Treatment Information

Crown Lengthening

This procedure is typically needed for one of two reasons; either cosmetic or restorative. Crown lengthening can cosmetically improve the smile line by eliminating the “gummy” smile look. The restorative reason is to provide more tooth to be visible in the mouth so the tooth can be properly restored. When a tooth breaks off near the gum line or when decay occurs on the root surface, crown lengthening is needed to properly restore the tooth. Crowns and/or bridges cannot be cemented with the edge of the crown near the bone, which is why crown lengthening is needed.

When performing a crown lengthening procedure, the gum and bone around the area needing treatment are reshaped to expose more of the natural tooth. For cosmetic procedures, one tooth can be treated to provide an even appearance at the gum line, or what we call the whole smile line can be treated to create a natural smile.

If the procedure is needed to restore a tooth that is decayed or fractured near the bone, then the area around the defect is treated. The only other option would be extraction of the involved tooth.


Frenectomy is the surgical procedure for removing a frenum. A frenum is a fold of tissue that passes from the lip or cheek to the gum, or from the tongue to the gum.

A surgical procedure is required to remove a frenum if it interferes with the normal alignment of teeth, the movement of the tongue during speech, or pulls the gum away from the tooth resulting in recession. There are several frenums in the mouth on both the top and bottom arches.

This is a simple procedure that only takes one office appointment.

Gum Tissue Graft

There are two main types of gum tissue. One type is the attached tissue, which is the pink, firm gum that is attached to the bone. The other type is the unattached tissue, which is red and not attached to the bone. When the attached tissue is lost, you need a periodontal procedure called a soft tissue graft to stop further dental problems and gum recession, and/or to improve the aesthetics of your gum line.

When the gum tissue has receded either from hard brushing, grinding, or from periodontal disease, the root surface is exposed. This can cause an unappealing appearance as well as sensitivity to the temperature of foods and liquids. If left untreated, this situation can lead to further bone loss and possibly tooth loss.

Soft tissue grafts can be used to cover exposed root surfaces. During this procedure, a piece of gum tissue is taken from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to repair your gum line and reduce sensitivity.

A soft tissue graft can reduce, and in some cases eliminate, further recession and bone loss. Since the tissue covers the previously exposed root surface, it may result in reduced tooth sensitivity. If the defect was visible when smiling, the result can also improve appearance.

Perio Plastic Surgery

Many of the procedures involving the gum and bone can be considered plastic surgery. Perio plastic surgery can improve many different situations such as:

Gummy smiles – when an abnormal amount of gum tissue shows when someone smiles. This is usually corrected with crown lengthening.
Uneven gum tissue height – this is usually corrected with crown lengthening.
Missing teeth – this can be corrected with fixed bridges or with implants.
Defects in the bone – when tooth loss occurs there is typically a loss of the bone that surrounded the lost tooth. The resulting defect can be treated to return the bone to its previous state. This treatment is known as ridge augmentation.
Combination therapy – when just the periodontal procedures are insufficient, restorative procedures are needed to obtain the proper alignment, shape, and color of the teeth.

Ridge Augmentation

A key to dental implant success is the amount and quality of the bone where the implant is to be placed.

Ridge deformities of the upper and lower jaw can leave you with inadequate bone and tissue thickness for either an esthetic and functional bridge or dental implant restoration. The defects may have been caused by trauma, developmental defects, periodontal disease and wearing dentures.

Ridge augmentation procedures have been shown to greatly enhance the cleansability and appearance of your restorations. They increase your chance for long-term successful dental implants, both esthetically and functionally.

Soft tissue ridge augmentations are performed to enhance the cleansability and aesthetics of a deficient site prior to its final restoration. During this procedure, an incision is made to expose the bony ridge. A soft tissue graft is then obtained either from a suitable site in your mouth and/or a soft tissue substitute and inserted into the area. The gum tissue is readapted over the soft tissue graft and sutured into place.

Hard tissue ridge augmentations are performed to recreate adequate bone dimensions prior to dental implant therapy. The hard tissue augmentation can also be done in combination with a soft tissue augmentation to simultaneously enhance the soft tissue profile of the deficient site. After the incision is made and the gum lifted away, the bony defect or bone substitute is placed in to build up the ridge. A membrane may be adapted over the bone graft based on individual defect morphology. Depending on defect size, an average bony healing and maturation time of 6-12 months is allowed before dental implants can be placed. In some cases, the implant can be placed at the same time as the hard tissue ridge augmentation is performed.

Scaling and Root Planing

We remove the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove the bacteria that contribute to the disease.

Medications may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending upon the severity of gum disease, we may still suggest surgical treatment. Long-term studies will be needed to determine whether using medications will reduce the need for surgery and whether they will be effective over a long period of time. Here are some medications that are currently used:

Medication Prescription antimicrobial mouthrinse
What is it? A prescription mouthrinse containing an antimicrobial agent called chlorhexidine
Why is it used? To control bacteria when treating gingivitis and after gum surgery
How is it used? Used like a regular mouthwash

Medication Antiseptic “chip”
What is it? A tiny piece of gelatin filled with the medicine chlorhexidine
Why is it used? To control bacteria and reduce the size of periodontal pockets
How is it used? After root planing, it’s placed in the pockets where the medicine is slowly released over time.

Medication Antibiotic gel
What is it? A gel that contains the antibiotic doxycycline
Why is it used? To control bacteria and reduce the size of periodontal pockets
How is it used? laced in the pockets after scaling and root planing, the antibiotic is released slowly over a period of about seven days.

Medication Antibiotic microspheres
What is it? Tiny, round particles that contain the antibiotic minocycline
Why is it used? To control bacteria and reduce the size of periodontal pockets
How is it used? Micro-spheres placed into the
pockets after scaling and root planing, the particles release
minocycline slowly over time.

Medication Enzyme suppressant
What is it? A low dose of the medication doxycycline that keeps destructive enzymes in check
Why is it used? To hold back the body’s enzyme response — If not controlled, certain enzymes can break down gum tissue and root planning
How is it used? This medication is in pill form. It is used in combination with scaling

See also: cosmetic dentistry