, and is an integral part of our specialized training.
This is sometimes performed in preparation for orthodontic tooth movement if the anticipated plan is to move teeth in a direction that will likely contribute to the gums receding.
More recently, soft tissue grafting is performed in preparation for dental implant placement, or years after dental implant placement, to correct esthetic or functional defects in the gums.

Soft Tissue Grafting

Crown Lengthening

Functional crown lengthening is a procedure that is used to prepare a tooth, or a group of teeth for a restorative procedure. For instance, you may have fractured a crown below the gumline, and the dentist requires more solid amount tooth structure exposed in order to place a prosthetic crown (cap) in a predictable manner.
Another reason may be that you have a cavity under your gumline, that the dentist is not able to remove and fill due to poor access. In this case, the gums and underlying bone needs to be recontoured in a way that gives the dentist access to your hidden cavity, in order to save the tooth.
Esthetic crown lengthening is performed when patients wish more of the crowns of their teeth exposed that may be hidden under their gums, in order to give a more appropriate length to their teeth, and help correct a “gummy” smile. This may also help when there is asymmetry between gum levels on either side.
In both of these circumstances, your gums and underlying bone needs to be recontoured to allow for a predictable and esthetic outcome.

Crown Lengthening

Gingivectomies

This procedure involves removing extra, unwanted gum tissue (not bone). Sometimes, your gums can be too long, too bulky, or overlapping a back tooth which may prevent you from cleaning it properly.
A gingivectomy is performed at one or many teeth, and sometimes prior to braces to help with proper bracket placement, or after braces, to give the final esthetic result.

Gingivectomy

Coronally Advanced Flap

This is a technical term used to describe a periodontal surgical procedure, whereby your receded gums are temporarily released, and then pulled back closer to where they use to be around the neck of your tooth/teeth.
This is done alone, or in conjunction with soft tissue grafting.
If you have enough thickness to your gums and good bone levels, yet, you were aggressive with your toothbrush in the past, this procedure may help you reposition your gumline closer to what you enjoyed in the past.
This may address unesthetic recession and/or root sensitivity, and may also give you a second chance to brush your teeth in an effective, rather than destructive manner.

Coronally Advanced Flap

Periodontal Flap Surgery

This is most commonly performed when periodontal disease and pocketing persists, or is too advanced to be effectively treated in a non-surgical manner.
Under local anesthetic, a temporary incision is made, hidden in your gumline, which allows for your gums to be temporarily retracted in order to gain access to your roots and diseased bone. Any diseases tissue is removed and your roots are cleaned in an open manner where direct vision is possible, especially in otherwise hard to reach anatomical regions. Diseased bone surrounding your teeth is recontoured to a more desirable architecture, and then your gums are sutured back in place to create a new healthier environment.
Flaps are also sometimes performed to investigate teeth that may have been fractured, to repair a failed root canal, or to evaluate if root resorption. This procedure may also help expose an inaccessible area for your dentist under the gumline so that they can remove a cavity from your teeth, and place a filling.

Bone Grafting/Regeneration

Bone grafts are used to regenerate missing bone and tissues around your natural teeth, implants, or in preparation for dental implant placement.
When around natural teeth, bone may have been lost due to periodontal disease or trauma, and as a result, may lead to periodontal pocketing (unhealthy environment), gum recession, or increased tooth movement. This procedure may help decrease your level of disease and/or missing bone, and thus help keep your tooth, or teeth longer.
When bone regeneration is used in preparation for future implants in either your top or bottom jaw, about 6-9 months of healing will be necessary to allow the bone graft to mature as a foundation in order for predictable implant placement.
Sometimes, and only when indicated, bone grafts are placed at the time of tooth removal, when a dental implant is planned in the future. This is done to preserve what remains after the tooth is removed, and regenerate what may have been lost due to an infection or trauma to the area. This may also be beneficial if implant placement needs to be delayed for logistical reasons.
When indicated, bone grafting allows for more ideal implant placement both functionally and esthetically. Over the long term, adequate bone width and health also helps keep healthy gums around them, which is the picture frame to your teeth and implants.

Frenectomies

This procedure which releases muscle pull from under your gums, is performed most routinely in three areas of your mouth: 1) under your top lip between your front teeth, 2) under your bottom lip, between your lower middle teeth, 3) and under your tongue, if it is attached too tightly to the back inside of your bottom jaw.
This is performed, when indicated, in some children and teenagers are undergoing orthodontic treatment.
Other times, frenum pulls are released when the pull is thought to be contributing to gum recession in adults.
When the frenum is released under the tongue (tongue-tied), this is sometimes needed to improve speech, or to allow the proper placement of orthodontic appliances.
This is a relatively routine procedure, which is performed on both adults and children, using local anesthetic after an adequate amount of numbing jelly is placed in advance.
This is sometimes performed in conjunction with soft tissue grafting.

Frenectomy

Canine Exposure

This procedure exposes impacted or hidden teeth, most commonly a canine (eye tooth), which is stuck in your top jawbone (maxilla), and is covered in gums and bone.
There are various areas your tooth could be hiding, and this is determined at your consultation appointment.
The exposure is done by making a small hole in your gums, to allow the important tooth to either erupt on its own, or with the help of braces.

Canine Exposure

Biopsies

A gum or gingival biopsy is sometimes necessary to remove a sample of abnormal tissue or a growth in order for microscopic laboratory analysis to help in the diagnosis of either an isolated lesion or a generalized process.

Biopsies

Extractions (Removal of Teeth)

Although keeping your own teeth, and in a healthy state as long as possible should always be your main goal, sometimes tooth removal is inevitable, and in your best interest, especially when disease or infection is involved.
Removal of teeth may be indicated due to periodontal disease, in preparation for implant placement, to prepare for orthodontics, because a tooth is fractured and is unable to be repaired, due to a failed root canal, due to trauma, or the teeth do not fit in your mouth and pose risk for future infection, or risk to adjacent teeth that are important to keep.
In many cases, your family dentist will be the one removing a tooth, and likely and oral and maxillofacial surgeon when it involves impacted wisdom teeth. However, if you are contemplating implant placement by Dr. Sasha, it is usually beneficial to have her remove the tooth, in an effort to save as much bone as possible, and to help in the overall planning.
Your dentist may also request that you have your periodontally hopeless teeth removed with us, in particular when it can be combined in conjunction with other periodontal procedures for your convenience.

Extraction

Treatment of Peri-Implant Diseases

Although dental implants are an excellent option for replacing missing teeth, they are a medical device that can over their lifetime, for a variety of reasons, be associated with disease processes.
Your dentist may have found gum recession around your implant, periodontal pockets, bleeding, pus, bone loss, or you may be experiencing discomfort at the site.
Progressive inflammatory processes may be isolated to your surrounding gums (peri-mucositis) or involve progressive bone loss around your implant (peri-implantitis).
There are a variety of reasons for this to occur, some of which include active periodontal disease, smoking, change in systemic health, poor oral hygiene, cement leftover from crown placement, open margins or contacts, unideal bite, poorly fabricated crown or implant placement, not enough bone and/or gums to begin with, and so on.
Regardless of the reason, if your dentist has diagnosed you with some type of problem around your dental implant, it is important to have it evaluated, just like if it were your own natural tooth.
Sometimes there are treatments or solutions to help with your problematic implant. However, in some circumstances, there is nothing that can improve the situation, and it may be in your best interest to remove the implant.

Treatment of Peri-implant Diseases