Periodontal & Gum Diseases



Periodontal diseases,  are infections of the gums, which gradually destroy the support of your natural teeth. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Dental plaque is the primary cause of gum disease in genetically susceptible individuals. Bacteria found in plaque produce toxins or poisons, which irritate the gums. They may cause them to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form.


Plaque, can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line. As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss. However, don’t be fooled, as, you can still have periodontal disease without the presence of bleeding, redness and swelling. Further, pain is usually not associated with periodontal disease.   Gums should not bleed when your touch or brush them. If you develop gingivitis, the initial stage of periodontal disease, it is your gums that will primarily be affected.




Symptoms of Gingivitis, the first stage, may include:          


  •   Tender & painful gums
  •   Swelling & red gums
  •   Bleeding gums, especially after brushing


Symptoms of Periodontitis, the second stage, may include:


  •  Bad breath & foul taste
  •  Bleeding gums intensified
  •  Difficulty eating
  •  Pus from the gums
  •  Teeth becoming loose
  •  Teeth falling out
  •  Abscessed gums (collection of infected fluid)


Periodontal Care

Periodontal treatment, is necessary when various conditions affect the health of your gums and the regions of your jawbone which hold your teeth in place. Retaining your teeth is directly dependent on proper periodontal care and maintenance. Healthy gums enhance the appearance of your teeth, like a frame around a beautiful painting. When your gums become unhealthy, they can either recede or become swollen and red. In later stages, the supporting bone is destroyed and your teeth will shift, loosen, or fall out. These changes not only affect your ability to chew and speak; they also destroy your smile.


How is gum disease treated?

The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.




Deep Cleaning (Scaling and Root Planing)


The dentist, periodontist,removes 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 bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.


Bone Grafting



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 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.


Bone Regeneration




Before Guided Tissue Regeneration


In the past,  teeth were often removed without placing bone graft into the site to preserve the shape of the jaw.  Once the tooth is missing, the body no longer needs to maintain the width of the jaw which previously accommodated the tooth.  Therefore the jaw bone shrinks in width and the gum tissue follows.  This can lead to a deficient jaw bone 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 at 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 1.5-2 hrs to complete.  It is generally associated with little discomfort and no swelling.  The greatest inconvenience after the procedure is the patient needs to chew softer foods on the opposite side of the mouth for 2-3 weeks.  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.  The furniture in the room (pressure from other forces; lips, cheeks, eating) also resides over the hole and places pressure in that spot.  In order to restore the hole, the wood floor would need rigid struts to bridge the gap in the floor.  A non rigid material would not be able to withstand the pressure from the carpet and furniture and would collapse.  This is often the situation with bone regeneration for implants (guided bone regeneration- GBR).


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 bone graft is placed within that shape.  The shape can best be maintained using rigid materials/barriers (non resorbable) not resorbable.   Non resorbable materials mean that they need to be removed at a secondary procedure.  Resorbable materials are indicated 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.


Cosmetic Periodontal Surgery


A cosmetic procedure using a connective tissue graft is used to cover unattractive tooth roots, gum recession, and protect the roots from decay and eventual tooth loss. Using micro-surgical techniques pain is often eliminated and complications can be avoided due to better visibility, illumination, enhanced skill, and the use of smaller instrumentation.  Using traditional & typical periodontal techniques, this procedure is often painful, fraught with complications.


If you are unhappy with the appearance of short teeth, this also can be greatly improved by cosmetic periodontal surgery.

Although your teeth appear short, they may actually be the proper length. The teeth may be covered with too much gum tissue. We can correct this by performing the periodontal plastic surgery procedure, crown lengthening.

With typical techniques there are often residual defects or invaginations in the gum tissue which can take from months and up to year to resolve.  This is avoided with micro surgical techniques where fewer traumas is transferred to the gum tissue and therefore healing is greatly promoted through careful handling of structures.





Crown lengthening (or crown exposure), is required when your tooth needs a new crown or other restoration. The edge of that restoration is deep below the gum tissue and not accessible. It is also usually too close to the bone or below the bone.

The procedure involves adjusting the levels of the gum and bone around the tooth in question, to create a new gum-to–tooth relationship. This allows us to reach the edge of the restoration, ensuring a proper fit to the tooth. It Should also provide enough tooth structure so the new restoration will not come loose in the future. This allows you to clean the edge of the restoration when you brush and floss to prevent decay and gum disease. Using micro-surgical techniques the chance of damaging the roots during bone reshaping is greatly reduced due to the enhanced visualization.


Guided Tissue Regeneration


Guided tissue regeneration, is the reconstruction and regrowth of lost bone due to periodontal disease. Predominately, a specialized piece of material made of freeze-dried human or synthetic bone is used for its healing proteins and resorbable membranes. This material is sewn around a tooth to cover a crater in the bone that has been meticulously cleaned. The gum is then sewn over the fabric to prevent the gum tissue from growing down into the bone defect. This stimulation allows the bone and the root to regenerate. After four to six weeks, the fabric is removed using a minor surgical procedure.



                    implant periodontist





Gum Grafting



Just as skin creates a sterile environment that protects our bones from bacteria and harm, gum tissue protects the bone in the mouth.  Gum recession occurs when the dense gum tissue barrier is broken leaving a small wound where bacteria can enter the bloodstream as well as leave the teeth vulnerable to bacterial invasion, erosion and root decay.  Without a gum graft procedure, gum recession is irreversible & will continue to exacerbate.


Fortunately gum grafting, (aka Soft Tissue Grafting or Connective Tissue Grafts) repairs the receding gum area to prevent further bone loss and recession and also to improve cosmetics of your smile. The procedure involves taking a piece of gum tissue from the roof of the mouth and placing it underneath existing gum tissue, covering the exposed tooth root while re-sealing the mucosa to once again protecting the tooth. Connective tissue grafts can also eliminate pigmentation of the gums, cover up crown margins (the black line visible when gums recede), thicken the gum tissue surrounding implants and crowns.


implant periodontist                     


When using microscopic techniques and proper micro surgical training and skills, patients claim to have little to no discomfort.  The gums heal quickly and without complications (traditional instruments and techniques can lead to significant discomfort, complications and delayed healing). Our periodontist, uses instruments that are used in eye surgery and clear stitches that will be invisible to others.  No dressing material is necessary.

Some of the factors which may contribute to recession of the gums are an off bite, where the tooth is ill-positioned in the jaw bone, tooth brush abrasion, poorly shaped posts/crowns and periodontal disease.


implant periodontist                                



Common Symptoms of Receding Gums May Include:


  •   Teeth look longer or gums appear to be pulling back from the teeth
  •   Yellow edge at the margin of the tooth where it meets the gum
  •   Hot & cold sensitivity at the gum line
  •   Deep pockets of gum forming in between the teeth
  •   See or feel spaces between the teeth developing
  •   Change in the way the teeth come together while biting
  •   Teeth shifting or moving
  •   Swollen, tender, or bleeding gums
  •   Bad breath or pus from the gums


The Gum Graft Procedure, is performed using the anesthetic Lidocaine and micro stitches and takes about 1.5 hrs to complete each tooth. The greatest inconvenience afterwards is that one cannot chew on the graft site for 6-8 weeks.


Source: Dr. Kissel (Manhattan)