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Crown Lengthening

Crown lengthening is generally performed to improve the health of the gum tissue or to prepare the mouth for restorative or cosmetic procedures.  In addition, crown lengthening procedures can also be used to correct a “gummy” smile, where teeth are covered with excess gum tissue.  Crown lengthening exposes more of the natural tooth by reshaping or recontouring bone and gum tissue.  This treatment can be performed on a single tooth, many teeth, or the entire gum line, exposing an aesthetically pleasing smile.

Reasons for crown lengthening

Crown lengthening is a versatile and common procedure that has many effective uses and benefits.  The vast majority of patients who have undergone this type of surgery are highly delighted with the results.

Here are some of the most common reasons for crown lengthening:

  • Restoration of damaged teeth – Periodontal disease can cause severe damage to the teeth, as can trauma and decay.  Where teeth have been broken beneath the gum line, crown lengthening can be used to prepare the area for a new restoration to correct the damaged teeth.
  • Cosmetic uses – Extra gum tissue can make teeth look unnaturally short and can also increase susceptibility to periodontal infections.  Removing excess gum tissue can restore a balanced, healthy look and improve the aesthetic appearance of the smile.
  • Dental crowns – Crown lengthening provides more space between the supporting jawbone and dental crown.  This prevents the new crown from damaging gum tissues and bone once it is in place.

What does crown lengthening involve?

Your dentist will make a series of small incisions around the soft tissue in order to separate the gums away from the teeth.  Even if only one tooth requires the re-contour, neighboring teeth are usually treated to provide a more even reshaping.  Separating the gums provides your dentist with access to the roots of the teeth and the underlying bone.

In some cases, the removal of a small amount of tissue will provide enough tooth exposure to place a crown.  In other cases, your dentist will also need to remove a small amount of bone from around the teeth.  The bone is usually removed using a combination of special hand instruments, and rotary instruments.  The rotary instruments roughly resemble the drill that is used in cavity treatment.

The teeth will look noticeably longer immediately after surgery because the gums will have been repositioned. The teeth will look noticeably longer immediately after surgery because the gums have now been repositioned.

Your dentist may secure the surgical site using an intraoral (periodontal) bandage which serves to prevent infection.  Prescriptions may be provided for pain medication, and a chlorhexidine (antimicrobial) mouth rinse will be given to help reduce any bacteria attempting to recolonize.  The surgical site will be completely healed in approximately two to three months.

Gum recession refers to the loss of gum tissue along the gumline. This can occur as a result of periodontal disease (gingivitis, periodontitis, advanced periodontitis), the natural aging process, or abrasive habits when it comes to brushing the teeth.

Why should gum recession be taken seriously?

When gum recession occurs, the root structure of the tooth becomes exposed. This means that tooth decay and other problems can affect the teeth along the gumline and beneath it. Since healthy gums are essential for a healthy mouth, getting gum recession treated is important for lasting dental wellness. When recession occurs to the point that no firm gum tissue remains, this leaves the roots of the teeth and the underlying bone relatively unprotected, which could result in root sensitivity, bacterial penetration, decay and even loss of teeth.

A gingival graft is designed to address these problems. A thin piece of tissue is taken from the roof of the mouth or gently moved over from adjacent areas to provide a stable band of attached gum tissue around the tooth. The gingival graft may be placed in such a way as to cover the exposed portion of the root, however, the main objective is to re­establish the protective barrier or layer of the gum around the tooth. Occasionally, the patient may need multiple procedures to achieve the ideal amount of root coverage.

Dr. Britten has trained in the latest minimally invasive techniques of gum grafting and can often perform the entire procedure through a pinhole incision.

Dr. Britten accepts your dental insurance as an out of network provider. What does this mean for you?
 
Understandably, many patients often have questions when it comes to understanding and utilizing dental insurance benefits, especially if extensive dentistry is needed. Dental insurance can provide assistance for dental health care expenses, however, often procedures that are covered often vary widely and the benefit to us is often below the actual cost of treatment.
 
When choosing how to budget for dental health care, or choosing the right benefit plan, it is important to take into consideration the different types of plans available. There are usually two main kinds of insurance plans: group plans or individual plans. A group plan, typically offered by your employer, is often a better value for your money when it comes to dental insurance. These plans have lower premiums and reasonable benefit coverage. Your benefit package can vary greatly depending upon what your employer has negotiated with the insurance company. Group plans often include dental HMOs, PPOs and indemnity plans. It is important to investigate if the plan that you select will allow you to see the doctor you want to see as well as receive the care you deserve. HMO’s typically only let you visit a doctor within your network, whereas a PPO and indemnity plan will still allow you coverage outside the insurance company’s “network”. Another type of plan, an individual plan, is also available. These plans are often more costly in the long run than simply “paying as you go” for your dental care. These plans can have high premiums and restrictive limitations on treatment and reimbursement.
 
As an out-of-network provider, our office can provide a treatment plan that is based on your clinical needs, overall health, financial limitations and desires and preferences. Following an extensive exam, and thorough consultation with Dr. Britten, you can make better decisions for your dental health care that are in your best interest to support lasting oral health:
 
Your periodontal health has an effect on your daily quality of life as well as your overall health. Addressing dental issues in earlier stages will save money in the long run. But no matter if you are experiencing a minor or isolated issue, or a more generalized or even severe issue, Dr. Britten and his staff are dedicated to helping you attain the best possible quality of life through conservative, comprehensive periodontal care. Our goal is to help our patients to restore our patients’ smiles to what was naturally intended: a healthy, natural, beautiful, and functional smile.

Dr. Britten is highly concerned about his patients who smoke. The likelihood of developing advanced periodontal disease or gum disease can be up to six times higher in smokers. Periodontal disease is an extremely serious condition affecting not only the gums, but also the membranes and ligaments and bone supporting the teeth.

Many studies on smoking and periodontal disease have concluded that smokers have:

  • Deeper probing depths and a larger number of deep pockets in the gums.
  • More attachment loss including more gingival recession
  • More alveolar boneloss & tooth loss
  • Less gingivitis and less bleeding on probing
  • One of the major problems with smoking is that it tends to mask the damage being caused to teeth and gums. This damage can be difficult to detect, producing very few early warning signs of advanced periodontal disease.
  • For years it was thought that nicotine being a vasoconstrictor was causing less blood flow to the gums, causing less infection-fighting white blood cells to reach the area. Newer studies are showing that smoking appears to have a long-term effect on the inflammatory lesions, or diseased gums of smokers, which have less blood vessels in them than in non-smokers.
  • More teeth with furcation involvement (where the bone levels have been destroyed below the area where the roots of the teeth meet, leaving this area exposed, making it prone to further destruction as well as decay.
  • Additionally, nicotine affects saliva, causing it to become thicker so it is less able to wash away acid created after eating. As a result, heavy smokers can be more likely to suffer from tooth decay than non-smokers, even though they may practice good oral hygiene.
  • Smoking has a profound effect on the immune and inflammatory system. Smokers have more infection-fighting cells in their body, but fewer of these helpful cells make it into the gingival pocket. Studies also show that these good cells have a decreased ability to accomplish their function, which is to destroy harmful periodontal bacteria.
  • Adhesion molecules are found within smoker’s tissues, in the white blood cells, in the inflammatory lesions, and even in the supporting gingival tissues. Studies have shown impairment in defensive functions of other defensive blood cells, even those using smokeless tobacco due to the high concentrations of nicotine.
  • Smoking also impairs the healing of dental implants and even in the healing from all other aspects of periodontal treatment including non-surgical treatments (including scaling and root planing or “deep cleaning”), surgical treatment, bone grafting and tissue grafting.
  • Studies have shown that tobacco smoke and nicotine affect blood vessels in the gums, healthy bone-building cells, connective tissue matrix, the jaw bone and even the root surface itself. Tooth root surfaces in smokers have actually been shown to be contaminated by products of smoking such as nicotine, cotinine, acrolein and acetaldehyde, which may inhibit the gum tissue from healing around the roots of teeth as they should.
  • Smoking has been shown to affect human bone, and is a risk factor for osteoporosis, which is also a risk factor for periodontal disease.

As a periodontist, Dr. Britten is a specialist in treating advanced periodontal disease and is able to provide patients with the very latest techniques and treatments to help slow down this condition. Where teeth are lost then one option is to replace them with dental implants, but smoking is not advisable during this treatment because it does slow down healing.

If you do currently smoke and value your smile, it’s worth thinking about quitting.

When you have periodontal disease, space begins to form between your teeth and the gum tissue that surrounds them. This space is called a periodontal pocket. The deeper the pocket, the greater the risk of tooth loss.
 
Your dentist or dental hygienist will perform a full periodontal charting at your visit to check for pocketing, infection (bleeding or pus), gum recession, & bone loss or defects in the bone. #brittenperio #clearwaterperiodontist

Regular examinations are very important to keep track of the present status of your disease and any disease progression over time. Your periodontist will work with you to create a maintenance schedule depending on how advanced your periodontal disease is at that time. Based on many variable factors such as your overall health, the severity of bone loss, and risk factors such as smoking and genetics, your periodontist will constantly tailor your care so your periodontal disease does not progress further. He or she may recommend exams every six months for mild periodontal disease, or every few months for more advanced stages.

Perio.org

Periodontal disease is often silent, meaning symptoms – particularly pain – may not appear until an advanced stage of the disease. However, you should still be on the lookout for the signs and symptoms, which include:

Red, swollen or tender gums or other pain in your mouth
Bleeding while brushing, flossing, or when eating certain foods
Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
Loose or separating teeth
Pus between your gums and teeth
Sores in your mouth
Persistent bad breath
A change in the way your teeth fit together when you bite
A change in the fit of partial dentures
If you notice any of these symptoms, be sure to contact your dentist or periodontist right away!

-Perio.org

We encourage our patients to find ways to incorporate taking care of your teeth into your day, however you can! Even while watching Netflix, if that is what works for you!

“Interdental cleansing (cleaning between the teeth) is necessary for … optimal oral health. Since most toothbrushes have limited access to proximal (in between) surfaces of teeth… interdental cleansing must be included in dental hygiene care plans. Interdental spaces are areas where bacteria can accumulate, multiply and remain undisturbed.
Undisturbed plaque biofilm can cause gingival inflammation and bleeding and increase the risk for and progression of periodontal disease.” Source: “Interdental Cleansing” by Jacquelyn L. Fried, RDH, MS
Actually, cleaning between your teeth with floss, proxabrushes, softpicks, rubber tip stimulators and watching Netflix at the same time is just fine with us. Dr. Britten and his hygiene team encourage patients to find ways to incorporate taking care of your teeth into your day, however you can!

According to the American Academy of Periodontology, topical antibiotic treatment may be used as an adjunct to scaling and root planing. Every person has different needs based on their particular situation, so be sure to talk to your dental professional about using these antibiotics as part of your course of treatment; he or she will determine if they are a good fit for you.

Perio.Org

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