List of Surgical Procedures:
- Crown lengthening
- Gingival graft
- Surgical extraction
- Socket preservation
When a wisdom tooth is impacted in the bone it requires a surgical procedure to be removed or when a tooth is too decayed and it cannot be removed in 1 piece it also involves a surgical extraction. A flap technique may be indicated and some bone may need to be removed in order to extract the tooth. There is a procedure called alveoloplasty; which involves filing of the bone after a surgical extraction to prevent bone spicules from bothering the soft tissue after healing.
There are patients who have very thin gingiva and brush too lard or with a very abrasive tooth paste or tooth brush and the recession takes place. Other causes of recession could be because the bite is off. When there is too much force being applied in some teeth because the bite is off recession can also take place. When the patient does grinding or clenching it can also lead to recession and abfraction. Calculus/ tartar build up can lead to recession as well since this is pushing the gum away. Frenums that are attached too close to the gingiva margin will also pull the gingival away causing recession.
Socket preservation and bone graft are other surgical procedures. When an extraction takes place a defect stays in the bone unless a socket preservation or also known as bone graft is done. The space where the root of the tooth was needs to be filled with a processed dead bone to stimulate the patient bone cells to form bone in a faster and more efficient way. This involves packing the bone in the space at the time of the extraction and placing a membrane to hold the bone inside the socket with sutures.
Crown lengthening is a surgical dental procedure done to expose a tooth part that is either decay or needed for part of a restoration. There are two types of crown lengthening and both can be done either though a minor surgery or with laser. There is the soft tissue crown lengthening which involves just the removal of gingiva or gum. There is hard tissue crown lengthening which involves removal of gingiva and bone. Another reason for crown lengthening is for esthetic purposes. Sometimes the patient desires longer teeth for esthetic purpose but the bite does not allow to make their teeth longer with just veneers. In these cases a little bit of gingiva is removed usually with laser to achieve the desired esthetic result. There are other cases where the patient may have a bony smile. Bony smiles must be treated with hard tissue crown lengthening usually through a surgery where the bone is filed and reduced to the desired esthetic level. However when the patient is a bruxier this bone may grow again.
The frenectomy is the removal of the frenum and all the fibers that allow it to grow again. The frenum is a loose soft tissue that attaches the lip or tongue to the attach gingiva which covers the maxilla or mandible bone. Sometimes the frenum is attached too high to the tongue and it doesn’t allow some patients to have proper pronunciation of certain words. At other times the frenum is attached too close to the marginal ridge and it can cause recession. Finally at times the frenum is attached to close to the incisive papilla and it causes separation (diastema) in between the central incisor which cannot be corrected successfully with ortho because the frenum level will cause ortho not to work as effectively. In all of these cases mentioned above a frenectomy is indicated. Frenectomy can also be done through a minor traditional surgery or with a soft tissue laser.